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Evaluating the Effectiveness of a Dialectical Behaviour Therapy (DBT) Informed Programme in a Community Perinatal Team. Behav Cogn Psychother 2018; 46:541-553. [DOI: 10.1017/s1352465817000790] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background:Adapted DBT programmes have been well documented but little has been published on such programmes in the perinatal period.Aim:To assess the effectiveness of a stand-alone DBT skills group for perinatal women with emotion dysregulation.Method:A stand-alone DBT-informed skills training group was offered to 21 women with emotional dysregulation under the care of a perinatal community mental health team; 14 completed the programme. Staff received support via a consultation group. Modules included mindfulness, emotional regulation, distress tolerance and interpersonal effectiveness adapted to the specific demands of parenting infants. Outcome measures were collected at three time points: assessment, start of the group and at the end.Results:Statistical analysis showed significant reduction in CORE scores over the intervention period (t(13) = 5.32,p< .001; Cohen'sd= 0.83), with similar effects on the Mental Health Confidence Scale (t(13) = ‒8.03,p< .001, Cohen'sd= 0.83) and Living with Emotions Scale (t(13) = ‒9.42,p< .001, Cohen'sd= 0.93). There were no significant changes on these three measures from assessment to start of the group.Conclusions:In this uncontrolled study, the intervention period was associated with reduced distress, increased confidence and ability to regulate emotion. Recommendations for continuing this model of service delivery are made. Further research is needed.
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Abstract
SummaryA variety of therapies have been developed or adapted to treat personality disorder over recent years. This article will review skills-based treatments (as opposed to insight-based treatments). Two approaches are outlined: cognitive-behavioural therapy and dialectical behaviour therapy. The article details the underpinning theory and the model of personality disorder utilised by the two approaches, and describes how the therapy is applied. Evidence of therapeutic efficacy is presented along with information about accessing training and therapy materials.
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Abstract
SummaryBinge eating occurs across the entire range of eating disorders. It is required for a diagnosis of bulimia nervosa but it is also seen in some cases of anorexia nervosa and in many cases of eating disorder not otherwise specified (usually referred to as eating disorder NOS or atypical eating disorder). This article focuses on the management of those eating disorders in which binge eating is a prominent feature.
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104
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Linardon J, Fairburn CG, Fitzsimmons-Craft EE, Wilfley DE, Brennan L. The empirical status of the third-wave behaviour therapies for the treatment of eating disorders: A systematic review. Clin Psychol Rev 2017; 58:125-140. [DOI: 10.1016/j.cpr.2017.10.005] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/16/2017] [Accepted: 10/20/2017] [Indexed: 11/17/2022]
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105
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Forbush KT, Hagan KE, Kite BA, Chapa DAN, Bohrer BK, Gould SR. Understanding eating disorders within internalizing psychopathology: A novel transdiagnostic, hierarchical-dimensional model. Compr Psychiatry 2017; 79:40-52. [PMID: 28755757 DOI: 10.1016/j.comppsych.2017.06.009] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/22/2017] [Accepted: 06/22/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Several problems with the classification and diagnosis of eating disorders (EDs) have been identified, including proliferation of 'other specified' diagnoses, within-disorder heterogeneity, and frequent diagnostic migration over time. Beyond problems within EDs, past research suggested that EDs fit better in a spectrum of internalizing psychopathology (characterized by mood and anxiety disorders) than in a separate diagnostic class. PURPOSE To develop a transdiagnostic, hierarchical-dimensional model relevant to ED psychopathology that: 1) reduces diagnostic heterogeneity, 2) includes important dimensions of internalizing psychopathology that are often excluded from ED diagnostic models, and 3) predicts clinical impairment. PROCEDURES Goldberg's (2006) method and exploratory structural equation modeling were used to identify a hierarchical model of internalizing in community-recruited adults with EDs (N=207). FINDINGS The lowest level of the hierarchy was characterized by 15 factors that defined specific aspects of eating, mood, and anxiety disorders. At the two-factor level, Internalizing bifurcated into Distress (low well-being, body dissatisfaction, suicidality, dysphoria, ill temper, traumatic intrusions) and Fear-Avoidance (claustrophobia, social avoidance, panic symptoms, dietary restricting, excessive exercise, and compulsions). Results showed that the lowest level of the hierarchy predicted 67.7% of the variance in clinical impairment. In contrast, DSM eating, mood, and anxiety disorders combined predicted 10.6% of the variance in impairment secondary to an ED. CONCLUSIONS The current classification model represents an improvement over traditional nosologies for predicting clinically relevant outcomes for EDs.
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106
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Blair M, Ferreria G, Gill S, King R, Hanna J, Deluca D, Ekblad A, Bowman D, Rau J, Smolewska K, Warriner E, Morrow SA. Dialectical Behavior Group Therapy is Feasible and Reduces Emotional Dysfunction in Multiple Sclerosis. Int J Group Psychother 2017; 67:500-518. [PMID: 38475612 DOI: 10.1080/00207284.2016.1260457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We examined whether dialectical behavior therapy (DBT) was feasible and effective in multiple sclerosis (MS). A convenience sample of 20 patients with anxiety or depression symptoms received either DBT (n = 10) or standard medical care (n = 10). The DBT protocol was found to be feasible in the MS population studied (e.g., good retention and acceptability). For the DBT group, significant improvements were demonstrated in self-rated and clinician-rated depressive symptoms, clinician-rated anxiety symptoms, self-rated general psychopathology symptoms, and quality of life. In contrast, the standard medical care group retained for exploratory purposes showed no significant improvements. This pilot work provides preliminary support for the utility of DBT in MS, but further work is needed to clarify this benefit using a large, randomized controlled approach.
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107
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Grenon R, Schwartze D, Hammond N, Ivanova I, Mcquaid N, Proulx G, Tasca GA. Group psychotherapy for eating disorders: A meta-analysis. Int J Eat Disord 2017; 50:997-1013. [PMID: 28771758 DOI: 10.1002/eat.22744] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 05/26/2017] [Accepted: 06/05/2017] [Indexed: 11/12/2022]
Abstract
OBJECTIVE In the current meta-analysis, we review the effect of group psychotherapy compared to both wait-list controls and other active treatments for adults with eating disorders (EDs). METHOD Twenty-seven randomized controlled trials (RCTs) that provide direct comparisons with a total of 1,853 participants were included. RESULTS Group psychotherapy is significantly more effective than wait-list controls at achieving abstinence rates of binge eating and/or purging (RR = 5.51, 95% CI: 3.73, 8.12), decreasing the frequency of binge eating and/or purging (g = 0.70, 95% CI: 0.51, 0.90), and reducing related ED psychopathology (g = 0.49, 95% CI: 0.32, 0.66) after treatment. The effects of group psychotherapy and other active treatments (e.g., behavioral weight loss, self-help, individual psychotherapy) did not differ on any outcome at post-treatment or at follow-ups. Group cognitive behavioral therapy (CBT) and other forms of group psychotherapy did not differ significantly on outcomes at any time point. DISCUSSION Additional research is needed to evaluate other group psychotherapy approaches, along with CBT, to provide more evidence-based treatment options for individuals with an ED. Group psychotherapy appears as effective as other common treatments and is perhaps more cost-effective than the most popular treatment, individual psychotherapy. Only 8.33% of comparisons in the current meta-analysis had at least 80% power to detect a moderate effect (d = .50) and we recommend that future RCTs be adequately powered.
