Hostname: page-component-f554764f5-sl7kg Total loading time: 0 Render date: 2025-04-12T15:47:54.569Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  17 November 2016

E. Y. Chen ,
J. Cacioppo ,
K. Fettich ,
R. Gallop ,
M. S. McCloskey ,
T. Olino  and
T. A. Zeffiro
E. Y. Chen*
Affiliation:
Department of Psychology, Temple University, Philadelphia, PA, USA
J. Cacioppo
Affiliation:
Department of Psychology, The University of Chicago, Chicago, IL, USA
K. Fettich
Affiliation:
Department of Psychology, Temple University, Philadelphia, PA, USA
R. Gallop
Affiliation:
Department of Mathematics, West Chester University, West Chester, PA, USA Department of Psychiatry, Center for Psychotherapy Research, Perelman School of Medicine, University of Pennsylvania, USA
M. S. McCloskey
Affiliation:
Department of Psychology, Temple University, Philadelphia, PA, USA
T. Olino
Affiliation:
Department of Psychology, Temple University, Philadelphia, PA, USA
T. A. Zeffiro
Affiliation:
Neurometrika, Potomac, MD, USA
*
*Address for correspondence: E. Y. Chen, Ph.D., Department of Psychology, Temple University, 1701 N 13th Street, Philadelphia, PA, USA. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Early weak treatment response is one of the few trans-diagnostic, treatment-agnostic predictors of poor outcome following a full treatment course. We sought to improve the outcome of clients with weak initial response to guided self-help cognitive behavior therapy (GSH).

Method

One hundred and nine women with binge-eating disorder (BED) or bulimia nervosa (BN) (DSM-IV-TR) received 4 weeks of GSH. Based on their response, they were grouped into: (1) early strong responders who continued GSH (cGSH), and early weak responders randomized to (2) dialectical behavior therapy (DBT), or (3) individual and additional group cognitive behavior therapy (CBT+).

Results

Baseline objective binge-eating-day (OBD) frequency was similar between DBT, CBT+ and cGSH. During treatment, OBD frequency reduction was significantly slower in DBT and CBT+ relative to cGSH. Relative to cGSH, OBD frequency was significantly greater at the end of DBT (d = 0.27) and CBT+ (d = 0.31) although these effects were small and within-treatment effects from baseline were large (d = 1.41, 0.95, 1.11, respectively). OBD improvements significantly diminished in all groups during 12 months follow-up but were significantly better sustained in DBT relative to cGSH (d = −0.43). At 6- and 12-month follow-up assessments, DBT, CBT and cGSH did not differ in OBD.

Conclusions

Early weak response to GSH may be overcome by additional intensive treatment. Evidence was insufficient to support superiority of either DBT or CBT+ for early weak responders relative to early strong responders in cGSH; both were helpful. Future studies using adaptive designs are needed to assess the use of early response to efficiently deliver care to large heterogeneous client groups.

