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Liakopoulou E, Vassalou G, Tzavara C, Gonidakis F. A 12-month study of dialectical behavioral therapy for bοrderline patients suffering from eating disorders. Eat Weight Disord 2023; 28:81. [PMID: 37798605 PMCID: PMC10556119 DOI: 10.1007/s40519-023-01612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 09/27/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE Individuals with eating disorders (ED) and comorbid borderline personality disorder (BPD) may benefit from therapies focusing on emotion regulation, such as dialectical behavioral therapy (DBT). The aim of the study was to evaluate the effectiveness of one-year standard DΒΤ enhanced with cognitive-behavioral therapy (CBT) strategies for patients suffering from ED and BPD. METHODS Seventy-two BPD and ED (anorexia and bulimia nervosa) participants were recruited from the eating disorders unit of the 1st Psychiatric Department of National and Kapodistrian University of Athens. All participants completed one year of standard DBT. ED-related behaviors were added to the treatment plan according to the DBT targeting hierarchy. Individual therapy and skills training group sessions were adapted to incorporate CBT strategies for nutritional and weight restoration. BPD and ED symptomatology were measured at the beginning and at the end of one year of treatment. RESULTS The major finding of the study was the significant improvement of patients in all the outcome measurements after one year of treatment. The study's second finding was that the severity of BPD symptomatology was significantly related to the severity of ED symptomatology. It was also shown that improvement of the patients coping skills was correlated with the reduction of ED and BPD symptomatology. CONCLUSIONS These results support previous studies on the effectiveness of DBT for comorbid BPD and EDs. Despite the promising results, randomized controlled trials are needed to establish the efficacy of DBT for BPD and ED patients. LEVEL OF EVIDENCE Level IV: Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
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Affiliation(s)
- Efi Liakopoulou
- 1st Psychiatric Department, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Vassalou
- 1st Psychiatric Department, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Chara Tzavara
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Fragiskos Gonidakis
- 1st Psychiatric Department, Eginition Hospital, National and Kapodistrian University of Athens, Athens, Greece.
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2
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Joshua PR, Lewis V, Simpson S, Kelty SF, Boer DP. What role do early life experiences play in eating disorders? The impact of parenting style, temperament and early maladaptive schemas. Clin Psychol Psychother 2023. [PMID: 37654072 DOI: 10.1002/cpp.2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/09/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Given that most eating disorders develop in adolescence and early adulthood, early life experiences are said to play a key role in the aetiology of eating disorders. There are well-documented relationships between early maladaptive schemas and eating disorders, early maladaptive schemas and temperament and temperament and perceived parenting style. The present study aimed to test a hypothesis that perceived parenting style predicts temperament, which predicts early maladaptive schemas, which predict eating disorder symptoms in young people. METHOD An online survey measured perceived parenting style, temperament, early maladaptive schemas and eating disorder symptoms in 397 people with disordered eating between the ages of 18 and 29. Path analysis was used to investigate the relationship between these elements. RESULTS The results found support for this hypothesis. Perceived maladaptive parenting ratings for mothers were a stronger predictor of temperament, and only two temperament factors were adequate predictors of early maladaptive schemas. CONCLUSIONS Overall, the present study found preliminary support for a linear relationship where perceived parenting style predicts temperament, which predicts early maladaptive schema levels, which predicts eating disorder symptoms. The present study was the first to propose and test this model; however, further research is required to confirm the nature and extent of this relationship.
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Affiliation(s)
- Phoebe R Joshua
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Vivienne Lewis
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Susan Simpson
- University of South Australia, Adelaide, South Australia, Australia
- NHS Forth Valley, Stirling, UK
| | - Sally F Kelty
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Douglas P Boer
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
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3
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Schreiber AM, Cawood CD. Treatment outcomes of Veteran men in a comprehensive dialectical behavior therapy program: Characterizing sex differences in symptom trajectories. J Psychiatr Res 2023; 164:90-97. [PMID: 37331262 DOI: 10.1016/j.jpsychires.2023.05.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 04/13/2023] [Accepted: 05/18/2023] [Indexed: 06/20/2023]
Abstract
Dialectical Behavior Therapy (DBT) is one of the primary psychosocial treatments for reducing suicidal behaviors and improving psychosocial outcomes among patients with borderline personality disorder (BPD) and has been shown to reduce BPD symptoms when delivered in a Veteran Affairs medical center setting. Despite evidence of similar rates of BPD in both men and women, the vast majority of treatment outcome research in BPD has focused on women. We sought to characterize sex differences in symptom trajectories among Veterans participating in a comprehensive DBT program. We found that Veteran men and women who entered the DBT program were diagnostically and demographically similar. Participants exhibited reductions in BPD symptoms and improvements in emotion regulation over the course of treatment. Moreover, Veteran men reported BPD symptom reductions that were not statistically inferior to those of Veteran women and exhibited a sharper reduction in these symptoms. This research provides support for the use of DBT as a psychosocial treatment for Veteran men with BPD symptoms.