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Affiliation(s)
- Renee Grenon
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada, K1N 6N5
| | - Dominique Schwartze
- Institute of Psychosocial Medicine and Psychotherapy, University Hospital Jena, Jena, D-07743, Germany
| | - Nicole Hammond
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada, K1H 8L1
| | - Iryna Ivanova
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, K1H 8L6
| | - Nancy Mcquaid
- Department of Psychology, The Ottawa Hospital, Ottawa, Ontario, Canada, K1H 8L6
| | - Genevieve Proulx
- Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada, K1H 8L6
| | - Giorgio A Tasca
- School of Psychology, University of Ottawa, Ottawa, Ontario, Canada, K1N 6N5.,Department of Psychiatry, University of Ottawa, Ottawa, Ontario, Canada, K1H 8L6.,Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, K1H 8L6
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108
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Abstract
Binge eating is a distressing symptom common to bulimia nervosa (BN), anorexia nervosa binge/purge subtype (AN-BP) and binge-eating disorder (BED). Over the last 40 years, many attempts have been made to conceptualise this symptom in terms of its antecedents, function, triggers, consequences, and maintaining factors. Cognitive theories of binge eating have evolved as new evidence has emerged. This literature review summarises the main and most influential cognitive models of binge eating across different eating disorder presentations. Many theories have examined binge eating in the context of restriction or compensatory behaviours, as is often observed in cases of BN. Few theories have examined binge eating as it occurs in BED specifically. The long-term efficacy of cognitive behavioural therapy (CBT) treatment based on these models leaves much to be desired, and indicates that there may be maintaining factors of binge eating not addressed in the typical CBT treatment for eating disorders. More recent cognitive models of binge eating propose possible maintaining beliefs, but further study is required to validate these models. Suggestions for future research are presented.
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Weiss NH, Peasant C, Sullivan TP. Intimate Partner Violence and HIV-Risk Behaviors: Evaluating Avoidant Coping as a Moderator. AIDS Behav 2017; 21:2233-2242. [PMID: 27778220 DOI: 10.1007/s10461-016-1588-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Women who experience intimate partner violence (IPV) report higher rates of HIV-risk behaviors. However, few studies have examined factors that may influence the strength of the link between IPV and HIV-risk behaviors. The goal of the current study was to extend extant research by evaluating the potential moderating role of avoidant coping in this relation. Participants were 212 women currently experiencing IPV (M age = 36.63, 70.8 % African American) who were recruited from the community. Significant positive associations were found between physical, psychological, and sexual IPV severity and both avoidant coping and HIV-risk behaviors. Avoidant coping moderated the relations between both physical and psychological IPV severity and HIV-risk behaviors, such that physical and psychological IPV severity were significantly associated with HIV-risk behaviors when avoidant coping was high (but not low). Findings underscore avoidant coping as an important factor in identifying and subsequently treating IPV-victimized women vulnerable to HIV-risk behaviors.
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Affiliation(s)
- Nicole H Weiss
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Ave, New Haven, CT, 06511, USA
| | - Courtney Peasant
- Substance Use, Gender, and Applied Research Program, RTI International, Research Triangle Park, NC, USA
| | - Tami P Sullivan
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Ave, New Haven, CT, 06511, USA.
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Altman JK, Linfield K, Salmon PG, Beacham AO. The body compassion scale: Development and initial validation. J Health Psychol 2017; 25:439-449. [DOI: 10.1177/1359105317718924] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
As the newer mindfulness and acceptance-based cognitive behavioral therapies continue to grow, it is important that corresponding valid and reliable assessment tools are developed and evaluated. This article describes the initial development and validation of the body compassion scale. The body compassion scale is a theoretically derived measure designed to bridge the constructs of body image and self-compassion to provide a targeted measure of underlying mindfulness and acceptance-based constructs. Herein, two studies using exploratory and confirmatory factor analysis and examining subsequent relationships among other health-related constructs in college-age samples are presented.
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111
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Kognitiv-affektive Neuropsychologie der Binge-Eating-Störung. PSYCHOTHERAPEUT 2017. [DOI: 10.1007/s00278-017-0190-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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112
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Chugani CD. Adapting Dialectical Behavior Therapy for College Counseling Centers. JOURNAL OF COLLEGE COUNSELING 2017. [DOI: 10.1002/jocc.12059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Carla D. Chugani
- Counseling and Psychological Services; Florida Gulf Coast University
- Now at Department of Pediatrics; Children's Hospital of Pittsburgh of UPMC; Pittsburgh Pennsylvania
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113
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Chen EY, Cacioppo J, Fettich K, Gallop R, McCloskey MS, Olino T, Zeffiro TA. An adaptive randomized trial of dialectical behavior therapy and cognitive behavior therapy for binge-eating. Psychol Med 2017; 47:703-717. [PMID: 27852348 PMCID: PMC7418949 DOI: 10.1017/s0033291716002543] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND 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). METHOD 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+). RESULTS 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 (d = 0.27) and CBT+ (d = 0.31) although these effects were small and within-treatment effects from baseline were large (d = 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 (d = -0.43). At 6- and 12-month follow-up assessments, DBT, CBT and cGSH did not differ in OBD. CONCLUSIONS 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.
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Affiliation(s)
- E. Y. Chen
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - J. Cacioppo
- Department of Psychology, The University of Chicago, Chicago, IL, USA
| | - K. Fettich
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - R. Gallop
- Department of Mathematics, West Chester University, West Chester, PA, USA
- Department of Psychiatry, Center for Psychotherapy Research, Perelman School of Medicine, University of Pennsylvania, USA
| | - M. S. McCloskey
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - T. Olino
- Department of Psychology, Temple University, Philadelphia, PA, USA
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Mason TB, Lewis RJ, Heron KE. Daily discrimination and binge eating among lesbians: a pilot study. PSYCHOLOGY & SEXUALITY 2017. [DOI: 10.1080/19419899.2017.1296484] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Tyler B. Mason
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | - Robin J. Lewis
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk State University, Norfolk, VA, USA
| | - Kristin E. Heron
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk State University, Norfolk, VA, USA
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115
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Burckhardt R, Manicavasagar V, Shaw F, Fogarty A, Batterham PJ, Dobinson K, Karpin I. Preventing mental health symptoms in adolescents using dialectical behaviour therapy skills group: a feasibility study. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2017. [DOI: 10.1080/02673843.2017.1292927] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Rowan Burckhardt
- The Black Dog Institute, Randwick, Australia
- School of Psychiatry, The University of NSW, Sydney, Australia
| | - Vijaya Manicavasagar
- The Black Dog Institute, Randwick, Australia
- School of Psychiatry, The University of NSW, Sydney, Australia
| | - Frances Shaw
- The Black Dog Institute, Randwick, Australia
- School of Psychiatry, The University of NSW, Sydney, Australia
| | | | - Philip J. Batterham
- Centre for Mental Health Research, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Katie Dobinson
- The Black Dog Institute, Randwick, Australia
- School of Psychiatry, The University of NSW, Sydney, Australia
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Choi-Kain LW, Finch EF, Masland SR, Jenkins JA, Unruh BT. What Works in the Treatment of Borderline Personality Disorder. Curr Behav Neurosci Rep 2017; 4:21-30. [PMID: 28331780 PMCID: PMC5340835 DOI: 10.1007/s40473-017-0103-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF THE REVIEW This review summarizes advances in treatments for adults with borderline personality disorder (BPD) in the last 5 years. RECENT FINDINGS Evidence-based advances in the treatment of BPD include a delineation of generalist models of care in contrast to specialist treatments, identification of essential effective elements of dialectical behavioral therapy (DBT), and the adaptation of DBT treatment to manage post-traumatic stress disorder (PTSD) and BPD. Studies on pharmacological interventions remain limited and have not provided evidence that any specific medications can provide stand-alone treatment. SUMMARY The research on treatment in BPD is leading to a distillation of intensive packages of treatment to be more broadly and practically implemented in most treatment environments through generalist care models and pared down forms of intensive treatments (e.g., informed case management plus DBT skills training groups). Evidence-based integrations of DBT and exposure therapy for PTSD provide support for changing practices to simultaneously treat PTSD and BPD.
