An adaptive randomized trial of dialectical behavior therapy and cognitive behavior therapy for binge-eating

Area of Science:

• Psychiatry
• Clinical Psychology
• Behavioral Science

Background:

• Early weak treatment response predicts poor outcomes in various mental health conditions.
• Guided self-help cognitive behavior therapy (GSH) is a common initial treatment.
• Improving outcomes for individuals with weak initial response to GSH is a clinical priority.

Purpose of the Study:

• To enhance treatment outcomes for patients with binge-eating disorder (BED) or bulimia nervosa (BN) who exhibit a weak initial response to GSH.
• To compare the efficacy of dialectical behavior therapy (DBT) and individual plus group cognitive behavior therapy (CBT+) against continued GSH for early weak responders.

Main Methods:

• One hundred nine women with BED or BN received 4 weeks of GSH.
• Early strong responders continued GSH (cGSH).
• Early weak responders were randomized to DBT or CBT+.

Main Results:

• While initial treatment led to significant improvements in objective binge-eating-day (OBD) frequency across all groups, the reduction was slower in DBT and CBT+ compared to cGSH.
• At the end of treatment, OBD frequency was slightly higher in DBT and CBT+ groups relative to cGSH.
• During 12-month follow-up, OBD improvements diminished in all groups, but were better sustained in the DBT group compared to cGSH. No significant differences in OBD were observed between DBT, CBT+, and cGSH at 6- and 12-month follow-ups.

Conclusions:

• Additional intensive treatments, such as DBT or CBT+, can effectively address early weak responses to GSH in patients with eating disorders.
• While both DBT and CBT+ were beneficial for early weak responders, evidence did not support their superiority over continued GSH for early strong responders.
• Future research employing adaptive designs is recommended to optimize treatment delivery for diverse patient populations based on early response indicators.