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Affiliation(s)
- Alison M Schreiber
- Ann Arbor VA Medical Center, Ann Arbor, MI, USA; University of North Carolina, Chapel Hill, NC, USA.
| | - Chelsea D Cawood
- Ann Arbor VA Medical Center, Ann Arbor, MI, USA; University of Michigan Medical School, Ann Arbor, MI, USA.
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Mishra N, Singh P. Community-Based Intervention Targeting Depressive Symptomatology in Indian Women: An Exploration of Its Efficacy in a Non-Specialized Healthcare Setting. Community Ment Health J 2023; 59:999-1012. [PMID: 36587370 DOI: 10.1007/s10597-022-01083-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/21/2022] [Indexed: 01/02/2023]
Abstract
Depressive symptomatology casts a more adverse impact on the well-being of women in countries with unfavourable societal norms. The prevalence of depressive symptomatology in Indian women and the treatment gap in case of mental health issues are alarming and thus may require interventions at a community level. The present study tested the efficacy of a psychosocial community-based intervention in managing depressive symptomatology and associated factors like rumination, reappraisal, psychological resilience, and self-efficacy using a pre-test post-test control group design. A total of 114 (Mage=23.03, SD = 5.29) and 37 (Mage=24.89, SD = 6.44) adult females were there in the experimental and the control group, respectively. A series of ANOVAs showed that participants' scores on depressive symptomatology and associated vulnerabilities and defences improved as compared to the baseline and the control group. The findings support the use of psychosocial community-based intervention in a non-specialized healthcare setting to manage depressive symptomatology, associated vulnerability and defences.
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Affiliation(s)
- Navneet Mishra
- Department of Humanities and Social Science, Indian Institute of Technology Ropar, Ropar, Punjab, 140001, India.
| | - Parwinder Singh
- Department of Humanities and Social Science, Indian Institute of Technology Ropar, Ropar, Punjab, 140001, India
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Gong J, Zhou L, Zhao L, Zhang S, Chen Z, Liu J. Epidemiology of Childhood Witnessing Domestic Violence and Exploration of Its Relationships With Affective Lability and Suicide Attempts in Chinese Young Adults. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP22834-NP22863. [PMID: 35229677 DOI: 10.1177/08862605211072221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Childhood witnessing domestic violence (CWDV) exerts short- and long-term negative impacts on emotional and behavioral health. The present study investigated the epidemiological features of CWDV, and its negative impact on psychological outcomes in a sample of Chinese college students. The mediating role of emotion regulation strategies on CWDV associations with psychological outcomes and gender differences in these relationships were examined. A total of 3,126 respondents (1,034 males; 2,086 females; 6 missing data in gender) completed the study questionnaire, which included demographic characteristics, CWDV, and suicide attempt history items as well as the Emotion Regulation Questionnaire (ERQ) and Affect Lability Scale-18 (ALS-18). Overall, 43.03% of the respondents reported CWDV, including 44.87% of males and 42.09% of females. Higher frequencies of CWDV were found to be related to the following factors: unstable marital status of parents; not being an only child; being a left-behind child, family financial difficulties, consumption of alcohol in the past year, and being in relatively poor physical condition. Among males, ERQ suppression scores were significantly higher for those men who experienced "often or every day" CWDV than for men who indicated that they did not have any history of CWDV (Bonferroni-corrected p = 0.047). More frequent CWDV was associated with higher ALS-18 scores and increased risk of suicide attempts in males and females (p < 0.05), and emotion regulation (suppression) was found to mediate the association between CWDV and affective lability among males. This study revealed high rates of CWDV, and serious impacts of CWDV on mental health in male and female Chinese college students. In males, but not females, emotion regulation strategy use, use of suppression, was found to act as a mediator in the association of CWDV with affective lability. Our findings suggest that interventions for individuals with CWDV should focus on the emotional regulation, which may help them improve mental health, especially in males.