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Affiliation(s)
- Lois W. Choi-Kain
- Harvard Medical School, McLean Hospital, 115 Mill St., Mail Stop 312, Belmont, MA 02478 USA
| | - Ellen F. Finch
- Harvard Medical School, McLean Hospital, 115 Mill St., Mail Stop 312, Belmont, MA 02478 USA
| | - Sara R. Masland
- Harvard Medical School, McLean Hospital, 115 Mill St., Mail Stop 312, Belmont, MA 02478 USA
| | - James A. Jenkins
- Massachusetts General Hospital, McLean Hospital, Belmont, MA 02478 USA
| | - Brandon T. Unruh
- Harvard Medical School, McLean Hospital, 115 Mill St., Mail Stop 312, Belmont, MA 02478 USA
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117
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Osborne TL, Michonski J, Sayrs J, Welch SS, Anderson LK. Factor Structure of the Difficulties in Emotion Regulation Scale (DERS) in Adult Outpatients Receiving Dialectical Behavior Therapy (DBT). JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2017. [DOI: 10.1007/s10862-017-9586-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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118
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Juarascio AS, Manasse SM, Espel HM, Schumacher LM, Kerrigan S, Forman EM. A Pilot Study of an Acceptance-based Behavioral Treatment for Binge Eating Disorder. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017; 6:1-7. [PMID: 28966910 PMCID: PMC5618713 DOI: 10.1016/j.jcbs.2016.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
While existing treatments produce remission in a relatively large percentage of individuals with binge eating disorder (BED), room for improvement remains. Interventions designed to increase emotion regulation skills and clarify one's chosen values may be well-suited to address factors known to maintain BED. The current study examined the preliminary efficacy of a group-based treatment, Acceptance-based Behavioral Therapy (ABBT), in a small open trial (n=19), as well as the relationship between changes in hypothesized mechanisms of action and outcomes. ABBT includes the behavioral components of cognitive behavioral treatment for BED and emotion-focused strategies from acceptance and commitment therapy and dialectical behavioral therapy. Results from generalized linear multilevel modeling revealed significant fixed linear effects of time on depression, quality of life, global eating pathology, and binge frequency (all ps < .05). Global eating disorder symptoms appeared to improve rapidly from pre- to mid-treatment, and continued to improve toward post-treatment and follow-up, but at a slower rate. Binge frequency decreased rapidly from pre- to mid-treatment, followed by a slight increase at post-treatment and a reduction again by follow-up. Improvements in experiential acceptance were strongly and consistently related to decreases in overall eating pathology across several measures (rs = .35-.54). Additionally, greater access to emotion regulation strategies was strongly related to decreases in overall eating pathology (r= .67). Preliminary results support the efficacy of this novel treatment approach and indicate that additional research on ABBT for BED is warranted.
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Affiliation(s)
| | | | - Hallie M Espel
- Drexel University, Department of Psychology, Philadelphia PA
| | | | | | - Evan M Forman
- Drexel University, Department of Psychology, Philadelphia PA
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119
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da Luz FQ, Swinbourne J, Sainsbury A, Touyz S, Palavras M, Claudino A, Hay P. HAPIFED: a Healthy APproach to weIght management and Food in Eating Disorders: a case series and manual development. J Eat Disord 2017; 5:29. [PMID: 28824810 PMCID: PMC5558732 DOI: 10.1186/s40337-017-0162-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/14/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There is a high prevalence of overweight or obesity in people with eating disorders. However, therapies for eating disorders, namely binge eating disorder and bulimia nervosa, do not address weight management. Conversely, weight loss treatments for people with overweight or obesity do not address psychological aspects related to eating disorders. Thus we developed a new treatment for overweight or obesity with comorbid binge eating disorder or bulimia nervosa, entitled HAPIFED (a Healthy APproach to weIght management and Food in Eating Disorders). This paper describes HAPIFED and reports a case series examining its feasibility and acceptability. METHODS Eleven participants with overweight or obesity and binge eating disorder or bulimia nervosa were treated with HAPIFED in two separate groups (with once or twice weekly meetings). Weight, body mass index (BMI) and eating disorder symptoms, as well as depression, anxiety and stress, were assessed at baseline and at the end of the 20-session HAPIFED intervention. RESULTS Eight of the 11 participants completed the intervention, with diverse results. Six of the 8 participants who completed HAPIFED reduced their weight between baseline and the end of the intervention. Median scores on the Eating Disorder Examination Questionnaire for binge eating, restraint, and concerns about eating or weight and shape, were reduced in the group overall between baseline and the end of the intervention. One participant, who at baseline was inducing vomiting and misusing laxatives in an attempt to lose weight, reduced these behaviors by the end of the intervention. Three participants at baseline were undertaking episodes of compulsive exercise, and they reduced or stopped this behavior, but one participant commenced episodes of compulsive exercise by the end of the intervention. All participants who completed the intervention rated the suitability and success of HAPIFED as 7 or more out of 10 (0 = not at all suitable/successful; 10 = extremely suitable/successful). CONCLUSION This case series supports the feasibility and acceptability of HAPIFED as a potential new treatment for overweight or obesity with comorbid binge eating disorder or bulimia nervosa. Clinical trials are necessary to examine the efficacy and effectiveness of HAPIFED. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (Universal Trial Number): U1111-1149-7766. Date of registration: 4th November 2013.
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Affiliation(s)
- Felipe Q da Luz
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia.,The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia.,CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70040-020 Brazil
| | - Jessica Swinbourne
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia
| | - Amanda Sainsbury
- The University of Sydney, The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Sydney Medical School, Charles Perkins Centre, Camperdown, NSW 2006 Australia.,The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia
| | - Stephen Touyz
- The University of Sydney, School of Psychology, Faculty of Science, Camperdown, NSW 2006 Australia
| | - Marly Palavras
- Program of Orientation and Attention of Eating Disorders, Federal University of São Paulo, São Paulo, Brazil
| | - Angelica Claudino
- Program of Orientation and Attention of Eating Disorders, Federal University of São Paulo, São Paulo, Brazil
| | - Phillipa Hay
- Centre for Health Research, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia
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Pjanic, Müller R, Laimer M, Hagenbuch N, Laederach K, Stanga Z. Evaluation of a multiprofessional, nonsurgical obesity treatment program: which parameters indicated life style changes and weight loss? J Eat Disord 2017; 5:14. [PMID: 28515933 PMCID: PMC5430604 DOI: 10.1186/s40337-017-0144-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Accepted: 04/03/2017] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND According to the current evidence, behavior modifications are an effective part of a non-surgical multiprofessional obesity treatment program (MOTP). The purpose of the present study was to report changes in weight as well in psychological variables during a one year MOTP. We aimed to identify the associations of emotional state and patients' emotion regulation skills with weight change. METHODS Prospective interventional study. Data of participants attending the one year obesity treatment in either a group or individual structured MOTP were analyzed. Weight, BMI (Body Mass Index) and measures on psychosomatic variables, emotion regulation skills, affective state, shame and guilt were collected at baseline, after three months and after one year. Mixed-effects models were used for the statistical analysis of BMI. RESULTS We included 238 patients at baseline (t1), 234 after three months (t2) and 179 after one year (t3). A drop in BMI measurements of at least 5% was observed in 20.6% of participants at t2 and 41.4% of participants at t3. After three months, participants showed significant improvements in the following psychosomatic variables: somatisation (p < 0.001), interpersonal sensitivity (p < 0.001), emotion regulation skills (p < 0.01), and attention to emotions (p < 0.05). Most of the improvements could be maintained after one year. BMI reduction was associated with a positive change in emotions, improvements in emotion regulation skills, and a reduction of depressive symptoms, disgust and shame. CONCLUSIONS The results indicate that the assessment and treatment of psychological aspects like depression, emotion regulation skills, body awareness, and acceptance should be a vital part of an interdisciplinary MOPT. TRIAL REGISTRATION Ethical approval for the present study was obtained from the Bern Kantonal Ethics Committee (KEK-Bern-Study Nr 258/14), Bern, Switzerland.
