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White ML, Triplett OM, Morales N, Van Dyk TR. Associations Among Sleep, Emotional Eating, and Body Dissatisfaction in Adolescents. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01692-4. [PMID: 38578582 DOI: 10.1007/s10578-024-01692-4] [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] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
The literature on adolescent sleep has shown a bidirectional relationship between sleep difficulties and altered eating habits, including emotional eating. However, it is unclear if this relationship is related to preexisting body concerns, or if poor sleep is the prime contributor to emotional eating patterns. This study therefore seeks to examine body dissatisfaction as a moderator of the sleep-emotional eating relationship in an at-risk sample. Adolescents (N = 106) presenting for overnight polysomnography self-reported on time-in-bed, insomnia, body dissatisfaction, and emotional eating. Less time-in-bed was correlated with a greater desire for thinness and greater insomnia severity was related to overall emotional eating and eating in response to anxiety, anger, and frustration and in response to depression. Moderation analyses revealed that the relationships between time-in-bed and eating in response to feeling unsettled (b = -.002, 95% CI[- .003, - .001], p < .005) and eating in response to anxiety, anger, and frustration (b = -.01, 95% CI[- .01, - .001], p < .05) were exacerbated by worse body dissatisfaction. Optimizing sleep may attenuate the risk for disordered eating, particularly for adolescents with high body dissatisfaction.
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Affiliation(s)
- Megan L White
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Suite 106, Loma Linda, CA, 92350, USA
| | - Olivia M Triplett
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Suite 106, Loma Linda, CA, 92350, USA
| | - Nuria Morales
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Suite 106, Loma Linda, CA, 92350, USA
| | - Tori R Van Dyk
- Department of Psychology, Loma Linda University, 11130 Anderson Street, Suite 106, Loma Linda, CA, 92350, USA.
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2
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Dol A, van Gemert-Pijnen L, Schwartz LM, Velthuijsen H, Bode C. Exploring tailored virtual emotion regulation approaches for individuals with emotional eating. J Eat Disord 2023; 11:134. [PMID: 37573369 PMCID: PMC10422816 DOI: 10.1186/s40337-023-00856-2] [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: 01/21/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Emotional eating is a complex problem fostering obesity and resulting from maladaptive emotion regulation. Traditional behavioural weight loss interventions have shown insignificant effect. They can be improved by targeting the specific needs of individuals with emotional eating. OBJECTIVE The current study explored a tailored online approach with the aim to positively influence affect (positive and negative) and emotion regulation by applying one of three exercises: body scan, opposite action, and positive reappraisal. DESIGN An embedded mixed-method design (questionnaire data (t0, t1, t2) and perceived usefulness of exercises in t2) was used to evaluate the effects of a two-week online quasi-experimental pilot study. SUBJECTS/SETTING In total, 80 participants with self-reported emotional eating difficulties (DEBQ-E; Memo = 3.48, SD = .64, range 1.62-4.92) finished baseline measurements; 15 completed the intervention. The study sample was predominantly female (95%), from 18 till 66 (Mage = 38,0 ± SD = 14.25). RESULTS Participants reported that the exercises helped them to pay attention to their physical sensations, and to see positive aspects in negative matters. The exercises were considered difficult by the participants, with too little explanation, and dull, due to minor variation. The observed changes revealed small, and moreover, not significant improvements of the three exercises on positive and negative affect and overall emotion dysregulation. Although the quantitative results did not reach significance, the qualitative data highlighted which aspects of the tailored exercises may have contributed to mood and emotion regulation outcomes. A notable observation in the present study is the substantial dropout rate, with the number of participants decreasing from 80 at baseline (T0) to 15 at the post-intervention stage (T2). CONCLUSIONS Future studies should identify tailored online exercises in emotion regulation skills in more detail and explore the contexts in which they are most effective in a personalized virtual coach virtual coach to be developed for individuals with emotional eating. Given the high dropout rate, more emphasis should be given to a proper presentation of the exercises, as well as more explanation of their usefulness and how to perform them.