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Affiliation(s)
- Jingbo Gong
- Shanghai Changning Mental Health Center, Shanghai 200335, China
- Department of Applied Psychology, Hunan University of Chinese Medicine118393, Changsha, Hunan, China
| | - Lihua Zhou
- College of Education Science, Hengyang Normal University12573, Hengyang, Hunan, China
| | - Lishun Zhao
- Department of Applied Psychology, Hunan University of Chinese Medicine118393, Changsha, Hunan, China
| | - Shujun Zhang
- Department of Applied Psychology, Hunan University of Chinese Medicine118393, Changsha, Hunan, China
| | - Ziyi Chen
- Department of Applied Psychology, Hunan University of Chinese Medicine118393, Changsha, Hunan, China
| | - Jianbo Liu
- Department of Child Psychiatry of Shenzhen Kangning Hospital, Shenzhen Mental Health Center, School of mental health, Shenzhen University504010, Shenzhen, China
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Shaker NM, Azzam LA, Zahran RM, Hashem RE. Frequency of binge eating behavior in patients with borderline personality disorder and its relation to emotional regulation and impulsivity. Eat Weight Disord 2022; 27:2497-2506. [PMID: 35301691 DOI: 10.1007/s40519-022-01358-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/31/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Eating disorders are common among patients with borderline personality disorder (BPD), contributing to their lack of treatment response and bad prognosis. In this context, it is helpful to examine the relevance of eating behavior and to understand whether borderline traits are higher in those individuals. In this study, a sample of patients with BPD screened to determine the frequency of binge eating (BE) behaviors and its relation to impulsivity and emotional dysregulation. METHOD Seventy participants aged 25.81 ± 6.34 years were recruited from Okasha Institute of psychiatry, Cairo, Egypt. Diagnosed by the Structured Clinical Interview for DSM-IV Axis II disorders (SCID-II), assessed for impulsivity, emotion regulation using the Barratt Impulsiveness Scale and the Trait Meta Mood Scale (TMMS), respectively, and screened for BE behaviors by Binge Eating Scale. RESULTS All of the participants had medium emotional regulation propensity 82.63 ± 10.81 and showed variable degrees of impulsivity, mainly moderate 42 (60%). More than half of the participants had BE behavior 37 (~ 53%), with a significant negative correlation with clarity of feeling, total score of TMMS, and age. Similarly, on comparing the participant with binging versus no binging group, a significant relation between BE behavior, fear of abandonment (p value 0.02), clarity of feeling, and total score of TMMS was found. However, no significant relation between BE behavior & impulsivity demonstrated. CONCLUSION A substantial number of patients with BPD suffering from BE, showing relation between binging, emotion dysregulation, and fear of abandonment. LEVEL OF EVIDENCE III, evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Nermin Mahmoud Shaker
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Lobna AbuBakr Azzam
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Randa Mohamad Zahran
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt
| | - Reem Elsayed Hashem
- Okasha insitute of Psychiatry, Faculty of Medicine, Ain Shams University, 22, Dair Al-Malak, Abbassia, P.O. Box 11657, Cairo, Egypt.
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Ledden S, Rains LS, Schlief M, Barnett P, Ching BCF, Hallam B, Günak MM, Steare T, Parker J, Labovitch S, Oram S, Pilling S, Johnson S. Current state of the evidence on community treatments for people with complex emotional needs: a scoping review. BMC Psychiatry 2022; 22:589. [PMID: 36064337 PMCID: PMC9442944 DOI: 10.1186/s12888-022-04171-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 07/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving the quality of care in community settings for people with 'Complex Emotional Needs' (CEN-our preferred working term for services for people with a "personality disorder" diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN. METHODS We conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020. RESULTS We included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people's lives, peer support, or ways of designing effective services. CONCLUSIONS Compared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.
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Affiliation(s)
- Sarah Ledden
- Division of Psychiatry, University College London, London, UK
| | - Luke Sheridan Rains
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Merle Schlief
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK.