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Affiliation(s)
- Pjanic
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, University of Bern and University Hospital of Bern, 3010 Bern, Switzerland
| | - Roland Müller
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, University of Bern and University Hospital of Bern, 3010 Bern, Switzerland
| | - Markus Laimer
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, University of Bern and University Hospital of Bern, 3010 Bern, Switzerland
| | | | - Kurt Laederach
- Department of Department of Visceral Surgery and Medicine, University of Bern and University Hospital of Bern, 3010 Bern, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, University of Bern and University Hospital of Bern, 3010 Bern, Switzerland
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121
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Emami AS, Woodcock A, Swanson HE, Kapphahn T, Pulvers K. Distress tolerance is linked to unhealthy eating through pain catastrophizing. Appetite 2016; 107:454-459. [DOI: 10.1016/j.appet.2016.08.119] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/23/2016] [Accepted: 08/29/2016] [Indexed: 12/24/2022]
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122
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Daubenmier JJ. The Relationship of Yoga, Body Awareness, and Body Responsiveness to Self-Objectification and Disordered Eating. PSYCHOLOGY OF WOMEN QUARTERLY 2016. [DOI: 10.1111/j.1471-6402.2005.00183.x] [Citation(s) in RCA: 258] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Study 1 tested whether yoga practice is associated with greater awareness of and responsiveness to bodily sensations, lower self-objectification, greater body satisfaction, and fewer disordered eating attitudes. Three samples of women (43 yoga, 45 aerobic, and 51 nonyoga/nonaerobic practitioners) completed questionnaire measures. As predicted, yoga practitioners reported more favorably on all measures. Body responsiveness, and, to some extent, body awareness significantly explained group differences in self-objectification, body satisfaction, and disordered eating attitudes. The mediating role of body awareness, in addition to body responsiveness, between self-objectification and disordered eating attitudes was also tested as proposed in objectification theory ( Fredrickson & Roberts, 1997 ). Body responsiveness, but not awareness, mediated the relationship between self-objectification and disordered eating attitudes. This finding was replicated in Study 2 in a sample of female undergraduate students. It is concluded that body responsiveness and, to some extent, body awareness are related to self-objectification and its consequences.
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123
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Are overeating and food addiction related to distress tolerance? An examination of residents with obesity from a U.S. metropolitan area. Obes Res Clin Pract 2016; 11:287-298. [PMID: 27793573 DOI: 10.1016/j.orcp.2016.09.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/09/2016] [Accepted: 09/20/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Low distress tolerance (DT) is an inability to handle negative emotions. There is strong support for the connection between low DT and substance addiction, which suggests that the former might be related to food addiction (FA). Previous work found that low DT was related to overeating in a college sample. The current study had two primary aims: (1) to determine whether low DT is associated with overeating in a sample of participants with diverse races and incomes, and (2) to investigate the relationships among DT and body mass index (BMI) as well as DT and FA symptoms. DT as a moderator of the association between general overeating and FA was also explored. METHODS One hundred and ninety residents of Metropolitan Detroit communities (mean age: 41.71; 45.8% male; 34.7% non-White race; 47.4% with obesity) completed the DT Scale, Dutch Eating Behavior Questionnaire, Three Factor Eating Questionnaire, and Yale FA Scale. BMI was based on measured weight and height. RESULTS After adjusting for covariates, linear regression models found significant negative relationships between DT and emotional eating (P<0.001), external eating (P<0.001), disinhibition (P<0.001), FA (P<0.001), and BMI (P<0.01). DT was determined to be a moderator, such that among individuals who endorsed high levels of overeating, those with low DT reported more FA symptoms than those with high DT. CONCLUSION These findings suggest interventions targeting low DT should be considered to reduce overeating, which is a precursor and maintenance factor of obesity and FA.
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124
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Annesi JJ, Mareno N, McEwen KL. Mediation of self-regulation and mood in the relationship of changes in high emotional eating and nutritional behaviors: Moderating effects of physical activity. Scand J Psychol 2016; 57:523-534. [DOI: 10.1111/sjop.12327] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 07/19/2016] [Indexed: 12/19/2022]
Affiliation(s)
- James J. Annesi
- YMCA of Metro Atlanta; Atlanta Georgia USA
- Kennesaw State University; Kennesaw Georgia USA
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125
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Fassbinder E, Schweiger U, Martius D, Brand-de Wilde O, Arntz A. Emotion Regulation in Schema Therapy and Dialectical Behavior Therapy. Front Psychol 2016; 7:1373. [PMID: 27683567 PMCID: PMC5021701 DOI: 10.3389/fpsyg.2016.01373] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/29/2016] [Indexed: 11/13/2022] Open
Abstract
Schema therapy (ST) and dialectical behavior therapy (DBT) have both shown to be effective treatment methods especially for borderline personality disorder. Both, ST and DBT, have their roots in cognitive behavioral therapy and aim at helping patient to deal with emotional dysregulation. However, there are major differences in the terminology, explanatory models and techniques used in the both methods. This article gives an overview of the major therapeutic techniques used in ST and DBT with respect to emotion regulation and systematically puts them in the context of James Gross' process model of emotion regulation. Similarities and differences of the two methods are highlighted and illustrated with a case example. A core difference of the two approaches is that DBT directly focusses on the acquisition of emotion regulation skills, whereas ST does seldom address emotion regulation directly. All DBT-modules (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) are intended to improve emotion regulation skills and patients are encouraged to train these skills on a regular basis. DBT assumes that improved skills and skills use will result in better emotion regulation. In ST problems in emotion regulation are seen as a consequence of adverse early experiences (e.g., lack of safe attachment, childhood abuse or emotional neglect). These negative experiences have led to unprocessed psychological traumas and fear of emotions and result in attempts to avoid emotions and dysfunctional meta-cognitive schemas about the meaning of emotions. ST assumes that when these underlying problems are addressed, emotion regulation improves. Major ST techniques for trauma processing, emotional avoidance and dysregulation are limited reparenting, empathic confrontation and experiential techniques like chair dialogs and imagery rescripting.
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Affiliation(s)
- Eva Fassbinder
- Department of Psychiatry and Psychotherapy, University of Luebeck Luebeck, Germany
| | - Ulrich Schweiger
- Department of Psychiatry and Psychotherapy, University of Luebeck Luebeck, Germany
| | - Desiree Martius
- De Viersprong, Netherlands Institute of Personality Disorders Halsteren, Netherlands
| | - Odette Brand-de Wilde
- De Viersprong, Netherlands Institute of Personality Disorders Halsteren, Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam Amsterdam, Netherlands
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126
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Conway CC, Hammen C, Brennan PA. Optimizing Prediction of Psychosocial and Clinical Outcomes With a Transdiagnostic Model of Personality Disorder. J Pers Disord 2016; 30:545-66. [PMID: 26168327 PMCID: PMC5520625 DOI: 10.1521/pedi_2015_29_218] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Transdiagnostic models hold promise for transforming research and treatment practices for personality disorders (PDs), but widespread acceptance and implementation of such approaches will require persuasive evidence of construct validity and clinical utility. Toward that end, the authors examined the criterion-related validity of a transdiagnostic PD model in relation to psychosocial and clinical outcomes in a high-risk community sample of 700 young adults. Participants and their mothers completed semistructured interviews to assess young adults' PD symptomatology, psychosocial functioning, suicidality, and mental health treatment use. Bifactor modeling revealed an overarching dimension of PD severity-capturing symptoms across all PD categories-that strongly predicted all functional and clinical outcomes in multivariate analyses. Effect sizes for lower-order, specific PD processes were comparatively modest for functional outcomes; however, they provided clinically significant information about suicide risk and treatment use. The authors discuss implications of a transdiagnostic perspective for research on PD etiology, classification, and treatment.
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Affiliation(s)
| | - Constance Hammen
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA
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127
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Abstract
Epidemiological research indicates that there is substantial comorbidity between posttraumatic stress disorder (PTSD) and substance use disorder (SUD). Moreover, there is growing evidence that having a comorbid PTSD diagnosis is associated with greater substance use problem severity and poorer outcomes from SUD treatment. In an attempt to improve the treatment outcome for individuals with PTSD-SUD, recently developed treatments combine exposure therapy for PTSD with an empirically supported treatment for SUD. This article describes one of the treatments and discusses treatment modifications that have been incorporated when translating this research-based therapy to practice in an inner-city community mental health center.
