{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T00:01:48Z","timestamp":1793836908070,"version":"4.6.1"},"reference-count":63,"publisher":"Cambridge University Press (CUP)","issue":"4","license":[{"start":{"date-parts":[[2016,11,17]],"date-time":"2016-11-17T00:00:00Z","timestamp":1479340800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Psychol. Med."],"published-print":{"date-parts":[[2017,3]]},"abstract":"<jats:sec id=\"S0033291716002543_sec_a1\"><jats:title>Background<\/jats:title><jats:p>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).<\/jats:p><\/jats:sec><jats:sec id=\"S0033291716002543_sec_a2\" sec-type=\"methods\"><jats:title>Method<\/jats:title><jats:p>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+).<\/jats:p><\/jats:sec><jats:sec id=\"S0033291716002543_sec_a3\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>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 (<jats:italic>d<\/jats:italic> = 0.27) and CBT+ (<jats:italic>d<\/jats:italic> = 0.31) although these effects were small and within-treatment effects from baseline were large (<jats:italic>d<\/jats:italic> = 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 (<jats:italic>d<\/jats:italic> = \u22120.43). At 6- and 12-month follow-up assessments, DBT, CBT and cGSH did not differ in OBD.<\/jats:p><\/jats:sec><jats:sec id=\"S0033291716002543_sec_a4\" sec-type=\"conclusion\"><jats:title>Conclusions<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.1017\/s0033291716002543","type":"journal-article","created":{"date-parts":[[2016,11,17]],"date-time":"2016-11-17T02:39:04Z","timestamp":1479350344000},"page":"703-717","source":"Crossref","is-referenced-by-count":78,"title":["An adaptive randomized trial of dialectical behavior therapy and cognitive behavior therapy for binge-eating"],"prefix":"10.1017","volume":"47","author":[{"given":"E. 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