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186 views22 pagesDBT An Update and Review of The Existing Treatment Models For Adults With Eating Disorders
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/ 22
4) Routled
ies : a
BIveNtea Eating Disorders
The Journal of Treatment & Prevention
ISSN: 1064-0266 (Print) 1532-530X (Online) Journal homepage: https:/Awww.tanéfontine.com/lai/uedi20
Dialectical behavioral therapy: an update and
review of the existing treatment models adapted
for adults with eating disorders
Denise Ben-Porath, Florencia Duthu, Tana Luo, Fragiskos Gonidakis, Emilio J.
Compte & Lucene Wisniewski
To cite this article: Denise Ben-Porath, Florencia Duthu, Tana Luo, Fragiskos Gonidakis, Emilio J
Compte & Lucene Wisniewski (2020): Dialectical behavioral therapy: an update and review of the
existing treatment models adapted for adults with eating disorders, Eating Disorders
To link to this article: https://doi.org/10.1080/10640266.2020.1723371
PB) rubles one: 04 Mar 2020
CF submityour article to this journal CZ
EG View retated aricies
® view crossmark data
Full Terms & Conditions of access and use can be found at,
htps://www:tandfonline.com/action/journalinformation?journalCode=uedi20 EATING SoRDERS
tsderg0 osa/0640266 2020172357
Routledge
Taylor Franc Group
[@ created
Dialectical behavioral therapy: an update and review of
the existing treatment models adapted for adults with
eating disorders
Denise Ben-Porath’, Florencia Duthu®, Tana Luo‘, Fragiskos Gonidakis ©*,
Emilio J. Compte ©°*, and Lucene Wisniewski"
“Department of Psychology, John Caroll University, University Heights, Ohio, USA; SDBT-Eating
Disorders Team, Fundacion Foro, Buenos ites, Argentina; ‘Eating Disorders Center for Treatment and
Research, University of Califomia, San Diego, Californ'a, USA,
partment of Psychiatry, National and
Kapodstrian University of Athens, Athens, Greece; “School of Human and Behavioral Sciences, Favalora
University, uenos Aires, Argentina; Research Department, Comenzar De Nuevo Treatment Center,
Monterrey, México; Department of Psychological Sciences, Case Western Reserve University,
Cleveland, Ohio, USA; "Center for Evidence Based Treatment Ohio, Shaker Heights, Ohio, USA
AssTRACT
Despite the electveness of CET in eucing shapetweight concems and
ltary restraint, esearch suagests that patients considered recovered
‘may sill exhibit emotional cifculies related to eating disorders (EDs
Dalectical behavior therapy (DBT) has been adapted for a variety of
‘mental disorders characterized by emotion dysregulation and, more
recently, for EDs specially, The current review found thatthe majnty
ofthe research studies employed one of thefllowing three adaptations
(of DBT for EDs: The Stanford Model, Radically Oper-DBT (RO-DBT), ot
‘Mulidiagnostic ED-DBT (MED-DET), Therefore, this review sought to
review and update the empirical research on each adaptation and (2)
(fer 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
Figorous and numerous studes demonstrating efficacy and effectiveness
in those diagnosed with binge eating isorder. Fever studies have been
Conducted using the Stanford Model with bulimia nervosa; therefore,
less strong asserions can be made about DBT with those diagnosed
With bulimia, The MED-DBT model has been evaluated in several open
‘vials within higher levels of care with promising results, but the ack of
randomized cinialh-controled ‘rls prevents a definitive statement
about is efficacy. Final, research on applying the RO-DBT model to
anorexianervosa, resting subtype & ints infancy, pxohibiting solid
Conclusions or recommendations regarding its efcacy or effectiveness.
Clinical implications
+ Evidence for adaptations for Eating Disorders in adults is presented.
+ Findings across research designs and treatment settings are discussed.
« Eating Disorder-Dialectical Behavior ‘Therapy adaptations guidelines
suggested,
‘CONTACT Denise Ben-Porath @) dbenporatnajcueda John Carol University, 1 Carol lug, Uniersy
Heights, OH 48118, USA
1 200 alr & Francs 2 © b-weN-PoRATH ETAL
Dialectical behavior therapy (DBT), was originally developed to treat highly
suicidal, self injurious individuals diagnosed with borderline personality disorder
(BPD) (Linehan, Armstrong, Suarez, Allmon, & Heard, 1991). Because of the
success of DBT in addressing deficits in emotion regulation in those with BPD, it
has been applied to comorbidly diagnosed individuals with ED and BPD with
promising results (Ben-Porath, Wisniewski, & Warren, 2009; Chen, Matthews,
Allen, Kuo, & Linchan, 2008; Krger et al., 2010; Palmer et al., 2003). In fact,
some theorists have argued that ED symptoms represent a maladaptive method
to regulate negative aflect (Heatherton & Baumeister, 1991; Safer, Telch, & Agras,
2001; Safer, Telch, & Chen, 2009; Telch, Agras, & Linehan, 2000, 2001), and
several studies have demonstrated that negative mood states are reduced in
‘women after a binge eating episode (Polivy & Herman, 1993).
