Abstract
Eating disorders (EDs), particularly anorexia nervosa (AN) and bulimia nervosa (BN), are characterized by emotional and behavioral disturbances in eating patterns and body image that result in significant distress and functional impairment (as reported by APA, (APA dictionary of psychology, American Psychological Association, Washington, DC, 2015)). Ben-Porath and colleagues (Journal of Contemporary Psychotherapy 40:115-123, 2010) have researched the effectiveness of dialectical behavioral therapy (DBT) day treatment program in reducing negative mood regulation and anxiety among women diagnosed with AN, BN, and eating disorder not otherwise specified (EDNOS). The current study extended past research on the effectiveness of DBT day treatment by analyzing the improvement in these patients’ scores on the beck anxiety inventory (BAI) and the generalized expectancy for negative mood regulation (NMR) Scale after treatment. We compared pre- and post-treatment scores using paired samples t-tests. We also examined rates of clinically significant change in these areas post-treatment. The results indicated that participants demonstrated a reduction in expectancies for negative mood dysregulation and anxiety after undergoing DBT day treatment for EDs. Limitations and implications of this study are discussed.
Similar content being viewed by others
References
American Psychological Association. (2015). APA dictionary of psychology (2nd ed.). Washington, D.C: American Psychological Association.
Bankoff, S. M., Karpel, M. G., Forbes, H. E., & Pantalone, D. W. (2012). A systematic review of dialectical behavior therapy for the treatment of eating disorders. Eating Disorders, 20, 196–215. https://doi.org/10.1080/10640266.2012.668478.
Bardhoshi, G., Duncan, K., & Erford, B. T. (2016). Psychometric meta-analysis of the english version of the beck anxiety inventory. Journal of Counseling and Development, 94, 356–373. https://doi.org/10.1002/jcad.12090.
Bell, C., Bulik, C., Clayton, P., Crow, S., Davis, D. M., DeMaso, D. R., et al. (2000). Practice guideline for the treatment of patients with eating disorders (revision). American psychiatric association work group on eating disorders. The American Journal of Psychiatry, 157, 1–39. PMID: 10642782.
Beck, A. T., & Steer, R. A. (1993). Beck anxiety inventory manual. San Antonio, TX: Psychological Corporation.
Ben-Porath, D. D., Wisniewski, L., & Warren, M. (2009). Differential treatment response for eating disordered patients with and without a comorbid borderline personality diagnosis using a dialectical behavior therapy (DBT)-informed approach. Eating Disorders, 17, 225–241. https://doi.org/10.1080/10640260902848576.
Ben-Porath, D. D., Wisniewski, L., & Warren, M. (2010). Outcomes of a day treatment program for eating disorders using clinical and statistical significance. Journal of Contemporary Psychotherapy, 40, 115–123. https://doi.org/10.1007/s10879-009-9125-5.
Brockmeyer, T., Skunde, M., Wu, M., Bresslein, E., Rudofsky, G., Herzog, W., et al. (2014). Difficulties in emotion regulation across the spectrum of eating disorders. Comprehensive Psychiatry, 55, 565–571. https://doi.org/10.1016/j.comppsych.2013.12.001.
Brown, T. A., Cusack, A., Anderson, L., Reilly, E. E., Berner, L. A., Wierenga, C. E., et al. (2019). Early versus later improvements in dialectical behavior therapy skills use and treatment outcome in eating disorders. Cognitive Therapy and Research, 43, 759–768. https://doi.org/10.1007/s10608-019-10006-1.
Catanzaro, S. J., & Mearns, J. (1990). Measuring generalized expectancies for negative mood regulation: Initial scale development and implications. Journal of Personality Assessment, 54, 546–563. https://doi.org/10.1080/00223891.1990.9674019.
Creamer, M., Foran, J., & Bell, R. (1995). The beck anxiety inventory in a non-clinical sample. Behaviour Research and Therapy, 33, 477–485. https://doi.org/10.1016/0005-7967(94)00082-U.
Davis, R., Freeman, R., & Solyom, L. (1985). Mood and food: An analysis of bulimic episodes. Journal of Psychiatric Research, 19, 331–335. https://doi.org/10.1016/0022-3956(85)90036-6.
Elmore, D. K., & de Castro, J. M. (1991). Meal patterns of normal, untreated bulimia nervosa and recovered bulimic women. Physiology and Behavior, 49, 99–105. https://doi.org/10.1016/0031-9384(91)90238-J.
Espeset, E. M. S., Gulliksen, K. S., Nordbø, R. H. S., Skårderud, F., & Holte, A. (2012). The link between negative emotions and eating disorder behaviour in patients with anorexia nervosa. European Eating Disorders Review, 20, 451–460. https://doi.org/10.1002/erv.2183.
Federici, A., Wisniewski, L., & Ben-Porath, D. (2012). Description of an intensive dialectical behavior therapy program for multidiagnostic clients with eating disorders. Journal of Counseling and Development, 90, 330–338. https://doi.org/10.1002/j.1556-6676.2012.00041.x.
Fittig, E., Jacobi, C., Backmund, H., Gerlinghoff, M., & Wittchen, H. (2008). Effectiveness of day hospital treatment for anorexia nervosa and bulimia nervosa. European Eating Disorders Review, 16, 341–351. https://doi.org/10.1002/erv.883.
Gilboa-Schechtman, E., Avnon, L., Zubery, E., & Jeczmein, P. (2006). Emotional processing in eating disorders: Specific impairment or general distress related deficiency? Depression and Anxiety, 23, 331–339. https://doi.org/10.1002/da.20163.
Haynos, A. F., Roberto, C. A., & Attia, E. (2015). Examining the associations between emotion regulation difficulties, anxiety, and eating disorder severity among inpatients with anorexia nervosa. Comprehensive Psychiatry, 60, 93–98. https://doi.org/10.1016/j.comppsych.2015.03.004.
Hill, D. M., Craighead, L. W., & Safer, D. L. (2011). Appetite-focused dialectical behavior therapy for the treatment of binge eating with purging: A preliminary trial. International Journal of Eating Disorders, 44, 249–261. https://doi.org/10.1002/eat.20812.
Hudson, J. I., Hiripi, E., Pope, H. G., Jr., & Kessler, R. C. (2013). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348–358. https://doi.org/10.1016/j.biopsych.2006.03.040.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 88, 21–24. https://doi.org/10.2106/JBJS.E.01273.
Leitenberg, H., Gross, J., Peterson, J., & Rosen, J. C. (1984). Analysis of an anxiety model and the process of change during exposure plus response prevention treatment of bulimia nervosa. Behavior Therapy, 15, 3–20. https://doi.org/10.1016/S0005-7894(84)80038-6.
Levinson, C. A., Zerwas, S., Calebs, B., Forbush, K., Kordy, H., Watson, H., et al. (2017). The core symptoms of bulimia nervosa, anxiety, and depression: A network analysis. Journal of Abnormal Psychology, 126, 340–354. https://doi.org/10.1037/abn0000254.
Levinson, C. A., Sala, M., Murray, S., Ma, J., Rodebaugh, T. L., & Lenze, E. J. (2019). Diagnostic, clinical, and personality correlates of food anxiety during a food exposure in patients diagnosed with an eating disorder. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 24, 1079–1088. https://doi.org/10.1007/s40519-019-00669-w.
Linehan, M. M. (1993). Cognitive behavioral treatment of borderline personality disorder. New York: Guilford Press.
Linehan, M. M., Tutek, D. A., Heard, H. L., & Armstrong, H. E. (1994). Interpersonal outcome of cognitive behavioral treatment for chronically suicidal borderline patients. The American Journal of Psychiatry, 151, 1771–1774. https://doi.org/10.1176/ajp.151.12.1771.
Mitchell, J. E., Agras, S., & Wonderlich, S. (2007). Treatment of bulimia nervosa: Where are we and where are we going? International Journal of eating Disorders, 40, 95–101. https://doi.org/10.1002/eat.
Nagl, M., Jacobi, C., Paul, M., Beesdo-Baum, K., Höfler, M., Lieb, R., et al. (2016). Prevalence, incidence, and natural course of anorexia and bulimia nervosa amongst adolescents and young adults. European Child and Adolescent Psychiatry, 25, 903–918. https://doi.org/10.1007/s00787-015-0808-z.
Spence, S., & Courbasson, C. (2012). The role of emotional dysregulation in concurrent eating disorders and substance use disorders. Eating Behaviors, 13, 382–385. https://doi.org/10.1016/j.eatbeh.2012.05.006.
Steinglass, J. E., Sysko, R., Mayer, L., Berner, L. A., Schebendach, J., Wang, Y., et al. (2010). Pre-meal anxiety and food intake in anorexia nervosa. Appetite, 55, 214–218. https://doi.org/10.1016/j.appet.2010.05.090.
Swinbourne, J., Hunt, C., Abbott, M., Russell, J., St Clare, T., & Touyz, S. (2012). The comorbidity between eating disorders and anxiety disorders: Prevalence in an eating disorder sample and anxiety disorder sample. Australian and New Zealand Journal of Psychiatry, 46, 118–131. https://doi.org/10.1177/0004867411432071.
Udo, T., & Grilo, C. M. (2018). Prevalence and correlates of DSM-5-defined eating disorders in a nationally representative sample of U.S. adults. Biological Psychiatry, 84, 345–354. https://doi.org/10.1016/j.biopsych.2018.03.014.
Westmoreland, P., Krantz, M. J., & Mehler, P. S. (2016). Medical complications from anorexia nervosa and bulimia. The American Journal of Medicine, 129, 30–37. https://doi.org/10.1016/j.amjmed.2015.06.031.
Wisniewski, L., & Ben-Porath, D. D. (2015). Dialectical behavior therapy and eating disorders: The use of contingency management procedures to manage dialectical dilemmas. American Journal of Psychotherapy, 69, 129–140. https://doi.org/10.1176/appi.psychotherapy.2015.69.2.129.
Zipfel, S., Reas, D. L., Thornton, C., Olmstead, M. P., Williamson, D. A., Gerlinghoff, M., et al. (2002). Day hospitalization programs for eating disorders: A systematic review of literature. International Journal of Eating Disorders, 31, 105–117. https://doi.org/10.1002/eat.10009.
Funding
The study was funded by the Colleran-Weaver fellowship.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors have no conflicts of interest to report.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
O’Mara, S., VanDine, L., Tarescavage, A.M. et al. Examining DBT Day Treatment in Treating Mood Dysregulation Expectancy and Anxiety in Women Diagnosed with Eating Disorders. J Contemp Psychother 51, 15–20 (2021). https://doi.org/10.1007/s10879-020-09475-3
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10879-020-09475-3