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Affiliation(s)
- Aranka Dol
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
- Research Group New Business & ICT, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Lisette van Gemert-Pijnen
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
| | - Lysanne M. Schwartz
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
| | - Hugo Velthuijsen
- Research Group New Business & ICT, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Christina Bode
- Department of Psychology, Health and Technology, University of Twente, De Zul 10, 7522 NJ Enschede, The Netherlands
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3
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Fekih-Romdhane F, Kanj G, Obeid S, Hallit S. Psychometric properties of an Arabic translation of the brief version of the difficulty in emotion regulation scale (DERS-16). BMC Psychol 2023; 11:72. [PMID: 36922893 PMCID: PMC10015724 DOI: 10.1186/s40359-023-01117-2] [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: 10/04/2022] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND The current study aimed to examine the psychometric properties of an Arabic translation of the short form of the Difficulty in Emotion Regulation Scale (DERS-16) in an Arabic-speaking population-based adult sample in Lebanon. In particular, the factorial structure, composite reliability, convergent validity and gender invariance were investigated. METHODS A total of 411 Lebanese adult participants (mean age of 32.86 ± 11.98 years, 75.4% females) took part of this cross-sectional web-based study. The forward and backward translation method was applied. RESULTS Findings revealed good internal consistency of the Arabic DERS-16 total scale and five subscales (McDonald's ω ranging from 0.81 to 0.95). Confirmatory factor analyses confirmed the five-factor solution of the scale and demonstrated strong measurement invariance across gender at the configural, metric, and scalar levels. No significant differences were found in all DERS-16 domains between men and women participants. Finally, the DERS-16 scores and sub-scores showed strong correlations with the Borderline Personality Questionnaire (r > .40), thus indicating its convergent validity. CONCLUSION Overall, the present findings suggest that the Arabic version of the DERS-16 may be a reliable and valid self-report measure that assesses ER difficulties as a multidimensional construct. Making the Arabic version of the DERS-16 available will hopefully strengthen its utilization for clinical and research purposes to benefit the millions of Arabic-speaking people worldwide.
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Affiliation(s)
- Feten Fekih-Romdhane
- The Tunisian Center of Early Intervention in Psychosis, Department of Psychiatry "Ibn Omrane", Razi Hospital, Manouba, 2010, Tunisia.,Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Gaelle Kanj
- School of Arts and Sciences, Holy Spirit University of Kaslik, Jounieh, P.O. Box 446, Lebanon
| | - Sahar Obeid
- Social and Education Sciences Department, School of Arts and Sciences, Lebanese American University, Jbeil, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, P.O. Box 446, Lebanon. .,Psychology Department, College of Humanities, Efat University, Jeddah, 21478, Saudi Arabia. .,Applied Science Research Center, Applied Science Private University, Amman, Jordan. .,Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon.
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4
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Cassioli E, Rossi E, D'Anna G, Martelli M, Hazzard VM, Crosby RD, Wonderlich SA, Ricca V, Castellini G. A 1-year follow-up study of the longitudinal interplay between emotion dysregulation and childhood trauma in the treatment of anorexia nervosa. Int J Eat Disord 2022; 55:98-107. [PMID: 34862809 PMCID: PMC8787461 DOI: 10.1002/eat.23647] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The study aimed to investigate the complex relationship between eating disorder (ED) specific psychopathology, emotion dysregulation, and their longitudinal variations in patients with anorexia nervosa (AN) treated with a multidisciplinary approach including enhanced cognitive-behavior therapy (CBT-E), and to provide an integrated model which includes childhood trauma as a predictor of worse treatment outcomes. METHOD In total, 120 female patients with AN were evaluated at admission (T0), and 105 were re-evaluated after 1 year (T1) of treatment. At T0, patients underwent a clinical assessment and filled the Symptom Checklist 90-Revised (SCL90-R), the Eating Disorders Examination Questionnaire (EDE-Q), the Difficulties in Emotion Regulation Scale (DERS), and the Childhood Trauma Questionnaire (CTQ). SCL-90-R, EDE-Q, and DERS were readministered at T1. Variations between T0 and T1 were evaluated, and the proposed model was investigated using bivariate latent change score analysis in a structural equation modeling (SEM) framework. RESULTS An overall significant clinical amelioration was observed after treatment. A unidirectional effect of DERS scores on EDE-Q variations was outlined by SEM: patients with higher baseline DERS scores achieved less EDE-Q improvements, and EDE-Q latent change score was significantly predicted by longitudinal variations of DERS-but not vice versa. Higher CTQ scores predicted reduced treatment efficacy for ED-specific psychopathology through the mediating effect of higher baseline DERS scores. DISCUSSION The present study sheds light on the mechanism by which early trauma compromises treatment outcome in patients with AN, underlining the crucial role of emotional dysregulation.