Thus, some have suggested that eating disorder (ED) patients present with
issues related to emotional undercontrol, such as those diagnosed with binge
eating disorder (BED) and bulimia nervosa (BN) who use bingeing and/or
urging to regulate emotions (Telch et al,, 2000), while other researchers have
posited that some ED patients present with emotional overcontrol, such as those
diagnosed with anorexia nervosa (AN), who may restrict food to regulate affect,
(Hempel, Vanderbleek, & Lynch, 2018). While symptom presentation may vary
amongst ED subtypes, difficulties in affect regulation appear to be a core problem.
for all who struggle with EDs, and, as such, there has been a growing interest in
applying DBT to individuals diagnosed with EDs.
Bankoff, Karpel, Forbes, and Pantalone (2012) conducted the first systematic
review of the empirical literature on DBT for EDs. Their review consisted of 13
peer- reviewed articles published between the years of 2000 to 2011. Collectively.
the reviewed studies indicated that DBT is effective in reducing ED behaviors.
‘While fewer studies in the review examined abstinence rates (defined as refraining
from binging or purging for one month), those that did found encouraging
findings, with rates ranging from 29% to 89% at post treatment, Data examining
individuals diagnosed with comorbid BPD and ED found similar results, with the
studies demonstrating a reduction in ED symptoms and remission rates ranging
from 33% to 50%. Findings were equivocal with respect to improvement in mood.
symptoms and social functioning, suggesting that the role of affect regulation in
maintaining ED symptoms is less well understood. In a meta-analysis of rando-
mized controlled trials of third-wave behavioral therapies, including DBT,
Linardon, Fairburn, Fitzsimmons-Craft, Wilfley, and Brennan (2017) concluded
that DBT was “possibly efficacious” for the treatment of BN and BED. With slightly
broader inclusion criteria, Lenz, Taylor, Fleming, and Serman (2014) evaluated
nine studies utilizing between and within-subjects designs. Both between subjects
design studies (n= 4) and within-subjects design studies (n ~ 4) indicated a large
effec size with respect to eating disorder symptoms and a medium effect size with
respect to depression symptoms. Likely a result of the small sample size (n= 8), the xtIne owsonDers Qa
one remaining study (Chen et al, 2008) of the nine yielded a small effect size on
eating disorder symptoms
In sum, the research for DBT in those with EDs is still in its nascent stages
as no study has yet to conduct a randomized trial comparing DBT to an
established treatment for EDs such as cognitive behavioral therapy (CBT) or
interpersonal therapy (IPT). Despite this, the data reviewed do seem to
indicate that DBT is superior to no treatment, is likely efficacious in treating
some ED diagnoses, and may improve psychosocial functioning and mood
symptoms in some patients.
Interpretation of these findings and the application of DBT to EDs is
complex, in part because the majority of the studies published have utilized
adaptations of DBT for EDs. For example, in the Bankoff et al. (2012) review,
12 of the 13 studies reviewed employed an adaptation of DBT for EDs, which
included either the Stanford Model for outpatient BED and BN (DBT-
BED:DBT-BN) or DBT adapted for EDs treated in higher levels of care called
the Multidiagnostic Complex Eating Disorders for DBT Model (MED-DBT;
Federici, Wisniewski, & Ben-Porath, 2012). Since the Bankoff et al. (2012)
review, an additional model, Radically Open-DBT (RO-DBI), has been
developed for those diagnosed with anorexia nervosa, restricting subtype
(AN-R; Lynch et al., 2013).