Keywords

Bulimiabinge-eating disordercognitive behavior therapydialectical behavior therapyguided self-helpstepped care
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 4 , March 2017 , pp. 703 - 717
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Aderka, IM, Nickerson, A, Bøe, HJ, Hofmann, SG (2012). Sudden gains during psychological treatments of anxiety and depression: a meta-analysis. Journal of Consulting and Clinical Psychology 80, 93.Google Scholar
Agras, W, Crow, S, Halmi, K, Mitchell, JE, Wilson, G, Kraemer, H (2000). Outcome predictors for the cognitive behavior treatment of bulimia nervosa: data from a multisite study. American Journal of Psychiatry 157, 1302–1308.Google Scholar
Almirall, D, Compton, SN, Gunlicks-Stoessel, M, Duan, N, Murphy, SA (2012). Designing a pilot sequential multiple assignment randomized trial for developing an adaptive treatment strategy. Statistics in Medicine 31, 1887–1902.Google Scholar
Almirall, D, Nahum-Shani, I, Sherwood, NE, Murphy, SA (2014). Introduction to SMART designs for the development of adaptive interventions: with application to weight loss research. Translational Behavioral Medicine 4, 260–274.Google Scholar
APA (2000). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Training Revision. American Psychiatric Association: Washington, DC.Google Scholar
APA (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th edn. Text Revision. American Psychiatric Association: Washington, DC.Google Scholar
Atkins, DC, Baldwin, SA, Zheng, C, Gallop, RJ, Neighbors, C (2013). A tutorial on count regression and zero-altered count models for longitudinal substance use data. Psychology of Addictive Behaviors 27, 166.Google Scholar
Chen, E, Touyz, SW, Beumont, PJV, Fairburn, CG, Griffiths, R, Butow, P, Russell, J, Schotte, DE, Gertler, R, Basten, C (2003). Comparison of group and individual cognitive-behavioral therapy for patients with bulimia nervosa. International Journal of Eating Disorders 33, 241–254.Google Scholar
Cohen, J (1988). Statistical Power Analysis for the Behavioral Sciences. Lawrence Earlbaum Associates: Hillsdale, NJ.Google Scholar
Crits-Christoph, P, Connolly, MB, Gallop, R, Barber, JP, Tu, X, Gladis, M, Siqueland, L (2001). Early improvement during manual-guided cognitive and dynamic psychotherapies predicts 16-week remission status. Journal of Psychotherapy Practice and Research 10, 145.Google Scholar
Dingemans, AE, Spinhoven, P, van Furth, EF (2007). Predictors and mediators of treatment outcome in patients with binge eating disorder. Behaviour Research and Therapy 45, 2551–2562.CrossRefGoogle ScholarPubMed
Fairburn, C (1995). Overcoming Binge Eating. Guilford Press: New York.Google Scholar
Fairburn, C, Cooper, Z (1993). The eating disorder examination. In Binge Eating: Nature, Assessment and Treatment (ed. Fairburn, C. and Wilson, G.), pp. 317–366. Guilford Press: New York.Google Scholar
Fairburn, CG (2008). Cognitive Behavior Therapy and Eating Disorders. Guilford Press: New York, NY, USA.Google Scholar
Fairburn, CG, Agras, W, Walsh, B, Wilson, G, Stice, E (2004). Prediction of outcome in Bulimia Nervosa by early change in treatment. American Journal of Psychiatry 161, 2322–2324.CrossRefGoogle ScholarPubMed
Fairburn, CG, Cooper, Z, Doll, HA, Norman, P, O'Connor, M (2000). The natural course of bulimia nervosa and binge eating disorder in young women. Archives of General Psychiatry 57, 659–665.Google Scholar
Federici, A, Wisniewski, L (2013). An intensive DBT program for patients with multidiagnostic eating disorder presentations: a case series analysis. International Journal of Eating Disorders 46, 322–331.Google Scholar
Feldman, G, Harley, R, Kerrigan, M, Jacobo, M, Fava, M (2009). Change in emotional processing during a dialectical behavior therapy-based skills group for major depressive disorder. Behaviour Research and Therapy 47, 316–321.Google Scholar
First, MB, Gibbon, M (2004). The structured clinical interview for DSM-IV axis I disorders (SCID-I) and the structured clinical interview for DSM-IV Axis II disorders (SCID-II). In Comprehensive Handbook of Psychological Assessment (ed. Hilsenroth, M. J. & Segal, D. L.), pp. 134–143. John Wiley & Sons, Inc: Hoboken, NJ.Google Scholar
Grilo, C, White, M, Wilson, G, Gueorguieva, R, Masheb, R (2012). Rapid response predicts 12-month post-treatment outcomes in binge-eating disorder: theoretical and clinical implications. Psychological Medicine 42, 807–817.Google Scholar
