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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])
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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 

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