title: Predictors and moderators of response to cognitive behavioral therapy and medication for the treatment of binge eating disorder.
abstract: OBJECTIVE
  To examine predictors and moderators of response to cognitive behavioral therapy (CBT) and medication treatments for binge-eating disorder (BED).
  
  
  METHODS
  108 BED patients in a randomized double-blind placebo-controlled trial testing CBT and fluoxetine treatments were assessed prior, throughout, and posttreatment. Demographic factors, psychiatric and personality disorder comorbidity, eating disorder psychopathology, psychological features, and 2 subtyping methods (negative affect, overvaluation of shape/weight) were tested as predictors and moderators for the primary outcome of remission from binge eating and 4 secondary dimensional outcomes (binge-eating frequency, eating disorder psychopathology, depression, and body mass index). Mixed-effects models analyzed all available data for each outcome variable. In each model, effects for baseline value and treatment were included with tests of both prediction and moderator effects.
  
  
  RESULTS
  Several demographic and clinical variables significantly predicted and/or moderated outcomes. One demographic variable signaled a statistical advantage for medication only (younger participants had greater binge-eating reductions), whereas several demographic and clinical variables (lower self-esteem, negative affect, and overvaluation of shape/weight) signaled better improvements if receiving CBT. Overvaluation was the most salient predictor/moderator of outcomes. Overvaluation significantly predicted binge-eating remission (29% of participants with vs. 57% of participants without overvaluation remitted). Overvaluation was especially associated with lower remission rates if receiving medication only (10% vs. 42% for participants without overvaluation). Overvaluation moderated dimensional outcomes: Participants with overvaluation had significantly greater reductions in eating disorder psychopathology and depression levels if receiving CBT. Overvaluation predictor/moderator findings persisted after controlling for negative affect.
  
  
  CONCLUSIONS
  Our findings have clinical utility for prescription of CBT and medication and implications for refinement of the BED diagnosis.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, 301 Cedar Street, New Haven, CT 06519, USA. carlos.grilo@yale.edu
authors.forename: Carlos M
authors.initials: CM
authors.lastname: Grilo
authors.forename: Robin M
authors.initials: RM
authors.lastname: Masheb
authors.forename: Ross D
authors.initials: RD
authors.lastname: Crosby
mesh_terms: D000293:Adolescent; D000328:Adult; D000339:Affect; D056912:Binge-Eating Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D001828:Body Image; D015992:Body Mass Index; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003863:Depression / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D003866:Depressive Disorder / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D004311:Double-Blind Method; D005260:Female; D005473:Fluoxetine / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012649:Self Concept; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors