Examination of the Effectiveness of a Brief, Adapted Dialectical Behavior Therapy-Skills Training Group for Bariatric Surgical Candidates

Self-Harm Before and Six Months After Obesity Surgery

PURPOSE

Previous research on obesity surgery (OS) showed that patients do not only experience weight loss but also improvements in certain mental health outcomes (e.g., depression) after OS. However, self-harm behaviors might increase after OS. Regarding self-harm, the literature is mostly limited to studies using data from hospital or emergency room charts. This longitudinal study examined self-reported self-harm behaviors and potential psychopathological correlates before and after OS.

MATERIALS AND METHODS

Pre-surgery patients (N = 220) filled out a set of questionnaires before and approximately six months after OS. Self-harm behaviors were captured with the Self-Harm Inventory. The assessments further included standardized instruments to measure symptoms of depression, anxiety, eating disorders, alcohol use, and suicidal ideations.

RESULTS

Any self-harm was reported by 24.6% before and by 25.0% after OS. No differences in the number of self-harm behaviors or prevalence of any self-harm before and after OS were found. Overall, 11.4% experienced self-harm behaviors at both times. A subset showed self-harm behaviors only before (13.2%) OS and another subset only after OS (13.6%). These two groups were about the same size. Self-harm behaviors showed strong associations with psychopathology after OS, especially with depression and suicidal ideation.

CONCLUSION

No increase in self-harm behaviors after OS emerged. Still, a subgroup showed self-harm behaviors after OS closely linked to further psychopathology. This mirrors the need to implement screening for self-harm before and after OS into OS care. Further studies with longer follow up periods are needed to extend these findings.

The effectiveness and safety of dialectical behavior therapy for suicidal ideation and behavior in autistic adults: a pragmatic randomized controlled trial

BACKGROUNDS

Many autistic people in mental health are suicidal. This study evaluated the effectiveness of dialectical behavior therapy (DBT) v. treatment as usual (TAU) in reducing suicidal ideation and suicide attempts.

METHODS

At six Dutch mental health centers, 123 outpatients (18-65 years) with DSM-5 diagnosed autism spectrum disorder (ASD) and suicidal behavior were randomly assigned to the DBT intervention group (n = 63) or TAU control group (n = 60). Assessments were conducted at baseline, post-treatment at 6 months and 12-month follow-up. The primary outcomes were severity of suicidal ideation and frequency of suicide attempts. The severity of depression and social anxiety were secondary outcomes.

RESULTS

At end-of-treatment, DBT significantly reduced both suicidal ideation (z = -2.24; p = 0.025; b = -4.41; s.e. = 197.0) and suicide attempts (z = -3.15; p = 0.002; IRR = 0.046; s.e. = 0.045) compared to TAU, but lost statistical significance at the 12-month follow-up. Depression severity significantly decreased with DBT (z = -1.99; p = 0.046: b = -2.74; s.e. = 1.37) remaining so at 12 months (z = -2.46; p = 0.014; b = -3.37; s.e. = 1.37). No effects were observed on social anxiety. Severe adverse events included two suicides in the TAU condition.

CONCLUSIONS

DBT is an acceptable, safe, and short-term effective intervention to reduce suicidal ideation and suicide attempts in autistic adults with suicidal behavior.

Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study

Self-harm and suicidal behaviors are prevalent among autistic adults without intellectual disability (ID). Emotion dysregulation (ED), the difficulty in modulating emotions, has been identified as an important risk factor. Dialectical behavior therapy (DBT) has been proved effective to treat ED in disorders other than autism spectrum disorder. Our study aimed at assessing the feasibility, acceptability and preliminary efficacy of DBT in seven autistic adults without ID exhibiting self-harm and/or suicidal behaviors linked to severe ED. Our results suggest that DBT is feasible and highly acceptable to autistic adults without ID. Additionally, mean scores on the Difficulties in Emotion Regulation Scale decreased significantly post-treatment and at 4-month follow-up, suggesting that DBT might be efficacious in reducing ED in this population.

Dialectical Behavior Therapy for Emotional and Mindless Eating After Bariatric Surgery: a Prospective Exploratory Cohort Study

PURPOSE

To assess the effect of dialectical behavior therapy (DBT) on emotional and mindless eating and, consequently, body mass index (BMI) loss, in patients who have undergone bariatric surgery.

MATERIALS AND METHODS

A prospective exploratory cohort study was conducted with two groups of patients who had undergone bariatric surgery: the DBT group received DBT group skills training sessions, while the control group received no intervention. Outcome measurements included BMI and scores of the Emotional Eating Scale (EES) and Mindful Eating Questionnaire (MEQ).

RESULTS

The study included 36 women: 18 in each group. In the DBT group, the interval from surgery was 11.17 ± 7.12 months, and in the control group 10.89 ± 5.74. Laparoscopic sleeve gastrectomy was done in 88.9% and 83.3% of patients in the DBT and control groups respectively. The rest underwent Roux-en-Y gastric bypass. The DBT group showed significant changes in overall and subscale scores of the EES and MEQ and BMI in kg/m² after 6 months of follow-up. BMI in kg/m² changed from mean ± SD 35.45 ± 6.17 to 28.47 ± 4.28 in the DBT group, in control 35.88 ± 5.07 to 31.56 ± 3.71. The excess weight loss percentage (EWL%) in the DBT was mean ± SD 75.3 ± 17.9 and in the control was 63.6 ± 14.5. In the DBT group, the EES score and MEQ score changed from mean ± SD 45.06 ± 20.19 to 20.50 ± 13.40 and 11.52 ± 2.02 to 15.87 ± 1.92, respectively. The control group showed no significant change in scores.

CONCLUSIONS

DBT skills training can reduce emotional eating, increase mindful eating, and facilitate weight loss after bariatric surgery.

Characteristics of inpatients in dialectical behaviour therapy modified for a resource-limited setting

Background

Aim

Setting

Methods

Results

Conclusions

Two decades of mindfulness-based interventions for binge eating: A systematic review and meta-analysis

OBJECTIVE

Mindfulness-based interventions (MBIs) are being increasingly used as interventions for eating disorders including binge eating. This systematic review and meta-analysis aimed to assess two decades of research on the efficacy of MBIs in reducing binge eating severity.

METHODS

We searched PubMed, Scopus and Cochrane Library for trials assessing the use of MBIs to treat binge eating severity in both clinical and non-clinical samples. The systematic review and meta-analysis was pre-registered at PROSPERO (CRD42020182395).

RESULTS

Twenty studies involving 21 samples (11 RCT and 10 uncontrolled samples) met inclusion criteria. Random effects meta-analyses on the 11 RCT samples (n = 618: MBIs n = 335, controls n = 283) showed that MBIs significantly reduced binge eating severity (g = -0.39, 95% CI -0.68, -0.11) at end of trial, but was not maintained at follow-up (g = -0.06, 95% CI, -0.31, 0.20, k = 5). No evidence of publication bias was detected. On the Cochrane Risk of Bias Tool 2, trials were rarely rated at high risk of bias and drop-out rates did not differ between MBIs and control groups. MBIs also significantly reduced depression, and improved both emotion regulation and mindfulness ability.

CONCLUSION

MBIs reduce binge eating severity at the end of trials. Benefits were not maintained at follow-up; however, only five studies were assessed. Future well-powered trials should focus on assessing diversity better, including more men and people from ethnic minority backgrounds.

"If you're offered help, take it": A qualitative study examining bariatric patients' experience of telephone-based cognitive behavioural therapy