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Affiliation(s)
- Emanuele Cassioli
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
| | - Eleonora Rossi
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
| | - Giulio D'Anna
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
| | - Michela Martelli
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
| | | | - Ross D. Crosby
- Sanford Center for Biobehavioral ResearchFargoNorth DakotaUSA
| | | | - Valdo Ricca
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
| | - Giovanni Castellini
- Psychiatry Unit, Department of Health SciencesUniversity of FlorenceFlorence
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Castro TF, Miller K, Araújo MX, Brandão I, Torres S. Emotional processing in recovered anorexia nervosa patients: A 15 year longitudinal study. EUROPEAN EATING DISORDERS REVIEW 2021; 29:955-968. [PMID: 34472158 DOI: 10.1002/erv.2858] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/09/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This 15 years longitudinal study aimed to examine whether difficulties in cognitive processing of emotions persisted after long-term recovery from anorexia nervosa (AN), and its link to anxiety and depression. METHOD Twenty-four females, who were tested longitudinally during their acute and recovered AN phases, and 24 healthy control (HC) women, were screened for anxiety, depression, alexithymia, emotion regulation difficulties (ER; only assessed in recovery phase), and completed an experimental task to analyse emotional experience. RESULTS In spite of significant improvement in alexithymia, anxiety, and depression with AN recovery, some emotion functioning difficulties did not normalize. The occurrence of comorbid anxiety and depression explained the reduced ability to identify, understand, and accept emotions in long-term recovery (relative to controls), but not the increased global difficulty in using ER strategies, which revealed a more stable nature of deficit. With recovery, negative emotions linked to situations addressing food and body weight are felt more intensely. CONCLUSIONS Managing emotions, especially the negative ones, remains a challenge for individuals recovered from AN. Under this circumstance, maladaptive eating behaviour can serve as an affect regulatory function, increasing the risk of relapse. Emotional education is an important avenue in protecting long-term AN relapse.
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Affiliation(s)
- Telma Fontão Castro
- Department of Psychology and Education Sciences, University of Porto, Porto, Portugal
| | - Kylee Miller
- Department of Pediatrics, Child Development and Rehabilitation Center, Oregon Health & Science University, Portland, Oregon, USA
| | - Maria Xavier Araújo
- Department of Psychology and Education, University Portucalense, Porto, Portugal.,Department of Psychology, Centro Hospitalar S. João, Porto, Portugal
| | - Isabel Brandão
- Department of Psychiatry, Centro Hospitalar S. João, Porto, Portugal
| | - Sandra Torres
- Department of Psychology and Education Sciences, University of Porto, Porto, Portugal.,Center for Psychology, University of Porto, Porto, Portugal
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6
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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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7
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Lawlor C, Vitoratou S, Hepworth C, Jolley S. Self-reported emotion regulation difficulties in psychosis: Psychometric properties of the Difficulties in Emotion Regulation Scale (DERS-16). J Clin Psychol 2021; 77:2323-2340. [PMID: 33971018 DOI: 10.1002/jclp.23164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 01/25/2021] [Accepted: 04/12/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Individuals with psychosis self-report difficulties in understanding, relating, and responding to emotions as treatment priorities, yet we lack comprehensive, reliable, and valid assessments for routine clinical use. METHODS The psychometric properties of a brief version of the Difficulties in Emotion Regulation Scale-16 (DERS-16) were examined using anonymized data from a sample of 150 outpatients with psychosis. RESULTS Confirmatory factor analysis supported the five-factor structure of the DERS-16. The model fit was further improved by omitting two items. Measurement invariance was shown with respect to age and gender. The DERS-16 demonstrated good internal consistency, well comparable to the original DERS. Evidence toward convergent validity is also presented. CONCLUSION Findings suggest that the DERS-16 is a reliable and valid measure of self-reported emotion regulation difficulties in individuals with psychosis. Further research on the clinical utility of the DERS-16 is needed, including examination of its test-retest reliability and predictive validity in response to targeted interventions.