| | - Phoebe Barnett
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Brian Chi Fung Ching
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Brendan Hallam
- Division of Psychiatry, University College London, London, UK
- Research Department of Primary Care & Population Health, University College London, London, UK
| | - Mia Maria Günak
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Thomas Steare
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - Jennie Parker
- NIHR Mental Health Policy Research Unit Co-Production Group, University College London, London, UK
| | - Sarah Labovitch
- NIHR Mental Health Policy Research Unit Co-Production Group, University College London, London, UK
- West London NHS Trust, London, UK
| | - Sian Oram
- NIHR Mental Health Policy Research Unit, Department of Health Service and Population Research, King's College London, London, UK
| | - Steve Pilling
- Centre for Outcomes Research and Effectiveness, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
- National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Sonia Johnson
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
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8
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Miller AE, Trolio V, Halicki-Asakawa A, Racine SE. Eating disorders and the nine symptoms of borderline personality disorder: A systematic review and series of meta-analyses. Int J Eat Disord 2022; 55:993-1011. [PMID: 35579043 DOI: 10.1002/eat.23731] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/11/2022] [Accepted: 04/27/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Eating disorders and borderline personality disorder have high rates of comorbidity. However, the extent to which individual BPD symptoms are elevated in patients with EDs is largely unknown. Meta-analyses examined: (1) which of the nine BPD symptoms are especially elevated in individuals with versus without EDs, (2) whether particular ED subtypes have elevated levels of certain BPD symptoms, and (3) which BPD symptoms remain unstudied/understudied in relation to EDs. METHODS We performed nine separate meta-analyses (one for each BPD symptom) to compare levels of symptoms in patients with EDs versus healthy controls. A total of 122 studies (range = 4-34 studies across symptoms) were included. RESULTS Affective instability was the BPD symptom most elevated, while anger was the BPD symptom least elevated, in patients with EDs compared to controls. When comparing effect sizes across ED subtypes, anorexia nervosa binge-eating/purging subtype had the largest effect sizes for the greatest number of BPD symptoms, while effect sizes for AN restrictive subtype were not significantly larger than those of other EDs for any BPD symptom. The least studied BPD symptoms were identity disturbance and interpersonal difficulties. DISCUSSION These meta-analyses suggest that certain symptoms of BPD play a more prominent role in the comorbidity between BPD and EDs than others. Targeting affective instability when treating cases of comorbid ED and BPD may be especially likely to ameliorate the negative outcomes related to this comorbidity. Future research should further investigate identity disturbance and interpersonal difficulties in the context of EDs. PUBLIC SIGNIFICANCE Having an eating disorder and borderline personality disorder is a common comorbidity associated with a severe clinical presentation. BPD is characterized by nine distinct symptoms. This research examined levels of individual BPD symptoms in patients with versus without EDs. Findings can guide researchers and clinicians towards studying and treating symptoms that may be most relevant for BPD-ED comorbidity and in turn, improve outcomes for these patients.
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Affiliation(s)
- Alexia E Miller
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Vittoria Trolio
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Amané Halicki-Asakawa
- Department of Psychology, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Sarah E Racine
- Department of Psychology, McGill University, Montreal, Quebec, Canada
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Lekgabe E, Pogos D, Sawyer SM, Court A, Hughes EK. Borderline personality disorder traits in adolescents with anorexia nervosa. Brain Behav 2021; 11:e2443. [PMID: 34807527 PMCID: PMC8671792 DOI: 10.1002/brb3.2443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 10/26/2021] [Accepted: 11/05/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To examine the correlation between eating disorder (ED) symptoms and borderline personality disorder (BPD) traits in a sample of adolescents with eating disorders. METHOD There were 168 participants (Mage = 16.0 years; SD = 1.16) with a diagnosis of anorexia nervosa (AN) or Eating Disorder Not Otherwise Specified-AN type. Eating Disorder Examination (EDE) and the Borderline Personality Questionnaire (BPQ) were used to assess ED symptoms and BPD traits. RESULTS A total of 10 participants (6.6%) scored above the clinical cut-off for a likely diagnosis of BPD. A positive correlation was observed between BPQ total score and EDE global (rs = 0.64, p < .001). There were also positive correlations between the BPQ self-image and emptiness subscales and all EDE subscales. Similarly, the EDE eating concern subscale was correlated with all BPQ subscales. DISCUSSION Previous studies have demonstrated that some BPD traits (i.e., suicidality, impulsivity, anger) are co-morbid with ED but the link with other BPD traits has been poorly studied in adolescents and those with AN. These findings indicate that while the prevalence of BPD in adolescents with AN may be relatively low, ED symptom severity is closely related to severity of BPD traits, particularly identity disturbance and feelings of emptiness.
