Binge Eating Disorder (BED) is a significant public health problem, with serious medical and psychosocial consequences. The most established treatment for BED is Cognitive Behavioral Therapy (CBT). Early response appears to predict good outcome in CBT for BED, while poor outcome may be predicted by more extreme emotion dysregulation. Standard Dialectical Behavior Therapy (DBT) is a group and individual therapy developed for individuals for whom other treatments have failed and who have extreme emotion dysregulation. A less intense (group only) version of DBT is efficacious for BED. A case series utilizing DBT with individuals with extreme emotion dysregulation (i.e., borderline personality disorder) and BED, suggests that DBT may be useful for 'difficult-to-treat'eating disorders. The Primary Aim of this K-23 is to examine the efficacy of standard DBT compared to CBT+ (individual plus group CBT) in women with BED who have early non-response to individual CBT. The primary objective of this K-23 is to enhance my skill in the conduct of complex clinical trials and to examine whether standard DBT is promising for early non-responders to CBT. Women meeting criteria for BED who are early non-responders to CBT, i.e., do not decrease their binge eating by 65% within the first 4 weeks of individual CBT, will be randomized to six-months of standard DBT or CBT+. The primary hypothesis is that standard DBT is more efficacious than CBT+ for early non-responders to CBT in achieving binge-eating abstinence and reduction. Compared to CBT+, DBT will show greater reduction 1) secondary eating disorder behaviors, 2) therapy-interfering behaviors;and greater improvement in: 3) general psychopathology (e.g., drug and alcohol abuse), and 4) psychosocial functioning. These hypotheses will be tested at post-treatment and at 3-month intervals for one year. The study will also assess the feasibility and acceptability of using psychophysiology (e.g., respiratory sinus arrhythmia), laboratory (mood induction and an interpersonal problem-solving task), and experience sampling (using a palm pilot to monitor every-day mood and behavior) tasks within the context of a randomized controlled trial. These measures will be used in an exploratory way to examine the moderators and mediators of treatment, derived from the DBT model of emotion dysregulation. Findings from the study will be used to determine a future R01 grant application
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