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Affiliation(s)
- Caroline Lawlor
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,North Lambeth Promoting Recovery Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Silia Vitoratou
- Psychometrics and Measurement Lab, Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Claire Hepworth
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Suzanne Jolley
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,North Lambeth Promoting Recovery Team, South London and Maudsley NHS Foundation Trust, London, UK
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8
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Brown TA, Cusack A, Berner LA, Anderson L, Nakamura T, Gomez L, Trim J, Chen JY, Kaye WH. Emotion Regulation Difficulties During and After Partial Hospitalization Treatment Across Eating Disorders. Behav Ther 2020; 51:401-412. [PMID: 32402256 PMCID: PMC7225176 DOI: 10.1016/j.beth.2019.07.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/01/2019] [Accepted: 07/03/2019] [Indexed: 01/19/2023]
Abstract
Emotion regulation deficits are associated with eating disorder (ED) symptoms, regardless of eating disorder diagnosis. Thus, recent treatment approaches for EDs, such as dialectical behavior therapy (DBT), have focused on teaching patients skills to better regulate emotions. The present study examined changes in emotion regulation among adult patients with EDs during DBT-oriented partial hospital treatment, and at follow-up (M[SD] = 309.58[144.59] days from discharge). Exploratory analyses examined associations between changes in emotion regulation and ED symptoms. Patients with anorexia nervosa, restricting (AN-R, n = 77), and binge-eating/purging subtype (AN-BP, n = 46), or bulimia nervosa (BN, n = 118) completed the Difficulties in Emotion Regulation Scale (DERS) at admission, discharge, and follow-up. Patients with BN demonstrated significant improvements across all facets of emotion dysregulation from admission to discharge and maintained improvements at follow-up. Although patients with AN-BP demonstrated statistically significant improvements on overall emotion regulation, impulsivity, and acceptance, awareness, and clarity of emotions, from admission to discharge, these improvements were not significant at follow-up. Patients with AN-R demonstrated statistically significant improvements on overall emotion dysregulation from treatment admission to discharge. Changes in emotion regulation were moderately correlated with changes in ED symptoms over time. Results support different trajectories of emotion regulation symptom change in DBT-oriented partial hospital treatment across ED diagnoses, with patients with BN demonstrating the most consistent significant improvements.
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Affiliation(s)
- Tiffany A. Brown
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Anne Cusack
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Laura A. Berner
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Leslie Anderson
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Tiffany Nakamura
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Lauren Gomez
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Julie Trim
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
| | - Joanna Y. Chen
- Department of Psychology, Drexel University; 3201 Chestnut St, Philadelphia, PA 19104
| | - Walter H. Kaye
- Eating Disorder Center for Treatment and Research, UC San Diego Health; 4510 Executive Drive, Suite 315; San Diego, CA 92121
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9
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Reilly EE, Orloff NC, Luo T, Berner LA, Brown TA, Claudat K, Kaye WH, Anderson LK. Dialectical behavioral therapy for the treatment of adolescent eating disorders: a review of existing work and proposed future directions. Eat Disord 2020; 28:122-141. [PMID: 32301680 DOI: 10.1080/10640266.2020.1743098] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Over the past several decades, Dialectical Behavior Therapy (DBT) has been adapted for a range of presenting problems related to emotion dysregulation. Considerable enthusiasm exists regarding the use of DBT for treating eating disorders; however, to date, there have been no reviews summarizing empirical efforts to adapt DBT for eating disorders in youth. Accordingly, in the present narrative review, we provide a comprehensive summary of existing work testing DBT for adolescent eating disorders. First, we briefly review existing work applying DBT to eating disorders in adults and general adolescent samples. We then review research focused specifically on the use of DBT for adolescent eating disorders, including both those studies applying DBT as the primary treatment and investigations of DBT as an adjunctive treatment. Overall, initial results for DBT-based approaches are promising. However, rigorous empirical work testing DBT for treating adolescent eating disorders remains limited; the majority of existing research is comprised of case series and small-scale studies. Therefore, we close with specific recommendations for future research testing this approach.