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Affiliation(s)
- Scott F Coffey
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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128
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McNair L, Woodrow C, Hare D. Dialectical Behaviour Therapy [DBT] with People with Intellectual Disabilities: A Systematic Review and Narrative Analysis. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2016; 30:787-804. [PMID: 27456814 DOI: 10.1111/jar.12277] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND There is mixed evidence regarding the effectiveness of psychological therapies for people with intellectual and developmental disorders. Although systematic reviews have supported the use of dialectical behaviour therapy with people with borderline personality disorder, there are no comparable reviews regarding DBT with people with intellectual and development disabilities. METHODS Studies were identified using a systematic approach and were selected if they reported an intervention that included a DBT skills group and then assessed using the Evaluative Method for Determining Evidence Based Practice. RESULTS Seven studies reported adaptations and outcomes of DBT for people with intellectual and development disabilities, four of which delivered full DBT programmes with three describing DBT skills groups. All studies were appraised with regard to methodological quality and the adaptations and results examined. CONCLUSIONS The findings indicate that DBT and DBT skills groups can be adapted for people with intellectual and development disabilities, but further high-quality research is needed to make conclusions about efficacy and effectiveness.
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Affiliation(s)
- Louisa McNair
- Cheshire and Wirral Partnership NHS Foundation Trust, Cheshire, UK
| | - Ceri Woodrow
- Cheshire and Wirral Partnership NHS Foundation Trust, Cheshire, UK
| | - Dougal Hare
- School of Psychology, Cardiff University, Cardiff, UK
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129
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Donofry SD, Roecklein KA, Wildes JE, Miller MA, Erickson KI. Alterations in emotion generation and regulation neurocircuitry in depression and eating disorders: A comparative review of structural and functional neuroimaging studies. Neurosci Biobehav Rev 2016; 68:911-927. [PMID: 27422451 DOI: 10.1016/j.neubiorev.2016.07.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 06/13/2016] [Accepted: 07/11/2016] [Indexed: 12/18/2022]
Abstract
Major depression and eating disorders (EDs) are highly co-morbid and may share liability. Impaired emotion regulation may represent a common etiological or maintaining mechanism. Research has demonstrated that depressed individuals and individuals with EDs exhibit impaired emotion regulation, with these impairments being associated with changes in brain structure and function. The goal of this review was to evaluate findings from neuroimaging studies of depression and EDs to determine whether there are overlapping alterations in the brain regions known to be involved in emotion regulation, evidence of which would aid in the diagnosis and treatment of these conditions. Our review of the literature suggests that depression and EDs exhibit common structural and functional alterations in brain regions involved in emotion regulation, including the amygdala, ventral striatum and nucleus accumbens, anterior cingulate cortex, insula, and dorsolateral prefrontal cortex. We present preliminary support for a shared etiological mechanism. Future studies should consider manipulating emotion regulation in a sample of individuals with depression and EDs to better characterize abnormalities in these brain circuits.
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Affiliation(s)
- Shannon D Donofry
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States.
| | - Kathryn A Roecklein
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States; The Center for the Neural Basis of Cognition, Pittsburgh, PA, United States
| | - Jennifer E Wildes
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Megan A Miller
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, United States; The Center for the Neural Basis of Cognition, Pittsburgh, PA, United States
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130
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Carmel A, Rose ML, Fruzzetti AE. Barriers and solutions to implementing dialectical behavior therapy in a public behavioral health system. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2016; 41:608-14. [PMID: 23754686 DOI: 10.1007/s10488-013-0504-6] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Dialectical behavior therapy (DBT) is an evidence-based treatment that is considered to be the standard of care in treating individuals with BPD, however there have been few published studies to identify the challenges and solutions for implementing DBT in community-based settings. The current study identified the barriers and solutions within a system-wide roll-out of DBT within a large, urban public health system encompassing both mental health and substance abuse treatment settings. Qualitative interviews were conducted with 19 clinicians receiving DBT training over a period of 13 months. A content analysis revealed three themes that were identified as challenges to the DBT implementation process including program development and recruitment of patients, a lack of administrative support or organizational investment in DBT, and time commitment of DBT. In order to transfer DBT into a public behavioral health system, investment from both clinic- and system-level administrators is required. Strategies to prevent drift, such as incorporating a train-the-trainer model, are discussed.
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Affiliation(s)
- Adam Carmel
- University of Washington, Box 359911, Seattle, WA, 98104, USA,
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131
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Young-Hyman DL, Peterson CM, Fischer S, Markowitz JT, Muir AB, Laffel LM. Depressive Symptoms, Emotion Dysregulation, and Bulimic Symptoms in Youth With Type 1 Diabetes: Varying Interactions at Diagnosis and During Transition to Insulin Pump Therapy. J Diabetes Sci Technol 2016; 10:845-51. [PMID: 27137457 PMCID: PMC4928239 DOI: 10.1177/1932296816645118] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
This study evaluated the associations between depressive symptoms, emotion dysregulation and bulimic symptoms in youth with type 1 diabetes (T1D) in the context of the diagnosis and treatment of T1D. Study participants were 103 youth in 2 distinct groups: newly diagnosed (New) or transitioning to pump therapy (continuous subcutaneous insulin infusion [CSII]; "Pump"), who completed questionnaires regarding symptoms of depression, emotion dysregulation, and bulimia. Glycemic control (A1c), height, weight, and questionnaires were evaluated within 10 days of diagnosis (n = 58) or at education/clinic visit before starting insulin utilizing CSII (n = 45). In the newly diagnosed group, only depression accounted for significant variance in bulimia scores (β = .47, P < .01). For the group with disease treatment experience (Pump), but not for the newly diagnosed group (New), greater depressive symptoms and emotion dysregulation were associated with greater bulimic symptoms. Depressive symptoms and emotion dysregulation, an indicator of poor coping/behavioral control, could help explain adoption of disordered eating behaviors in youth with T1D who are transitioning to pump therapy.
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Affiliation(s)
- Deborah L Young-Hyman
- Office of Behavioral and Social Sciences Research, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Claire M Peterson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Sarah Fischer
- Department of Psychology, George Mason University, Fairfax, VA, USA
| | | | - Andrew B Muir
- School of Medicine, Emory University, Atlanta, GA, USA
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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132
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Kelly AC, Wisniewski L, Martin-Wagar C, Hoffman E. Group-Based Compassion-Focused Therapy as an Adjunct to Outpatient Treatment for Eating Disorders: A Pilot Randomized Controlled Trial. Clin Psychol Psychother 2016; 24:475-487. [DOI: 10.1002/cpp.2018] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/05/2016] [Accepted: 04/08/2016] [Indexed: 11/06/2022]
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133
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Chugani CD, Landes SJ. Dialectical Behavior Therapy in College Counseling Centers: Current Trends and Barriers to Implementation. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2016. [DOI: 10.1080/87568225.2016.1177429] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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134
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Cook NE, Gorraiz M. Dialectical behavior therapy for nonsuicidal self-injury and depression among adolescents: preliminary meta-analytic evidence. Child Adolesc Ment Health 2016; 21:81-89. [PMID: 32680373 DOI: 10.1111/camh.12112] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dialectical behavior therapy (DBT) has proven effective in reducing symptoms and behaviors related to Borderline Personality Disorder. More recently, it has been modified and applied to adolescents struggling with regulating their emotions and who may engage in impulsive, self-destructive behaviors, including nonsuicidal self-injury (NSSI). However, there is limited research evidence regarding the effectiveness of DBT for reducing NSSI behavior and depression among adolescents. Given the high suicide risk associated with NSSI and its association with depression, this is clearly an important focus of clinical and research attention. METHOD This meta-analysis sought to offer preliminary evidence regarding the effectiveness of DBT to treat NSSI and depression in adolescents. Twelve published studies were included; all 12 reported pre- and post-treatment measures of depression and six of these studies reported pre- and post-treatment measures of NSSI. RESULTS The weighted mean effect size for NSSI was large (g = 0.81, 95% CI = 0.59-1.03); the weighted mean effect size for depression was small (g = 0.36, 95% CI = 0.30-0.42). CONCLUSIONS Intervention effects for both outcomes were positive, suggesting decreased NSSI and improvement in depressive symptoms for adolescents following a course of DBT. However, given considerable limitations in the research base available for meta-analysis, these findings are preliminary and tentative. Limitations in the current knowledge base and suggestions for future research are discussed.