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Affiliation(s)
- Edna Lekgabe
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Australia.,North Western Mental Health, The Royal Melbourne Hospital, Melbourne, Australia
| | - Danielle Pogos
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Susan M Sawyer
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Centre of Adolescent Health, Royal Children's Hospital, Melbourne, Australia
| | - Andrew Court
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Elizabeth K Hughes
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Centre of Adolescent Health, Royal Children's Hospital, Melbourne, Australia
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10
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Puttevils L, Vanderhasselt MA, Horczak P, Vervaet M. Differences in the use of emotion regulation strategies between anorexia and bulimia nervosa: A systematic review and meta-analysis. Compr Psychiatry 2021; 109:152262. [PMID: 34265598 DOI: 10.1016/j.comppsych.2021.152262] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 06/08/2021] [Accepted: 07/05/2021] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE Research has identified abnormal emotion regulation (ER) as an underlying mechanism in the onset and maintenance of eating disorders. Yet, it still remains unclear whether different forms of ER, adaptive and maladaptive strategies, are similar across categories of eating disorders. METHOD A systematic review and meta-analysis were carried out to look at ER differences between anorexia nervosa (AN) and bulimia nervosa (BN), two common eating disorder pathologies with different eating patterns. RESULTS 41 studies were included in the meta-analysis. The results revealed no differences in the use of maladaptive ER strategies between individuals with AN and BN, however patients with AN tend to use less adaptive ER strategies as compared to patients with BN. CONCLUSIONS Making less use of adaptive strategies in AN might be due to low body weight and high levels of alexithymia which define AN. In order to improve treatment outcome in individuals suffering from AN, these findings suggest to focus more on improving the use of adaptive ER strategies.
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Affiliation(s)
- Louise Puttevils
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium.
| | - Marie-Anne Vanderhasselt
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium; Department of Experimental-Clinical and Health Psychology, Ghent University, Belgium
| | - Paula Horczak
- Department of Head and Skin, Ghent University, Belgium; Ghent Experimental Psychiatry (GHEP) lab, Belgium
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11
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Juarascio AS, Parker MN, Hunt R, Murray HB, Presseller EK, Manasse SM. Mindfulness and acceptance-based behavioral treatment for bulimia-spectrum disorders: A pilot feasibility randomized trial. Int J Eat Disord 2021; 54:1270-1277. [PMID: 33851734 PMCID: PMC8780759 DOI: 10.1002/eat.23512] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/19/2021] [Accepted: 03/19/2021] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Although existing research supports the efficacy of mindfulness- and acceptance-based treatments (MABTs) for eating disorders (EDs), few studies have directly compared outcomes from MABTs to standard CBT. METHOD Participants (N = 44), treatment-seeking adults with bulimia-spectrum EDs, were screened for eligibility, consented, and randomized to receive 20 sessions of outpatient, individual CBT or MABT treatment. Treatment outcomes (binge eating and compensatory behavior episodes, global ED severity, depressive symptoms, quality of life, emotional awareness/clarity, distress tolerance, values-based decision-making, and emotion modulation) were measured at pre-treatment, post-treatment, and 6-month follow up. Data on feasibility and acceptability are also presented. RESULTS Treatment and assessment retention rates were comparable between MABT and CBT (p range = .51-.73) and between-group differences on acceptability measures were very small (d range = 0.03-0.19). Both conditions produced notable and generally comparable changes in most treatment outcomes at post-treatment (within group d range = 0.06-1.77). DISCUSSION The MABT and CBT conditions demonstrated comparable degrees of feasibility, acceptability, and symptom improvement, suggesting that MABTs warrant further evaluation as ED treatments.
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Affiliation(s)
- Adrienne S. Juarascio
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania,Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania
| | - Megan N. Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USU), Bethesda, Maryland,Section on Growth and Obesity, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Division of Intramural Research, National Institutes of Health (NIH), Bethesda, Maryland
| | - Rowan Hunt
- Department of Psychological and Brain Sciences, University of Louisville, Louisville, Kentucky
| | - Helen Burton Murray
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts,Harvard Medical School, Boston, Massachusetts
| | - Emily K. Presseller
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania,Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania
| | - Stephanie M. Manasse
- Center for Weight, Eating, and Lifestyle Science, Drexel University, Philadelphia, Pennsylvania
