The role of emotion in group cognitive-behavioral therapy for binge eating disorder: When things have to feel worse before they get better

The goal of this study was to investigate the client's emotional experience in group cognitive-behavioral therapy for binge eating disorder (BED). Sixty-five individuals meeting the DSM-IV criteria for BED completed a 12-week manualized treatment conducted by experienced therapists. As predicted, the client's emotional experience was characterized by both positive and negative emotions. Also as expected, the experience of negative emotions was most prevalent in the middle phase of therapy. The client's emotional experience also discriminated between treatment responders and nonresponders. As predicted, the results suggest that the prevalence of positive feelings (e.g., hope, relief) and perception of positive group climates (e.g., stimulating, affectionate) was related to client change. The findings also suggest that the lack of negative feelings (e.g., worried, upset) in the beginning of treatment and, paradoxically, the perception of negative group climates (e.g., depressed, discouraged, inhibited, tense) in the middle of therapy was associated with positive treatment response.