# Dialectical Behavior Therapy and Cognitive Behavior Therapy in Individuals With Binge‐Eating Disorder: What Works for Whom?

## TL;DR

This study compares how different types of therapy affect binge-eating disorder outcomes and finds that certain traits predict which therapy works best for individuals.

## Contribution

The study identifies specific psychological traits that moderate or predict treatment outcomes for DBT and CBT in BED patients.

## Key findings

- Low self-esteem and shape concerns predict better outcomes in CBT+ than DBT-BED at end of treatment.
- Emotional eating and difficulty identifying feelings predict better outcomes in DBT-BED at follow-up.
- Depression levels predict treatment outcomes but do not moderate therapy effectiveness.

## Abstract

To evaluate moderators and predictors of response to cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) for binge‐eating disorder (BED).

Moderators/predictors of treatment outcome, central to CBT and to DBT treatment, were chosen from an aggregated dataset of two clinical outcome studies with non‐random allocation to treatment groups (N = 203). Both studies compared DBT‐BED (n = 71) to a more intensive outpatient CBT program (CBT+, n = 132) in individuals with BED. Generalized linear models examined moderators and predictors of objective binge‐eating (OBE) frequency at end of treatment (EOT) and six‐month follow up (FU).

Baseline shape/weight overvaluation, shape concerns and low self‐esteem significantly predicted and moderated reductions in OBE frequency at EOT whereas difficulty in identifying feelings predicted and moderated outcome at FU. Emotional eating predicted outcome at FU (medium effect) and moderated outcome at EOT (large effect). Depression levels predicted, but not moderated, treatment outcome at both EOT and FU. For shape/weight overvaluation, shape concerns and low self‐esteem, low levels were related to fewer reductions in outcome in DBT‐BED than in CBT+. Individuals with the highest levels of emotional eating and difficulty identifying feelings showed more decrease in OBE episodes with DBT‐BED than with CBT+ at EOT and FU respectively.

Findings suggest that BED treatment outcomes could be enhanced by matching individuals with certain symptom presentations to treatment overall, and to DBT‐BED or CBT+ specifically. DBT‐BED may be a promising alternative to CBT+ for those with more severe psychopathology.