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Witt KG, Hetrick SE, Rajaram G, Hazell P, Taylor Salisbury TL, Townsend E, Hawton K. Psychosocial interventions for self-harm in adults. Cochrane Database Syst Rev 2021; 4:CD013668. [PMID: 33884617 PMCID: PMC8094743 DOI: 10.1002/14651858.cd013668.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Self-harm (SH; intentional self-poisoning or self-injury regardless of degree of suicidal intent or other types of motivation) is a growing problem in most counties, often repeated, and associated with suicide. There has been a substantial increase in both the number of trials and therapeutic approaches of psychosocial interventions for SH in adults. This review therefore updates a previous Cochrane Review (last published in 2016) on the role of psychosocial interventions in the treatment of SH in adults. OBJECTIVES To assess the effects of psychosocial interventions for self-harm (SH) compared to comparison types of care (e.g. treatment-as-usual, routine psychiatric care, enhanced usual care, active comparator) for adults (aged 18 years or older) who engage in SH. SEARCH METHODS We searched the Cochrane Common Mental Disorders Specialised Register, the Cochrane Library (Central Register of Controlled Trials [CENTRAL] and Cochrane Database of Systematic reviews [CDSR]), together with MEDLINE, Ovid Embase, and PsycINFO (to 4 July 2020). SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing interventions of specific psychosocial treatments versus treatment-as-usual (TAU), routine psychiatric care, enhanced usual care (EUC), active comparator, or a combination of these, in the treatment of adults with a recent (within six months of trial entry) episode of SH resulting in presentation to hospital or clinical services. The primary outcome was the occurrence of a repeated episode of SH over a maximum follow-up period of two years. Secondary outcomes included treatment adherence, depression, hopelessness, general functioning, social functioning, suicidal ideation, and suicide. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and appraised trial quality. For binary outcomes, we calculated odds ratio (ORs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated mean differences (MDs) or standardised mean differences (SMDs) and 95% CIs. The overall quality of evidence for the primary outcome (i.e. repetition of SH at post-intervention) was appraised for each intervention using the GRADE approach. MAIN RESULTS We included data from 76 trials with a total of 21,414 participants. Participants in these trials were predominately female (61.9%) with a mean age of 31.8 years (standard deviation [SD] 11.7 years). On the basis of data from four trials, individual cognitive behavioural therapy (CBT)-based psychotherapy may reduce repetition of SH as compared to TAU or another comparator by the end of the intervention (OR 0.35, 95% CI 0.12 to 1.02; N = 238; k = 4; GRADE: low certainty evidence), although there was imprecision in the effect estimate. At longer follow-up time points (e.g., 6- and 12-months) there was some evidence that individual CBT-based psychotherapy may reduce SH repetition. Whilst there may be a slightly lower rate of SH repetition for dialectical behaviour therapy (DBT) (66.0%) as compared to TAU or alternative psychotherapy (68.2%), the evidence remains uncertain as to whether DBT reduces absolute repetition of SH by the post-intervention assessment. On the basis of data from a single trial, mentalisation-based therapy (MBT) reduces repetition of SH and frequency of SH by the post-intervention assessment (OR 0.35, 95% CI 0.17 to 0.73; N = 134; k = 1; GRADE: high-certainty evidence). A group-based emotion-regulation psychotherapy may also reduce repetition of SH by the post-intervention assessment based on evidence from two trials by the same author group (OR 0.34, 95% CI 0.13 to 0.88; N = 83; k = 2; moderate-certainty evidence). There is probably little to no effect for different variants of DBT on absolute repetition of SH, including DBT group-based skills training, DBT individual skills training, or an experimental form of DBT in which participants were given significantly longer cognitive exposure to stressful events. The evidence remains uncertain as to whether provision of information and support, based on the Suicide Trends in At-Risk Territories (START) and the SUicide-PREvention Multisite Intervention Study on Suicidal behaviors (SUPRE-MISS) models, have any effect on repetition of SH by the post-intervention assessment. There was no evidence of a difference for psychodynamic psychotherapy, case management, general practitioner (GP) management, remote contact interventions, and other multimodal interventions, or a variety of brief emergency department-based interventions. AUTHORS' CONCLUSIONS Overall, there were significant methodological limitations across the trials included in this review. Given the moderate or very low quality of the available evidence, there is only uncertain evidence regarding a number of psychosocial interventions for adults who engage in SH. Psychosocial therapy based on CBT approaches may result in fewer individuals repeating SH at longer follow-up time points, although no such effect was found at the post-intervention assessment and the quality of evidence, according to the GRADE criteria, was low. Given findings in single trials, or trials by the same author group, both MBT and group-based emotion regulation therapy should be further developed and evaluated in adults. DBT may also lead to a reduction in frequency of SH. Other interventions were mostly evaluated in single trials of moderate to very low quality such that the evidence relating to the use of these interventions is inconclusive at present.