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Affiliation(s)
- Nathan E Cook
- Massachusetts General Hospital Department of Psychiatry, Learning and Emotional Assessment Program, 151 Merrimac Street 5th Floor, Boston, Massachusetts, 02114, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Maggie Gorraiz
- Center for Cognitive and Dialectical Behavior Therapy, Lake Success, NY, USA
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135
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Pollert GA, Kauffman AA, Veilleux JC. Symptoms of Psychopathology Within Groups of Eating-Disordered, Restrained Eating, and Unrestrained Eating Individuals. J Clin Psychol 2016; 72:621-32. [PMID: 26990755 DOI: 10.1002/jclp.22283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE While eating-disordered individuals have shown high levels of comorbid psychopathology, there has not been an assessment of these symptoms across groups exhibiting different forms of problematic eating behavior. METHOD Using 1,122 participants recruited via Amazon Mechanical Turk, this study examined self-reported differences between controls, restrained eaters, and individuals meeting criteria for binge eating disorder and bulimia nervosa on several measures of psychopathology unrelated to eating. RESULTS On nearly all outcome measures, eating-disordered participants had greater symptoms of psychopathology compared to restrained eaters, who had greater levels compared to controls. Among the eating-disordered participants, bulimia nervosa participants had more symptoms of psychopathology than binge eating-disordered participants. CONCLUSION Treatment of the populations included in this study may be informed by an understanding of the different amounts of symptoms of comorbid psychopathology that confer additional distress and impairment above and beyond disordered eating behavior.
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136
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Binge Eating among Women Veterans in Primary Care: Comorbidities and Treatment Priorities. Womens Health Issues 2016; 26:420-8. [PMID: 26972486 DOI: 10.1016/j.whi.2016.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Little is known about the clinical profile and treatment priorities of women with binge eating disorder (BED), a diagnosis new to the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. We identified comorbidities and patients' treatment priorities, because these may inform implementation of clinical services. METHODS Data were collected from women veteran primary care patients. Analyses compared those who screened positive for BED (BED+), and those without any binge eating symptoms (BED-). RESULTS Frequencies of comorbid medical and psychological disorders were high in the BED+ group. The BED+ group's self-identified most common treatment priorities were mood concerns (72.2%), weight loss (66.7%), and body image/food issues (50%). Among those with obesity, a greater proportion of the BED+ group indicated body image/food issues was their top treatment priority (12.9% vs. 2.8%; p < .01), suggesting that these patients may be more apt to seek treatment beyond weight management for their problematic eating patterns. CONCLUSIONS Women primary care patients with BED demonstrate high medical and psychological complexity; their subjective treatment priorities often match objective needs. These findings may inform the development of targeted BED screening practices for women with obesity in primary care settings, and the eventual adoption of patient-centered BED treatment resources.
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137
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Rowsell M, MacDonald DE, Carter JC. Emotion regulation difficulties in anorexia nervosa: associations with improvements in eating psychopathology. J Eat Disord 2016; 4:17. [PMID: 27195121 PMCID: PMC4870742 DOI: 10.1186/s40337-016-0108-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/12/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Difficulties with emotion regulation have been established as a core deficit in anorexia nervosa (AN). However, limited research has evaluated whether weight gain is associated with improvements in emotion regulation difficulties in AN and whether improvements in emotion regulation are associated with reductions in eating disorder psychopathology. The aims of this study were threefold: 1) to examine the nature and extent of emotion regulation difficulties in AN; 2) to determine whether these difficulties improved during intensive treatment for the eating disorder; and 3) to study whether improvements in emotion regulation were associated with improvements in eating disorder psychopathology. METHOD The participants were 108 patients who met DSM-IV-TR criteria for AN and were admitted to a specialized intensive treatment program. Self-report measures of eating disorder symptoms and difficulties with emotion regulation were administered at admission to and discharge from the program. RESULTS Patients with the binge-purge subtype of AN reported greater difficulties with impulse control when upset and more limited access to emotion regulation strategies when experiencing negative emotions than those with the restricting subtype. Among those who completed treatment and became weight restored, improvements in emotion regulation difficulties were observed. Greater pre-to-post treatment improvements in emotional clarity and engagement in goal directed behaviours when upset were associated with greater reductions in eating disorder psychopathology during treatment. CONCLUSIONS These findings add to growing evidence suggesting that eating disorder symptoms may be related to emotion regulation difficulties in AN and that integrating strategies to address emotion regulation deficits may be important to improving treatment outcome in AN.
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Affiliation(s)
- Marsha Rowsell
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL A1B 3X9 Canada
| | - Danielle E MacDonald
- Department of Psychology, Ryerson University, Toronto, Ontario M5G 2C4 Canada ; Department of Psychiatry, University Health Network, Toronto, Ontario M5G 2C4 Canada
| | - Jacqueline C Carter
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL A1B 3X9 Canada
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138
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Buckholdt KE, Weiss NH, Young J, Gratz KL. Exposure to Violence, Posttraumatic Stress Symptoms, and Borderline Personality Pathology Among Adolescents in Residential Psychiatric Treatment: The Influence of Emotion Dysregulation. Child Psychiatry Hum Dev 2015; 46:884-92. [PMID: 25500759 PMCID: PMC4466212 DOI: 10.1007/s10578-014-0528-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Exposure to violence during adolescence is a highly prevalent phenomenon associated with a range of deleterious outcomes. Theoretical literature suggests that emotion dysregulation is one consequence of exposure to violence associated with the manifestation of posttraumatic stress symptoms (PTSS) and borderline personality (BP) pathology. Thus, the goal of the present study was to examine the mediating role of emotion dysregulation in the relation between exposure to violence and both PTSS and BP pathology in a sample of 144 adolescents (age 10- to 17-years; 51% male; 55% African American) admitted to a psychiatric residential treatment center. Exposure to violence was associated with greater emotion dysregulation, which, in turn, was associated with greater PTSS and BP pathology. Furthermore, emotion dysregulation mediated the associations between exposure to violence and both PTSS and BP pathology. Findings suggest the importance of assessing and treating emotion dysregulation among violence-exposed adolescents in psychiatric residential treatment.
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Affiliation(s)
- Kelly E Buckholdt
- Department of Psychiatry, University of Mississippi Medical Center, Jackson, MS, USA.
- Psychology Division, G.V. (Sonny) Montgomery VAMC, 1500 E Woodrow Wilson Ave., C-154, Jackson, MS, 39216, USA.
| | - Nicole H Weiss
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - John Young
- Department of Psychology, University of Mississippi, Oxford, MS, USA
| | - Kim L Gratz
- Department of Psychiatry, University of Mississippi Medical Center, Jackson, MS, USA
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139
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Ditty MS, Landes SJ, Doyle A, Beidas RS. It Takes a Village: A Mixed Method Analysis of Inner Setting Variables and Dialectical Behavior Therapy Implementation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 42:672-81. [PMID: 25315183 PMCID: PMC4400206 DOI: 10.1007/s10488-014-0602-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Guided by the Consolidated Framework for Implementation Research, this mixed method study explored the relationship between inner setting variables and dialectical behavior therapy (DBT) implementation. Intensively trained DBT clinicians completed an online quantitative survey (n = 79) and a subset were sequentially interviewed using qualitative methods (n = 20) to identify relationships between inner setting variables and DBT implementation. Four interpersonal variables-team cohesion, team communication, team climate, and supervision-were correlated with the quantity of DBT elements implemented. Qualitative themes corroborated these findings. Additional variables were connected to implementation by either quantitative or qualitative findings, but not both.
