Gianluca Castelnuovo is a psychologist and associate professor in clinical psychology at the Catholic University of Milan (Italy) and a clinician at San Giuseppe Hospital (Verbania – Italy), the most important hospital in Italy in terms of the number of patients treated for disorders food (particularly for obesity).

The STRATOB study was recently presented at the international conference in Florence and Arezzo.

The study aims to compare Brief Strategic Therapy (TBS) with Behavioral and Cognitive Therapy (CBT)  for hospitalized patients with telephone follow-up. The pathology studied in this study is Binge Eating Disorder (BED) with obesity.


This is why the study was called the STRATOB study = STRAtegic Therapy for Obesity.

The study is based on a classic scientific methodology by Randomized Controlled Clinical Trial. The results were collected not only at the time of patient care, but also after an 18-month follow-up. The study is simple to set up. It could be shared with the strategic community of clinicians and each clinician could replicate the study.

The objective of the study is to compare the control group, which was the cognitive-behavioral therapy group, with the strategic brief therapy group.

The use of telemedicine (telephone call sections) is intended to allow patients to be followed also outside the hospital, to guarantee continuity and avoid relapses.

When selecting a psychotherapy for a study one must choose the specific clinical mode to be used. For example, for cognitive-behavioural therapy, the clinical mode traditionally used is that of Cooper and Fairburn , for brief strategic therapy, the clinical mode used is that of Nardone-Portelli Knowing through changing (2005).

The work involved 80 participants randomly divided into two groups: 40 participants for the TCC group and 40 participants for the BST group.

The STRATOB study used a very reliable outcome questionnaire to detect the smallest changes in other psychological behaviors in a short time. After 2, 3 and 4 weeks, it is possible to report improvements using this questionnaire.

  • The first measure is the OQ 45.2 questionnaire.
  • The second measure is the percentage of patients who stop vomiting (BED)

Data were collected after 1 month, 6 months, 12 months and 18 months. And for the inclusion criteria were considered only patients with the problem of Binge Eating, and not patients suffering from depression etc. Patients with co-morbidity were not retained.

The results were very positive in general for CBT psychotherapists as well as for BST psychotherapists with statistically and clinically significant differences between CBT and BST on some aspects.

Indeed, the study obtained better results with BST in terms of weight, number of Binge Eating episodes per week, reduction in symptoms of distress and improvement in social role .

The greatest improvement with BST was seen in the second part of treatment (the so-called relapse phase). In the first part (treatment of hospitalized patients during the first month) the differences between CBT and BST were not significant. BST showed better results after several months (6, 12, 18 months)

The observed superiority of BST (vs CBT) regarding weight loss and remissions of weekly Binge Eating episodes from 6 months post-discharge to 18 months, could correspond to the fact that BST emphasizes attempts at commonly attempted solutions and how the problem works rather than why it exists.

The improvement is significant if we take into account the stress reduction symptom OQ 45.2 (SD) and the social role (SR) whose score is measured from 12 to 18 months of follow-up, as well as for the OQ 45 .2 Global index of 6 up to 18 months observed for the BST group. This improvement is likely related to the emphasis that is placed on reducing symptoms in a short period of time by working on individuals' perceptions and emotions, rather than emphasizing the primacy of cognition in mediating psychological disorder.

In conclusion, the current clinical trial represents a single randomized controlled study, the generalizability of the research findings is limited. Further trials should expand both the use of alternative models of psychological support and the implementation of new technologies, in order to find the best combination of treatment (psychotherapeutic model, level of technology, number of sessions, etc.) for Binge Eating Disorder.