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Affiliation(s)
- Katrina G Witt
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Gowri Rajaram
- Orygen, Parkville, Melbourne, Australia
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Philip Hazell
- Speciality of Psychiatry, University of Sydney School of Medicine, Sydney, Australia
| | - Tatiana L Taylor Salisbury
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ellen Townsend
- Self-Harm Research Group, School of Psychology, University of Nottingham, Nottingham, UK
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, Oxford, UK
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Heath N, Midkiff MF, Gerhart J, Turow RG. Group-based DBT skills training modules are linked to independent and additive improvements in emotion regulation in a heterogeneous outpatient sample. Psychother Res 2021; 31:1001-1011. [PMID: 33539233 DOI: 10.1080/10503307.2021.1878306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Objective: Dialectical Behavior Therapy (DBT) was initially developed to treat symptoms of Borderline Personality Disorder (BPD), but has also been shown to improve symptoms of several other mental health conditions. Emotion regulation difficulties comprise a key target of DBT as well as a common challenge for individuals with depression, anxiety, PTSD, and other conditions. The current study investigated the impact of a DBT skills-training group on emotion regulation, and whether improvement in specific facets of emotion regulation would be linked to training in specific modules.Method: One hundred and thirty-six patients diagnosed with heterogeneous mental health conditions participated in the study. Patients were enrolled in the group on a rolling basis, and emotion regulation was assessed at the beginning and end of every six- to eight-week module.Results: Mixed model analysis revealed that each DBT skills-training module (i.e., mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation) was associated with improvements in emotion regulation (all Bonferroni corrected ps < .003).Conclusions: These findings add to the growing literature on the applicability of DBT skills-training to heterogeneous psychological conditions, particularly when patients' challenges reflect underlying difficulties with emotion regulation.
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Affiliation(s)
- Nicole Heath
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA
| | - Melanie F Midkiff
- Department of Psychology, Central Michigan University, Mt. Pleasant, MI, USA
| | - James Gerhart
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, USA.,Department of Psychology, Central Michigan University, Mt. Pleasant, MI, USA
| | - Rachel Goldsmith Turow
- Department of Psychology, Seattle University, Seattle, WA, USA.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Navarro-Haro MV, Botella VG, Badenes-Ribera L, Borao L, García-Palacios A. Dialectical Behavior Therapy in the Treatment of Comorbid Borderline Personality Disorder and Eating Disorder in a Naturalistic Setting: A Six-Year Follow-up Study. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10170-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Marco JH, Cañabate M, Pérez S. Meaning in life is associated with the psychopathology of eating disorders: differences depending on the diagnosis. Eat Disord 2019; 27:550-564. [PMID: 30663525 DOI: 10.1080/10640266.2018.1560852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Previous studies indicated that meaning in life was inversely associated with eating behaviors and a negative attitude toward food, body satisfaction, and borderline symptoms. However, research on the association between meaning in life and eating disorder psychopathology is scarce, and there are no studies on the association between meaning in life and the eating disorder psychopathology depending on the diagnosis. The aim of the present study is to verify whether meaning in life is differentially associated with a broad range of psychopathology symptoms commonly observed in people with ED, depending on the diagnosis, in a sample of 240 ED patients. We found that meaning in life was negatively associated with eating behaviors and a negative attitude toward food, body satisfaction, borderline symptoms, and hopelessness in all types of eating disorders, regardless of the specific diagnosis. Moreover, the association with meaning in life was different depending on the type of eating disorders. Specifically in the participants with Anorexia Nervosa Restrictive, meaning in life had a higher percentage of explained variance in the eating disorders psychopathology (between 30% and 65%). Therefore, these results seem to indicate that, although meaning in life is an important variable in all the eating disorders subtypes, it is especially relevant in participants with the Anorexia Nervosa Restrictive subtype.
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Affiliation(s)
- José H Marco
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Valencia, Valencia, España
| | - Montserrat Cañabate
- Escuela de doctorado, San Vicente Mártir, España, Facultad de Psicología, Magisterio y Ciencias de la Educación, Universidad Católica de Valencia, Universidad Católica de Valencia "San Vicente Mártir", Valencia, España
| | - Sandra Pérez
- Universidad Católica de Valencia "San Vicente Mártir", España. Facultad de Psicología, Magisterio y Ciencias de la Educación, Universidad Católica de Valencia "San Vicente Mártir", Valencia, España
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Miller AE, Racine SE, Klonsky ED. Symptoms of anorexia nervosa and bulimia nervosa have differential relationships to borderline personality disorder symptoms. Eat Disord 2019; 29:1-14. [PMID: 31305226 DOI: 10.1080/10640266.2019.1642034] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Eating disorders (EDs) and borderline personality disorder (BPD) are highly comorbid. BPD is characterized by the presence of at least five of nine symptoms. Given the number/variety of emotional and interpersonal symptoms that comprise BPD, some BPD traits may relate to EDs, whereas others may not be associated. This study examined relationships between BPD symptoms and symptoms of bulimia nervosa (BN) and anorexia nervosa (AN), including whether the nine BPD symptoms differentially relate to BN versus AN. Participants were 208 adolescent psychiatric inpatients. BPD symptoms, measured via structured interview, correlated more strongly with self-reported BN than AN symptoms. BN and AN symptoms were greater among individuals who endorsed unstable relationships, affective instability, emptiness, identity disturbance, inappropriate anger, dissociation/paranoia, and suicidal behavior. BN, but not AN symptoms, were higher when impulsivity was endorsed. Avoiding abandonment was neither related to BN nor AN. Affective instability, impulsivity, and anger had substantially larger associations with BN compared to AN, while identity disturbance was more strongly related to AN than BN. Findings provide useful information for targeting specific BPD symptoms to help prevent and reduce co-occurring EDs and BPD and the negative consequences associated with this comorbidity.
