A Stepped Care approach for the treatment of Binge Eating Disorder: main outcome analyses of a Randomized Controlled Trial

Binge Eating Disorder (BED) is a common mental illness, with lifetime prevalence estimates of 3%. BED is usually associated with a higher occurrence of psychological difficulties (e.g. interpersonal problems), and is often comorbid with obesity, poor physical health and somatic diseases. However, due to high treatment costs or the lack of clinicians to treat all existing cases, most of the patients do not receive a specialized care. A possible solution is the wider adoption of stepped care programs, or models of healthcare delivery that use briefer treatments, distributed in different steps. A typical first step consists in self-help (i.e. books), a minimal-care and evidence-based intervention derived from cognitive behavioral therapy. A second step could be a group treatment, which is effective as the individual one and allow to treat more patients at once, thus reducing welfare burden. The present dissertation examined the efficacy of a stepped care model for Binge Eating Disorder: a total of 135 patients first attended a 10-week program of unguided self-help (USH). After USH, 85 participants were later randomized to either a control no-treatment condition or Group Psychodynamic Interpersonal Psychotherapy (GPIP). Outcomes were evaluated up to 6 months after treatment. Results evidenced that USH reduced binge eating frequency and the core eating disorder psychopathology (i.e. over-evaluation of weight, shape, eating). In addition, patients randomized to GPIP experienced a further reduction in binge eating and a greater improvement in attachment avoidance, interpersonal problems and weight concerns. Our findings provided preliminary evidence on the effectiveness of a stepped care approach for patients with BED, supporting its wider adoption and suggesting that this model could reduce welfare costs and potentially increase the percentage of treated patients. Further investigation should explore changes in other secondary outcomes (e.g. attachment states of mind, reflective functioning) not examined yet, as well as the potential moderating factors of treatment outcomes.