*4.4. Clinical Implications*

The present study has several clinical implications. Given the high levels of punishment sensitivity, it is essential that the treatment of patients with ED focuses on acquiring emotion regulation skills to help patients cope with emotional distress [37]. This is not surprising, given that EDs are often considered anxiety disorders. Evidence-based treatments of EDs, such as CBT-E and DBT-E [56–59], often include strategies to deal with emotions and to replace maladaptive ED behaviors with more adaptive emotion regulation strategies [37]. Furthermore, for binge eating and/or purging patients, the lack of effortful control certainly needs attention. First of all, it is important that patients focus on the aims of the treatment (which can be complicated by difficulties in attentional control) and learn to steer their behaviors (which can be complicated by difficulties in inhibitory/activation control). Furthermore, we know from prior research that a lack of effortful control/self-directedness can increase drop-out rates and worsen outcomes in patients with ED and obesity [60]. Therefore, impulse regulation strategies are included in evidence treatments for ED and obesity (e.g., CBT) [61]. Dalle Grave et al. [60], for example, conclude that CBT techniques to increase self-control, such as "setting short-term and achievable goals, developing adaptive coping behaviors through problem-solving in order to achieve these goals, and developing the confidence that they possess the resources required to achieve these goals (via progressive increases in self-efficacy through mastery experiences)", could decrease drop-out rates and improve therapy outcomes for patients

with obesity [60], (p. 35). Adapting the evidence-based treatments to the temperamental profile of our patients will probably also decrease drop-out rates and further improve our treatments [62,63].
