title: An adaptive randomized trial of dialectical behavior therapy and cognitive behavior therapy for binge-eating.
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).
  
  
  METHODS
  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.
authors.affiliation: Department of Psychology,Temple University,Philadelphia, PA,USA.
authors.forename: E Y
authors.initials: EY
authors.lastname: Chen
authors.affiliation: Department of Psychology,The University of Chicago,Chicago, IL,USA.
authors.forename: J
authors.initials: J
authors.lastname: Cacioppo
authors.affiliation: Department of Psychology,Temple University,Philadelphia, PA,USA.
authors.forename: K
authors.initials: K
authors.lastname: Fettich
authors.affiliation: Department of Mathematics,West Chester University,West Chester, PA,USA.
authors.forename: R
authors.initials: R
authors.lastname: Gallop
authors.affiliation: Department of Psychology,Temple University,Philadelphia, PA,USA.
authors.forename: M S
authors.initials: MS
authors.lastname: McCloskey
authors.affiliation: Department of Psychology,Temple University,Philadelphia, PA,USA.
authors.forename: T
authors.initials: T
authors.lastname: Olino
authors.affiliation: Neurometrika,Potomac, MD,USA.
authors.forename: T A
authors.initials: TA
authors.lastname: Zeffiro
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D056912:Binge-Eating Disorder / Q000628:therapy*; D052018:Bulimia Nervosa / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D055815:Young Adult
keywords: Bulimia; binge-eating disorder; cognitive behavior therapy; dialectical behavior therapy; guided self-help; stepped care