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Affiliation(s)
- Erin E Reilly
- Department of Psychiatry, University of California, San Diego, CA, USA.,Department of Psychology, Hofstra University, Hempstead, NY, USA
| | - Natalia C Orloff
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Tana Luo
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Laura A Berner
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Tiffany A Brown
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Kimberly Claudat
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Walter H Kaye
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Leslie K Anderson
- Department of Psychiatry, University of California, San Diego, CA, USA
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10
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Ben-Porath D, Duthu F, Luo T, Gonidakis F, Compte EJ, Wisniewski L. Dialectical behavioral therapy: an update and review of the existing treatment models adapted for adults with eating disorders. Eat Disord 2020; 28:101-121. [PMID: 32129724 DOI: 10.1080/10640266.2020.1723371] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite the effectiveness of CBT in reducing shape/weight concerns and dietary restraint, research suggests that patients considered recovered may still exhibit emotional difficulties related to eating disorders (EDs). Dialectical behavior therapy (DBT) has been adapted for a variety of mental disorders characterized by emotion dysregulation and, more recently, for EDs specifically. The current review found that the majority of the research studies employed one of the following three adaptations of DBT for EDs: The Stanford Model, Radically Open-DBT (RO-DBT), or Multidiagnostic ED-DBT (MED-DBT). Therefore, this review sought to review and update the empirical research on each adaptation and (2) offer preliminary recommendations for when and which adaptation of DBT to use when treating adults with EDs. Findings from the empirical literature on DBT and EDs indicate that the Stanford Model has the most rigorous and numerous studies demonstrating efficacy and effectiveness in those diagnosed with binge eating disorder. Fewer studies have been conducted using the Stanford Model with bulimia nervosa; therefore, less strong assertions can be made about DBT with those diagnosed with bulimia. The MED-DBT model has been evaluated in several open trials within higher levels of care with promising results, but the lack of randomized clinically-controlled trials prevents a definitive statement about its efficacy. Finally, research on applying the RO-DBT model to anorexia-nervosa, restricting subtype is in its infancy, prohibiting solid conclusions or recommendations regarding its efficacy or effectiveness.
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Affiliation(s)
- Denise Ben-Porath
- Department of Psychology, John Carroll University, University Heights, Ohio, USA
| | - Florencia Duthu
- DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina
| | - Tana Luo
- Eating Disorders Center for Treatment and Research, University of California, San Diego, California, USA
| | - Fragiskos Gonidakis
- Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece
| | - Emilio J Compte
- DBT-Eating Disorders Team, Fundación Foro, Buenos Aires, Argentina.,School of Human and Behavioral Sciences, Favaloro University, Buenos Aires, Argentina.,Research Department, Comenzar De Nuevo Treatment Center, Monterrey, México
| | - Lucene Wisniewski
- Department of Psychological Sciences, Case Western Reserve University, Cleveland, Ohio, USA.,Center for Evidence Based Treatment Ohio, Shaker Heights, Ohio, USA
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11
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Lawlor C, Hepworth C, Smallwood J, Carter B, Jolley S. Self-reported emotion regulation difficulties in people with psychosis compared with non-clinical controls: A systematic literature review. Clin Psychol Psychother 2020; 27:107-135. [PMID: 31661593 DOI: 10.1002/cpp.2408] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 01/10/2023]
Abstract
Emotions play a key role in the development and experience of psychosis, yet there are important gaps in our understanding of how individuals with psychosis understand and respond to their emotions. This systematic review investigated self-reported emotion regulation difficulties in individuals with psychosis compared with non-clinical controls. An electronic database search was conducted in Medline, PsychINFO, and Embase and supplemented by searches of reference lists and citations. Seventeen studies were included. A narrative synthesis was conducted because contextual diversity was present across the studies and outcomes. Individuals with psychosis reported greater difficulties in (i) emotional clarity (specifically with identifying, describing, and understanding their emotions), (ii) emotional acceptance, (iii) engaging in goal-directed behaviours when experiencing negative emotions, and (iv) willingness to experience emotional distress in the pursuit of meaningful activities in life. Evidence pertaining to other self-reported emotion regulation difficulties was less clear. Effect sizes were generally large in magnitude but there were few studies on some self-reported emotion regulation difficulties, and all studies were at moderate to high risk of bias. Further research is needed to clarify the nature of emotion regulation difficulties in individuals with psychosis to inform the provision of targeted clinical interventions.