Grilo, CM, Masheb, RM (2007). Rapid response predicts binge eating and weight loss in binge eating disorder: findings from a controlled trial of orlistat with guided self-help cognitive behavioral therapy. Behaviour Research and Therapy 45, 2537–2550.Google Scholar
Grilo, CM, Masheb, RM, Wilson, G (2006). Rapid response to treatment for Binge eating disorder. Journal of Consulting and Clinical Psychology 74, 602–613.CrossRefGoogle ScholarPubMed
Grilo, CM, White, MA, Masheb, RM, Gueorguieva, R (2015). Predicting meaningful outcomes to medication and self-help treatments for binge-eating disorder in primary care: the significance of early rapid response. Journal of Consulting and Clinical Psychology 83, 387.Google Scholar
Harned, MS, Korslund, KE, Linehan, MM (2014). A pilot randomized controlled trial of Dialectical Behavior Therapy with and without the Dialectical Behavior Therapy Prolonged Exposure protocol for suicidal and self-injuring women with borderline personality disorder and PTSD. Behaviour Research and Therapy 55, 7–17.Google Scholar
Hay, P (2013). A systematic review of evidence for psychological treatments in eating disorders: 2005–2012. International Journal of Eating Disorders 46, 462–469.CrossRefGoogle ScholarPubMed
Hay, PPJ, Bacaltchuk, J, Stefano, S, Kashyap, P (2009). Psychological treatments for bulimia nervosa and binging. Cochrane Database of Systematic Reviews 4, DOI: 10.1002/14651858.CD000562.pub3.Google Scholar
Hedeker, D, Gibbons, RD (2006). Longitudinal Data Analysis. John Wiley & Sons, Hoboken, New Jersey.Google Scholar
Hilbert, A, Hildebrandt, T, Agras, WS, Wilfley, DE, Wilson, GT (2015). Rapid response in psychological treatments for binge eating disorder. Journal of Consulting and Clinical Psychology 83, 649.Google Scholar
Hudson, JI, Hiripi, E, Pope, HG Jr., Kessler, RC (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry 61, 348–358.CrossRefGoogle ScholarPubMed
Jacobson, NS, Truax, P (1991). Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 12–19.Google Scholar
Johnsen, TJ, Friborg, O (2015). The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: a meta-analysis. Psychological Bulletin 141, 747.Google Scholar
Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, McDonald-Scott, P, Andreasen, NC (1987). The Longitudinal Interval Follow-up Evaluation. A comprehensive method for assessing outcome in prospective longitudinal studies. Archives of General Psychiatry 44, 540–548.CrossRefGoogle ScholarPubMed
Kessler, RC, Shahly, V, Hudson, JI, Supina, D, Berglund, PA, Chiu, WT, Gruber, M, Aguilar-Gaxiola, S, Alonso, J, Andrade, LH (2014). A comparative analysis of role attainment and impairment in binge-eating disorder and bulimia nervosa: results from the WHO World Mental Health Surveys. Epidemiology and Psychiatric Sciences 23, 27–41.Google Scholar
Lieb, K, Zanarini, MC, Schmahl, C, Linehan, MM, Bohus, M (2004). Borderline personality disorder. Lancet 364, 453–461.Google Scholar
Little, RJ, Rubin, DB (2014). Statistical Analysis with Missing Data. John Wiley & Sons, Hoboken, New Jersey.Google Scholar
Linehan, MM (1993 a). Cognitive-Behavioral Treatment of Borderline Personality Disorder. The Guilford Press: New York, NY.Google Scholar
Linehan, MM (1993 b). Skills Training Manual for Treating Borderline Personality Disorder. The Guilford Press: New York, NY.Google Scholar
Linehan, MM (1999). Standard protocol for assessing and treating suicidal behaviors for patients in treatment. In The Harvard Medical School guide to suicide assessment and intervention (ed. Jacobs, D. G.), pp. 146–187. Jossey-Bass Inc, Publishers: San Francisco, CA.Google Scholar
Linehan, MM (2014). DBT® Skills Training Manual . Guilford Publications: New York.Google Scholar
Linehan, MM, Armstrong, HE, Suarez, A, Allmon, D, Heard, HL (1991). Cognitive-behavioral treatment of chronically parasuicidal borderline patients. Archives of General Psychiatry 48, 1060–1064.Google Scholar
Linehan, MM, Dimeff, LA, Reynolds, SK, Comtois, KA, Welch, SS, Heagerty, P, Kivlahan, DR (2002). Dialectal behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence 67, 13–26.Google Scholar
Linehan, MM, Schmidt, H III, Dimeff, LA, Craft, JC, Kanter, J, Comtois, KA (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. American Journal of Addictions 8, 279–292.Google Scholar
Lynch, FL, Striegel-Moore, RH, Dickerson, JF, Perrin, N, DeBar, L, Wilson, GT, Kraemer, HC (2010). Cost-effectiveness of guided self-help treatment for recurrent binge eating. Journal of Consulting and Clinical Psychology 78, 322–333.Google Scholar