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Affiliation(s)
- Alexia E Miller
- a Department of Psychology , McGill University , Montreal , QC , Canada
- b Department of Psychology , University of British Columbia , Vancouver , Canada
| | - Sarah E Racine
- a Department of Psychology , McGill University , Montreal , QC , Canada
| | - E David Klonsky
- b Department of Psychology , University of British Columbia , Vancouver , Canada
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Barney JL, Murray HB, Manasse SM, Dochat C, Juarascio AS. Mechanisms and moderators in mindfulness- and acceptance-based treatments for binge eating spectrum disorders: A systematic review. EUROPEAN EATING DISORDERS REVIEW 2019; 27:352-380. [PMID: 30887695 PMCID: PMC6570825 DOI: 10.1002/erv.2673] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 02/21/2019] [Accepted: 02/24/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Increasing evidence suggests that mindfulness- and acceptance-based psychotherapies (MABTs) for bulimia nervosa (BN) and binge eating disorder (BED) may be efficacious; however, little is known about their active treatment components or for whom they may be most effective. METHODS We systematically identified clinical trials testing MABTs for BN or BED through PsychINFO and Google Scholar. Publications were categorized according to analyses of mechanisms of action and moderators of treatment outcome. RESULTS Thirty-nine publications met inclusion criteria. Twenty-seven included analyses of therapeutic mechanisms, and five examined moderators of treatment outcome. Changes were largely consistent with hypothesized mechanisms of MABTs, but substandard mediation analyses, inconsistent measurement tools, and infrequent use of mid-treatment assessment points limited our ability to make strong inferences. DISCUSSION Analyses of mechanisms of action and moderators of outcome in MABTs for BN and BED appear promising, but the use of more sophisticated statistical analyses and adequate replication is necessary.
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Affiliation(s)
| | - Helen B Murray
- Department of Psychology, Drexel University, Philadelphia, Pennsylvania
| | | | - Cara Dochat
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California
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Blanchard BE, Stevens A, Cann AT, Littlefield AK. Regulate yourself: Emotion regulation and protective behavioral strategies in substance use behaviors. Addict Behav 2019; 92:95-101. [PMID: 30597337 DOI: 10.1016/j.addbeh.2018.12.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 12/14/2018] [Accepted: 12/16/2018] [Indexed: 10/27/2022]
Abstract
Although research suggests links between emotion regulation strategies and substance use outcomes, little work has examined the relationship between specific strategies (i.e., reappraisal and suppression) and outcomes (i.e., alcohol and cannabis consumption and related problems). To date, no research has examined the association between emotion regulation strategies and protective behavioral strategies used while engaging in substance use. Thus, the current study examined these relations for females and males. Undergraduates (N = 643) completed an online battery of self-report measures. Using structural equation modeling, results indicated improved Emotion Regulation Questionnaire model fit after one item was removed. Reappraisal was negatively associated with alcohol binge frequency and related problems for females, though suppression was negatively related to these outcomes for males. Reappraisal was also negatively associated with cannabis-related problems for males only. Reappraisal was positively associated with all types of protective behavioral strategies use for females, whereas only alcohol-specific serious harm reduction and cannabis protective behavioral strategies were significant for males. Latent variable interactions between reappraisal and protective behavioral strategies were significant for past-month cannabis use and related problems for males and indicated protective behavioral strategies use was more protective against past-month use and cannabis-related problems for those high in reappraisal. Although replication is necessary, these preliminary findings suggest the link between emotion regulation strategies and substance use outcomes among college students is complex and future work may benefit from examining these relations from an emotion regulation flexibility perspective.
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