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Affiliation(s)
- Caroline Lawlor
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Claire Hepworth
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jane Smallwood
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Suzanne Jolley
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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12
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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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13
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Early Versus Later Improvements in Dialectical Behavior Therapy Skills Use and Treatment Outcome in Eating Disorders. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10006-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Navarro-Haro MV, Botella C, Guillen V, Moliner R, Marco H, Jorquera M, Baños R, Garcia-Palacios A. Dialectical Behavior Therapy in the Treatment of Borderline Personality Disorder and Eating Disorders Comorbidity: A Pilot Study in a Naturalistic Setting. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9906-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Hunnicutt Hollenbaugh KM, Lenz AS. Preliminary Evidence for the Effectiveness of Dialectical Behavior Therapy for Adolescents. JOURNAL OF COUNSELING AND DEVELOPMENT 2018. [DOI: 10.1002/jcad.12186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - A. Stephen Lenz
- Department of Counseling and Educational Psychology; Texas A&M University-Corpus Christi
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16
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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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17
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Mac Neil BA, Leung P, Nadkarni P, Stubbs L, Singh M. A pilot evaluation of group-based programming offered at a Canadian outpatient adult eating disorders clinic. EVALUATION AND PROGRAM PLANNING 2016; 58:35-41. [PMID: 27288960 DOI: 10.1016/j.evalprogplan.2016.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 04/29/2016] [Accepted: 05/08/2016] [Indexed: 06/06/2023]
Abstract
Eating disorder clinics across Canada place heavy reliance on group-based programming. However, little work has examined whether this modality of treatment is well-received by patients and results in clinical improvements. The purpose of this pilot study was to evaluate patient satisfaction and outcomes for group-based programming offered through an adult eating disorders clinic. Participants were 81 adults who met DSM-5 criteria for an eating disorder and participated in the study as part of the clinic's program evaluation. Participants received medical monitoring, psychiatric follow-up, adjunct nutrition and pre-psychological treatment, and participated in the clinic's core cognitive behavioural therapy (CBT) group. Demographic information and weight were collected at intake. Participants also completed pre- and post-group programming measures of life satisfaction, depressive and anxiety symptoms, psychological symptoms of the eating disorder, and satisfaction with the programming. Participants' experienced a significant increase in satisfaction with life, and decreases in depressive symptoms and psychological symptoms of the eating disorder post-group. Adults endorsed feeling fairly satisfied with the group-based services provided. Results draw attention to the importance of program evaluation as an integral component of an adult outpatient eating disorder clinic by providing a voice for patients' views of the services received and program outcomes.
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Affiliation(s)
- Brad A Mac Neil
- Adult Eating Disorders Program (AEDP) of Hotel Dieu Hospital, Adjunct Assistant Professor and Clinical Supervisor, Departments of Psychiatry, and Psychology, Queens University, Kingston, Ontario, Canada.
| | - Pauline Leung
- AEDP of Hotel Dieu Hospital, Clinical Psychology Graduate Program, Queens University
| | - Pallavi Nadkarni
- AEDP of Hotel Dieu Hospital, Assistant Professor, Department of Psychiatry, Queens University, Kingston, Ontario, Canada
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18
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Sala M, Heard A, Black EA. Emotion-focused treatments for anorexia nervosa: a systematic review of the literature. Eat Weight Disord 2016; 21:147-64. [PMID: 26886827 DOI: 10.1007/s40519-016-0257-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/29/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The present review explores emotion-focused treatments for anorexia nervosa (AN). METHODS We conducted a systematic literature search across key databases (PsychINFO, PubMed/Medline, and Web of Science) prior to September 2015. Twenty studies were selected for systematic review. RESULTS The present review found initial evidence supporting the acceptability and feasibility of emotion-focused treatments for AN. Although preliminary results are promising, further controlled studies are necessary to establish the efficacy of emotion-focused treatments for AN. CONCLUSIONS Future controlled trials should compare emotion-focused treatments against each other and against other AN treatments. Future studies should also examine the mechanisms of action for the emotion-focused treatments and treatment moderators.