The increased recognition of patients' mental health needs after bariatric surgery has resulted in the emergence of accessible psychosocial interventions; however, there is a dearth of literature on patient experience and satisfaction with these interventions. We explored patients' perceptions and experiences of telephone-based cognitive behavioural therapy (Tele-CBT) in this qualitative study. Ten participants from the Toronto Western Hospital Bariatric Surgery Program in Toronto, Canada who completed the Tele-CBT (ClinicalTrials.gov Identifier: NCT02920112) were individually interviewed from November 2014 to June 2016 until thematic saturation occurred (ie, no more new coding groups emerged). Interviews were transcribed, independently coded, checked for discrepancies, and analysed using grounded theory. Four themes emerged: (1) participants were generally satisfied with Tele-CBT (eg, therapeutic alliance, resources provided, relevance of therapy to their own bariatric journey), (2) participants noticed emotional, cognitive, and behavioural changes following therapy, (3) the optimal time to deliver the Tele-CBT was when weight loss plateaued, generally at one-year post-surgery, and (4) participants found the telephone modality convenient. CBT was generally found to be helpful and the telephone format increased convenience and accessibility. Patients reported learning skills and receiving resources that could help them improve their well-being following bariatric surgery.

Emotion regulation mediates relationships between perceived childhood invalidation, emotional reactivity, and emotional eating

Dialectical Behavior Therapy (DBT) is informed by the biosocial model which suggests that emotional sensitivity and childhood invalidation interact to influence emotion dysregulation, leading to behavioral disorders. Although adapted DBT interventions have resulted in improved emotional eating, little research has been conducted to examine whether key aspects of the biosocial model apply to emotional eating. Adults ( N = 258) were enrolled via Amazon’s Mechanical Turk. Three separate mediation analyses were performed using Hayes’ SPSS macro. Results showed that emotion regulation difficulties mediated the relationships between biosocial variables (i.e. perceived maternal and paternal invalidation and emotional reactivity) and emotional eating.

Preoperative and post-operative psychosocial interventions for bariatric surgery patients: A systematic review

Psychosocial interventions are increasingly being utilized to help patients prepare for, and adjust to changes following, bariatric surgery in order to optimize psychosocial adjustment and weight loss. The current systematic review examined the impact of preoperative and post-operative psychosocial interventions with a behavioural and/or cognitive focus on weight, dietary behaviours, eating pathology, lifestyle behaviours, and psychological functioning. A PsycINFO and Medline search of publications was conducted in March 2019. Two authors assessed retrieved titles and abstracts to determine topic relevance and rated the quality of included studies using a validated checklist. Forty-four articles (representing 36 studies) met the study inclusion criteria. The current evidence is strongest for the impact of psychosocial interventions, particularly cognitive behavioural therapy, on eating behaviours (eg, binge eating and emotional eating) and psychological functioning (eg, quality of life, depression, and anxiety). The evidence for the impact of psychosocial interventions on weight loss, dietary behaviours (eg, dietary intake), and lifestyle behaviours (eg, physical activity) is relatively weak and mixed. Psychosocial interventions can improve eating pathology and psychosocial functioning among bariatric patients, and the optimal time to initiate treatment appears to be early in the post-operative period before significant problematic eating behaviours and weight regain occur.

Impact on mindfulness, emotion regulation, and emotional overeating of a DBT skills training group: a pilot study

PURPOSE

The current study investigated the impact of a modified Dialectical Behavior Therapy skills (DBT) training group for patients at a hospital outpatient weight management clinic. Emotional eating is a problematic strategy for managing unpleasant feelings that can have a deleterious impact on weight management. DBT addresses emotional dysregulation via incorporation of skills aimed at coping with unpleasant affect.

METHODS

This study examines outcomes for 18 patients who participated in a 12-week DBT skills building group. A pre-post design with 3-month follow-up investigated the impact of the group on emotional eating, psychological distress, emotion regulation, and mindfulness.

RESULTS

Four repeated measures ANOVAs were run to assess for changes related to life difficulties and functioning, emotional overeating, emotion regulation, and mindfulness. Fisher's LSD tests assessed for linear and quadratic trends. Improvements in mindfulness, emotion regulation, and emotional overeating were found; these were maintained at follow-up.

CONCLUSIONS

This study demonstrated the utility of a group-based intervention aimed at improving emotion regulation and mindfulness skills among weight management patients. Further study is needed to determine whether improvements in the constructs studied in this research would translate to improved weight management outcomes and in determining the pathway for improvements.

LEVEL OF EVIDENCE

Level IV, multiple time series with intervention.