Lynch, TR, Cheavens, JS, Cukrowicz, KC, Thorp, SR, Bronner, L, Beyer, J (2007). Treatment of older adults with co-morbid personality disorder and depression: a dialectical behavior therapy approach. International Journal of Geriatric Psychiatry 22, 131–143.Google Scholar
Masheb, RM, Grilo, CM (2007). Rapid response predicts treatment outcomes in binge eating disorder: implications for stepped care. Journal of Consulting and Clinical Psychology 75, 639–644.Google Scholar
Mitchell, JE, Agras, S, Crow, S, Halmi, K, Fairburn, CG, Bryson, S, Kraemer, H (2011). Stepped care and cognitive-behavioural therapy for bulimia nervosa: randomised trial. British Journal of Psychiatry 198, 391.Google Scholar
Nahum-Shani, I, Qian, M, Almirall, D, Pelham, WE, Gnagy, B, Fabiano, GA, Waxmonsky, JG, Yu, J, Murphy, SA (2012). Experimental design and primary data analysis methods for comparing adaptive interventions. Psychological Methods 17, 457.Google Scholar
Neacsiu, AD, Rizvi, SL, Linehan, MM (2010). Dialectical behavior therapy skills use as a mediator and outcome of treatment for borderline personality disorder. Behaviour Research and Therapy 48, 832–839.CrossRefGoogle ScholarPubMed
R Core & Team (2014). R: A language and environment for statistical computing . In R Foundation for Statistical Computing: Vienna, Austria.Google Scholar
Safer, DL, Jo, B (2010). Outcome from a randomized controlled trial of group therapy for binge eating disorder: comparing dialectical behavior therapy adapted for binge eating to an active comparison group therapy. Behavior Therapy 41, 106–120.Google Scholar
Safer, DL, Telch, CF, Agras, WS (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry 158, 632–634.Google Scholar
Safer, DL, Telch, CF, Chen, EY (2009). Dialectical Behavior Therapy as adapted for Binge Eating Disorder and Bulimia. The Guilford Press: New York.Google Scholar
SAS Institute Inc. (2015). Language Reference: Concepts. In SAS® 9.4 Language Reference: Concepts: Cary, NC.Google Scholar
Szegedi, A, Jansen, WT, van Willigenburg, APP, van der Meulen, E, Stassen, HH, Thase, ME (2009). Early improvement in the first 2 weeks as a predictor of treatment outcome in patients with major depressive disorder: a meta-analysis including 6562 patients. Journal of Clinical Psychiatry 70, 344–353.Google Scholar
Telch, CF, Agras, WS, Linehan, MM (2000). Group dialectical behavior therapy for binge-eating disorder: a preliminary, uncontrolled trial. Behavior Therapy 31, 569–582.Google Scholar
Telch, CF, Agras, WS, Linehan, MM (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology 69, 1061–1065.Google Scholar
Thompson-Brenner, H, Shingleton, RM, Sauer-Zavala, S, Richards, LK, Pratt, EM (2015). Multiple measures of rapid response as predictors of remission in cognitive behavior therapy for bulimia nervosa. Behaviour Research and Therapy 64, 9–14.Google Scholar
Val-Laillet, D, Aarts, E, Weber, B, Ferrari, M, Quaresima, V, Stoeckel, L, Alonso-Alonso, M, Audette, M, Malbert, C, Stice, E (2015). Neuroimaging and neuromodulation approaches to study eating behavior and prevent and treat eating disorders and obesity. NeuroImage: Clinical 8, 1–31.Google Scholar
Van Dijk, S, Jeffrey, J, Katz, MR (2013). A randomized, controlled, pilot study of dialectical behavior therapy skills in a psychoeducational group for individuals with bipolar disorder. Journal of Affective Disorders 145, 386–393.Google Scholar
Wilson, G, Fairburn, CC, Agras, W, Walsh, B, Kraemer, H (2002). Cognitive-behavioral therapy for bulimia nervosa: time course and mechanisms of change. Journal of Consulting and Clinical Psychology 70, 267–274.CrossRefGoogle ScholarPubMed
Wilson, GT, Wilfley, DE, Agras, WS, Bryson, SW (2010). Psychological treatments of binge eating disorder. Archives of General Psychiatry 67, 94–101.Google Scholar
Wilson, GT, Zandberg, LJ (2012). Cognitive–behavioral guided self-help for eating disorders: effectiveness and scalability. Clinical Psychology Review 32, 343–357.Google Scholar
Yuan, Y (2011). Multiple imputation using SAS software. Journal of Statistical Software 45, 1–25.Google Scholar
Supplementary material: File

Chen supplementary material

Table S1

Download Chen supplementary material(File)
File 30 KB
Supplementary material: File

Chen supplementary material

Chen supplementary material 1

Download Chen supplementary material(File)
File 30.5 KB