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Affiliation(s)
- Matthew S Ditty
- The Ebright Foundation, LLC, 2800 Lancaster Ave., Suite 6, Wilmington, DE, 19810, USA.
| | - Sara J Landes
- National Center for PTSD, VA Palo Alto Health Care System, Palo Alto, CA, USA
- University of Washington, Seattle, WA, USA
| | - Andrea Doyle
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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140
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Examining challenging behaviors of clients with borderline personality disorder. Behav Res Ther 2015; 75:11-9. [PMID: 26496225 DOI: 10.1016/j.brat.2015.10.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 10/04/2015] [Accepted: 10/07/2015] [Indexed: 11/20/2022]
Abstract
Few studies have examined effects of challenging behaviors of clients with borderline personality disorder (BPD) on psychotherapy outcomes. Dialectical behavior therapy (DBT) is an evidence-based treatment designed to treat chronic suicidality, self-directed violence (SDV), and emotion dysregulation, while targeting challenging behaviors. DBT has been shown to be effective with clients with BPD. We evaluated whether therapist reported challenging behaviors, such as high volume phone contacts or violating the therapist's limits, during DBT would be associated with dropping out of DBT, severity and frequency of SDV, emotion regulation deficits, psychological symptom severity and client's and therapist's satisfaction of treatment. The current study examined challenging behaviors reported by therapists in a sample of 63 psychiatrically disabled outpatient DBT clients diagnosed with BPD (73% women, average age 37 years). More frequent phone contacts were associated with a decrease in dropout and psychological symptoms, and an increase in client and therapist satisfaction. More avoidance/disengagement behavior was associated with more than twice the risk of SDV and a decrease in therapist satisfaction. Findings suggest that the phone coaching might serve to maximize client satisfaction and reduce the likelihood of dropout.
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141
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Stein AT, Hearon BA, Beard C, Hsu KJ, Björgvinsson T. Properties of the Dialectical Behavior Therapy Ways of Coping Checklist in a Diagnostically Diverse Partial Hospital Sample. J Clin Psychol 2015; 72:49-57. [PMID: 26390145 DOI: 10.1002/jclp.22226] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Dialectical behavior therapy (DBT) was developed for treatment of borderline personality disorder (BPD), and adapted forms of DBT are currently used to treat bipolar disorder, eating disorders, anxiety, and depression. This study was designed to validate the Dialectical Behavior Therapy Ways of Coping Checklist (DBT-WCCL) DBT Skills subscale (DSS) for use in a diagnostically heterogeneous sample. METHOD We used naturalistic data from 228 patients receiving treatment at a partial hospital program to assess psychometric properties of the DBT-WCCL DSS. We assessed interitem correlations, internal consistency, factor structure, construct validity and sensitivity to change. RESULTS Internal consistency, construct validity, and sensitivity to change were good. The measure displayed good convergent and discriminant validity. Factor analysis results were consistent with previous research indicating a 1-factor solution for this subscale. CONCLUSIONS Psychometric properties were similar to the original BPD sample, indicating that this measure can be used as an assessment tool for DBT skill use in a diverse psychiatric population.
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142
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Goldbacher E, La Grotte C, Komaroff E, Vander Veur S, Foster GD. An initial evaluation of a weight loss intervention for individuals who engage in emotional eating. J Behav Med 2015; 39:139-50. [DOI: 10.1007/s10865-015-9678-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/26/2015] [Indexed: 11/30/2022]
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143
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Berg KC, Crosby RD, Cao L, Crow SJ, Engel SG, Wonderlich SA, Peterson CB. Negative affect prior to and following overeating-only, loss of control eating-only, and binge eating episodes in obese adults. Int J Eat Disord 2015; 48:641-53. [PMID: 25808854 PMCID: PMC4543439 DOI: 10.1002/eat.22401] [Citation(s) in RCA: 128] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The objective was to examine the trajectory of five types of negative affect (global negative affect, fear, guilt, hostility, sadness) prior to and following three types of eating episodes (overeating in the absence of loss of control [OE-only], loss of control eating in the absence of overeating [LOC-only], and binge eating) among obese adults using ecological momentary assessment (EMA). METHOD Fifty obese adults (84% female) completed a two-week EMA protocol during which they were asked to record all eating episodes and rate each episode on continua of overeating and loss of control. Momentary measures of global negative affect, fear, guilt, hostility, and sadness were assessed using an abbreviated version of the Positive and Negative Affect Schedule (PANAS). Trajectories for each of the five types of negative affect were modeled prior to and following episodes of OE-only, LOC-only, and binge eating. RESULTS Consistent with previous findings, global negative affect and Guilt increased prior to and decreased following binge eating episodes (all ps < .05). Guilt also decreased following OE-only episodes (p < .05). DISCUSSION These results are consistent with the affect regulation model of binge eating and suggest that binge eating may function to regulate global negative affect, and more specifically, guilt among obese adults. These data suggest that the relationship between negative affect and binge eating may not be unique to individuals with clinical eating disorders and indicate that targeting negative affect may be an effective strategy for the treatment of binge eating in the context of obesity.
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Affiliation(s)
| | - Ross D. Crosby
- Neuropsychiatric Research Institute University of North Dakota School of Medicine and Health Sciences
| | - Li Cao
- Neuropsychiatric Research Institute
| | | | - Scott G. Engel
- Neuropsychiatric Research Institute University of North Dakota School of Medicine and Health Sciences
| | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute University of North Dakota School of Medicine and Health Sciences
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144
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Expanding binge eating assessment: Validity and screening value of the Binge Eating Scale in women from the general population. Eat Behav 2015; 18:41-7. [PMID: 25880043 DOI: 10.1016/j.eatbeh.2015.03.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 01/14/2015] [Accepted: 03/19/2015] [Indexed: 01/18/2023]
Abstract
There is growing recognition that binge eating is a prevalent problem with serious implications for both clinical and nonclinical samples. The current study aimed at examining the factor structure, psychometric properties and the screening usefulness of the Binge Eating Scale (BES) in a large sample of female college students and women from the Portuguese general population. A sample of 1008 participants was collected to conduct a confirmatory factor analysis and test the BES psychometric properties; 150 participants were further evaluated through the Eating Disorder Examination 16.0D to assess the discriminant validity of the BES. Results confirmed that the BES presents a sound one-dimensional factorial structure, with very good construct reliability and convergent validity. Also, the scale presented very good retest-reliability. Findings also offered evidence that the BES is positively associated with measures of eating and general psychopathology, and BMI. Furthermore, the BES revealed an excellent performance (96.7%) on discriminating clinically significant cases of binge eating, showing a sensitivity of 81.8% and a specificity of 97.8%. Results support the validity and usefulness of the BES as an assessment and screening tool for binge eating in women from the general population.
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145
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Weiss NH, Sullivan TP, Tull MT. Explicating the role of emotion dysregulation in risky behaviors: A review and synthesis of the literature with directions for future research and clinical practice. Curr Opin Psychol 2015; 3:22-29. [PMID: 25705711 DOI: 10.1016/j.copsyc.2015.01.013] [Citation(s) in RCA: 126] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Extant literature provides support for emotion dysregulation as a transdiagnostic construct with relevance to the pathogenesis and treatment of numerous psychiatric difficulties and maladaptive behaviors, including risky, self-destructive, and health-compromising behaviors (e.g., substance use, risky sexual behavior). The aim of the present review is to synthesize theory and empirical research on the relationship between emotion dysregulation and risky behaviors. In addition, we highlight cutting-edge approaches for investigating the emotion dysregulation-risky behavior, including examination of the role of positive emotional experiences and inclusion of context-dependent and physiological assessments. Finally, we note the relevance of the emotion dysregulation-risky behavior relation to intervention efforts aimed at reducing risky behaviors.