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Affiliation(s)
- Margarita Sala
- Department of Psychology, Southern Methodist University, Dallas, TX, 75275, USA.
| | - Amy Heard
- Department of Psychology, Loyola University Chicago, Chicago, USA
| | - Elizabeth A Black
- Department of Psychology, Southern Methodist University, Dallas, TX, 75275, USA
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19
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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: 37] [Impact Index Per Article: 4.6] [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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20
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Bjureberg J, Ljótsson B, Tull MT, Hedman E, Sahlin H, Lundh LG, Bjärehed J, DiLillo D, Messman-Moore T, Gumpert CH, Gratz KL. Development and Validation of a Brief Version of the Difficulties in Emotion Regulation Scale: The DERS-16. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015; 38:284-296. [PMID: 27239096 DOI: 10.1007/s10862-015-9514-x] [Citation(s) in RCA: 342] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Difficulties in Emotion Regulation Scale (DERS) is a widely-used, theoretically-driven, and psychometrically-sound self-report measure of emotion regulation difficulties. However, at 36-items, the DERS may be challenging to administer in some situations or settings (e.g., in the course of patient care or large-scale epidemiological studies). Consequently, there is a need a briefer version of the DERS. The goal of the present studies was to develop and evaluate a 16-item version of the DERS - the DERS-16. The reliability and validity of the DERS-16 were examined in a clinical sample (N = 96) and two large community samples (Ns = 102 and 482). The validity of the DERS-16 was evaluated comparing the relative strength of the association of the two versions of the DERS with measures of emotion regulation and related constructs, psychopathology, and clinically-relevant behaviors theorized to stem from emotion regulation deficits. Results demonstrate that the DERS-16 has retained excellent internal consistency, good test-retest reliability, and good convergent and discriminant validity. Further, the DERS-16 showed minimal differences in its convergent and discriminant validity with relevant measures when compared to the original DERS. In conclusion, the DERS-16 offers a valid and brief method for the assessment of overall emotion regulation difficulties.
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Affiliation(s)
- Johan Bjureberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Matthew T Tull
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
| | - Erik Hedman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Sahlin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | | | | | - David DiLillo
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, NE, USA
| | | | | | - Kim L Gratz
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
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Murray SB, Anderson LK, Cusack A, Nakamura T, Rockwell R, Griffiths S, Kaye WH. Integrating Family-Based Treatment and Dialectical Behavior Therapy for Adolescent Bulimia Nervosa: Preliminary Outcomes of an Open Pilot Trial. Eat Disord 2015; 23:336-44. [PMID: 26009971 DOI: 10.1080/10640266.2015.1044345] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Adolescent bulimia nervosa (BN) remains relatively understudied, and the complex interaction between core eating psychopathology and emotional regulation difficulties provides ongoing challenges for full symptom remission. In an open pilot trial, we aimed to investigate the efficacy of a program integrating family-based treatment (FBT) and dialectical behavior therapy (DBT) in treating adolescent BN, without exclusion criteria. Participants were 35 adolescents who underwent partial hospital treatment for BN, and outcomes included measures of core BN pathology and emotional regulation difficulties, as well as parental measures of self-efficacy, completed at intake and discharge. Results indicate significant improvements in overall eating disorder pathology, t(68) = 4.52, p = .002, and in core BN symptoms, including objective binge episodes, t(68) = 2.01, p = .041, and self-induced vomiting, t(68) = 2.90, p = .005. Results also illustrated a significant increase in parental efficacy throughout the course of treatment, t(20) = .081, p = .001, although no global improvement in difficulties in emotion regulation was noted, t(68) = 1.12, p = .285. These preliminary findings support the utility of this integration of FBT and DBT, although raise interesting questions as to the mechanism of symptom remission.
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Affiliation(s)
- Stuart B Murray
- a Department of Psychiatry , University of California, San Diego , San Diego , California , USA
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