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Affiliation(s)
- Nicole H Weiss
- Yale University School of Medicine, Department of Psychiatry 389 Whitney Avenue, New Haven, CT, 06511
| | - Tami P Sullivan
- Yale University School of Medicine, Department of Psychiatry 389 Whitney Avenue, New Haven, CT, 06511
| | - Matthew T Tull
- University of Mississippi Medical Center, Department of Psychiatry 2500 North State Street, Jackson, MS, 39216
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146
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Lillis J, Niemeier HM, Ross KM, Thomas JG, Leahey T, Unick J, Kendra KE, Wing RR. Weight loss intervention for individuals with high internal disinhibition: design of the Acceptance Based Behavioral Intervention (ABBI) randomized controlled trial. BMC Psychol 2015; 3:17. [PMID: 26019869 PMCID: PMC4446109 DOI: 10.1186/s40359-015-0075-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 05/21/2015] [Indexed: 11/22/2022] Open
Abstract
Background Obesity is public health problem associated with significant health risks and healthcare costs. Behavioral weight control programs produce clinically meaningful weight losses, however outcomes have high variability and maintenance continues to be a problem. The current study is an NIH-funded randomized clinical trial testing a novel approach, Acceptance-Based Behavioral Intervention (ABBI), that combines techniques from standard behavioral treatment (SBT) and Acceptance and Commitment Therapy (ACT). We test this approach among individuals reporting high internal disinhibition who typically respond poorly to standard interventions and appear to benefit from ACT components. Methods/Design The ABBI study targets recruitment of 160 overweight or obese adults (BMI of 25–50) who report that they overeat in response to negative emotional states. These individuals are randomly assigned to either (1) ABBI or (2) SBT. Both interventions involve weekly meetings for 22 sessions, bi-weekly for 6 sessions, and then monthly for 3 sessions and both receive the same calorie intake target (1200–1800, depending on starting weight), exercise goal (work up to 250 min per week), and self-monitoring skills training. SBT incorporates current best practice interventions for addressing problematic thoughts and emotions, sometimes called “change” or “control” strategies. ABBI uses acceptance-based techniques based on ACT. Full assessments occur at baseline, 6, 12, and 18 months. Weight loss from baseline to 18 months is the primary outcome. Discussion The ABBI study is unique in its focus on integrating acceptance-based techniques into a SBT intervention and targeting a group of individuals with problems with emotional overeating who might experience particular benefit from this novel approach. Trial Registration ClinicalTrials.gov, NCT01461421 (registered October 25, 2011)
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Affiliation(s)
- Jason Lillis
- The Miriam Hospital, Brown Medical School, Providence, USA ; Weight Control and Diabetes Research Center, The Miriam Hospital, Brown Medical School, 196 Richmond Street, Providence, RI 02903 USA
| | | | - Kathryn M Ross
- The Miriam Hospital, Brown Medical School, Providence, USA
| | | | | | - Jessica Unick
- The Miriam Hospital, Brown Medical School, Providence, USA
| | | | - Rena R Wing
- The Miriam Hospital, Brown Medical School, Providence, USA
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147
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Medina J, Hopkins L, Powers M, Baird SO, Smits J. The Effects of a Hatha Yoga Intervention on Facets of Distress Tolerance. Cogn Behav Ther 2015; 44:288-300. [PMID: 25952547 PMCID: PMC4681579 DOI: 10.1080/16506073.2015.1028433] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Individuals with low distress tolerance (DT) experience negative emotion as particularly threatening and are highly motivated to reduce or avoid such affective experiences. Consequently, these individuals have difficulty regulating emotions and tend to engage in maladaptive strategies, such as overeating, as a means to reduce or avoid distress. Hatha yoga encourages one to implement present-centered awareness and non-reaction in the face of physical and psychological discomfort and, thus, emerges as a potential strategy for increasing DT. To test whether a hatha yoga intervention can enhance DT, a transdiagnostic risk and maintenance factor, this study randomly assigned females high in emotional eating in response to stress (N = 52) either to an 8-week, twice-weekly hatha (Bikram) yoga intervention or to a waitlist control condition. Self-reported DT and emotional eating were measured at baseline, weekly during treatment, and 1-week post-treatment. Consistent with prediction, participants in the yoga condition reported greater increases in DT over the course of the intervention relative to waitlist participants (Cohen's d = .82). Also consistent with prediction, the reduction in emotional eating was greater for the yoga condition than the waitlist condition (Cohen's d = .92). Importantly, reductions distress absorption, a specific sub-facet of DT, accounted for 15% of the variance in emotional eating, a hallmark behavior of eating pathology and risk factor for obesity.
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Affiliation(s)
- Johnna Medina
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | | | - Mark Powers
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Scarlett O. Baird
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
| | - Jasper Smits
- Department of Psychology, University of Texas at Austin, Austin, TX, USA
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148
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Johnston JAY, O'Gara JSX, Koman SL, Baker CW, Anderson DA. A pilot study of maudsley family therapy with group dialectical behavior therapy skills training in an intensive outpatient program for adolescent eating disorders. J Clin Psychol 2015; 71:527-43. [PMID: 25867492 DOI: 10.1002/jclp.22176] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The goal of this study was to provide pilot clinical data on the effectiveness of an intensive outpatient treatment model for adolescent eating disorders that combines Maudsley-based family therapy and group dialectical behavior therapy skills training. METHOD Measures of physical and psychological status were gathered upon admission, discharge, and at 3 follow-up intervals. RESULTS Adolescents who completed the program gained a significant amount of weight and experienced a significant decrease in eating disorder psychopathology. At the 1-year follow-up, 64% of adolescents were weight restored and menstruating normally. Measures of eating disorder psychopathology continued to improve up to a year after treatment. CONCLUSIONS This pilot, multimodal program warrants further investigation and may be an effective intermediate level of care treatment option for adolescent eating disorders.
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149
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Kramer U, Pascual-Leone A, Berthoud L, de Roten Y, Marquet P, Kolly S, Despland JN, Page D. Assertive Anger Mediates Effects of Dialectical Behaviour-informed Skills Training for Borderline Personality Disorder: A Randomized Controlled Trial. Clin Psychol Psychother 2015; 23:189-202. [PMID: 25864773 DOI: 10.1002/cpp.1956] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/10/2015] [Accepted: 03/14/2015] [Indexed: 12/14/2022]
Abstract
UNLABELLED Dialectical behaviour therapy (DBT)-informed skills training for borderline personality disorder (BPD) aims at the development of specific emotion regulation skills in patients, particularly with regard to the regulation of problematic anger. While the effects of dialectical behaviour skills training have been shown, their processes of change are rarely examined. Neacsiu, Rizvi and Linehan (2010) found that patient's self-reported use of emotion regulation skills was a mediator of therapeutic change in these treatments; however, they found no effect for problematic anger. From an integrative perspective on anger (Pascual-Leone & Greenberg, 2007; Pascual-Leone & Paivio, 2013), there are several forms of anger, varying in their degree of therapeutic productivity. The present add-on randomized controlled trial included n = 41 patients with BPD (n = 21 DBT-informed skills training versus n = 20 treatment as usual). The first study examined the outcome of the DBT-informed skills training encompassing basic components of training in mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation. Results showed that symptom reduction was significantly greater in the DBT-informed skills training, compared with the treatment as usual. The second study used process assessment, for which all patient completers underwent a 50-min-long psychological interview both early and late in treatment, which was rated using the Classification of Affective Meaning States. DBT-informed skills training produced increased levels of primary 'assertive' anger, as compared with the treatment as usual, whereas no effect was found for 'rejecting' secondary anger. Most importantly, we showed that changes in assertive anger mediated the reported symptom reduction, in particular in patient's social roles. We discuss these results in the context of underlying mechanisms of change in DBT skills group treatments, in particular towards developing more productive forms of anger in this patient population. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE A 20-session dialectical behaviour therapy (DBT)-informed skills training is a promising adjunct intervention for patients with borderline personality disorder, in particular for reducing problems related to social role. Increases in assertive anger mediate the effects of DBT-informed skills training, whereas rejecting anger remains unchanged over the course of treatment. Short-term objectives for intervention might involve the specific increase of assertive anger in BPD, by using DBT-informed skills training; long-term objectives for intervention might involve a specific decrease of rejecting anger in BPD.
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Affiliation(s)
- Ueli Kramer
- Institute of Psychotherapy, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
- General Psychiatry Service, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | | | - Laurent Berthoud
- Institute of Psychotherapy, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Yves de Roten
- Institute of Psychotherapy, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Pierre Marquet
- General Psychiatry Service, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Stéphane Kolly
- General Psychiatry Service, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Jean-Nicolas Despland
- Institute of Psychotherapy, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Dominique Page
- Institute of Psychotherapy, Department of Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
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150
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The role of functional assessment in third wave behavioral interventions: foundations and future directions for a fourth wave. Curr Opin Psychol 2015. [DOI: 10.1016/j.copsyc.2014.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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