‘Thus, a primary aim of the current review is to provide an update to the Bankoff
et al. (2012) review of the literature on DBT and EDs. In an effort to do this, we
searched the electronic database, Psyelnfo, using the same terms (eg, DBT or
dialectical behavior therapy and eating disorder anorexia, bulimia, or binge eating)
that were used in the Bankoff et al. (2012) review. This resulted in 232 articles. We
further narrowed the search by limiting articles from August 2011 (where the
Bankoff et al. review ended) until the present (December 2019), This search
resulted in 138 articles. From these abstracts like Bankoff et a. (2012), we selected
for inclusion, English-language, peer-reviewed, journals with empirical data for
which the target population was adults diagnosed with EDs. This left 19 remaining
studies. From these, 6 studies were excluded due to the lack of treatment outcome
data (n= 3), confounding treatment interventions intermingled with DBT (n= 2),
or limited information about the treatment (n = 1). This left 13 studies. By
searching the reference section from selected articles, four additional studies
were found (Brown et al, 2018, 20192; 2019b; Carter, Kennedy, Singleton, Van
‘Wijk, & Heath, 2019) bringing the count up to 17. Similar to Bankoff et al. (2012),
with the exception of two studies (Courbasson, Nishikawa, & Dixon, 2012;
‘Navarro-Haro et al., 2018), all of the remaining 15 articles reviewed used one of
the following adaptations of DBT for EDs; (1) The Stanford Model, (2) RO-DBT,
or (3) DBT-MED.
While these adaptations of DBT to EDs may be necessary to effectively
treat ED symptoms, scientist-practitioners may not know which model to
use, under which circumstances, and for which patients. Therefore, the goal 4 © d.wewroRATH ET AL
of this review is to provide a brief overview of each of these three adaptations
and then summarize the empirical research on each since the Bankoff et al
(2012) review (see Table 1). Given that the studies prior to August 2011 have
already been described in greater depth, they will not be reviewed in detail
(Interested readers are referred to Bankoff et al, 2012 for a more thorough
review of these previous studies.) A final aim of this review is to offer
preliminary recommendations based upon the current literature for when
and which adaptation of DBT to use when treating adults with EDs.
The stanford model: DBT-BED and DBT-BN
The first and most widely researched DBT adaptation for EDs is what has been
referred to as the Stanford Model for BED and BN or DBT-BED/DBT-BN.
‘Although CBT has been the treatment of choice for decades with respect to BN
and BED, as many as half the patients treated with CBT do not respond (Haye,
Bacaltchuk, & Stefano, 2009). Several studies indicate that individuals diagnosed
with BED and BN often report engaging in ED behaviors when emotionally
dysregulated (Arnow, Kenardy, & Agras, 1992). Thus, this adaptation, which
proposes that bingeing and/or purging occur as a way to regulate painful affect,
‘was developed to address emotion regulation deficits found in those with BN
and BED (Linehan & Chen, 2005; Waller, 2003; Wiser & Telch, 1999;
Wisniewski & Kelly, 2003).
Review of the empirical literature on DBT- BED and DBT-BN
Several uncontrolled clinical trials (Chen et al., 2008; Safer, Lively, Telch, &
Agras, 2002; Safer, Telch, Agras, 2001) and randomized clinical tials (RCT;
Safer, Robinson, & Jo, 2010; Safer et al, 2001; Telch et al., 2001) have been
conducted using DBT-BED/BN for adults with EDs. These studies have yielded
promising results, including abstinence from binge eating at rates ranging from
64% to 89% (Safer et al, 2010; Telch et al,, 2001), improvements in weight,
shape, and eating concerns (Telch et al., 2001), and quicker response rates in
those assigned to DBT-BED as compared to active comparison group treatment
(ACG; Safer et al., 2010).
Since the Bankoff et al. (2012) review, five RCTs (Carter, Kennedy, Singleton,
Van Wijk, & Heath, 2019; Chen et al, 2017; Masson, von Ranson, Wallace, &
Safer, 2013; Rahmani, Omidi, Asemi, & Akbari, 2018; Robinson & Safer, 2012),
and three uncontrolled clinical trials (Erb, Farmer, & Meblenbeck, 2013; Klein,
Skinner, & Hawley, 2012; Mushquash & McMahan, 2015) using DBT with BED
or BN have been conducted. Of these nine studies, eight employed the Stanford
‘Model for DBT-BED/BN.
Like studies reviewed in Bankoff et al. (2012), findings continue to demon-
strate that DBT is efficacious for those diagnosed with BED, Utilizing DBT-BED, extn owonDers Qs
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ask: “Do I have the skills to adequately address these problems or do I need more
training in order to provide this treatment effectively?” The recommendations
below are meant to act as a guideline, as well as a catalyst for clinicians to
determine areas of competence and areas where more research and/or training
is needed.
If the patient has an uncomplicated BED, and has already received
a course of CBT for ED, it is recommended that the Stanford model be
offered. This recommendation is somewhat tempered for patients with BN,
as there are fewer research studies with this population. If an individual has
a complex/co-morbid ED of any diagnosis, has not been helped by a course
of EBT, demonstrates TIBs, or reports a high degree of emotional dysregula-
tion, a program where their ED will be treated and conceptualized within the
MED-DBT model is tentatively recommended. More research is needed on
this model as there have been no RCTs in this area to date. Finally, if the
patient has AN-R and has not been helped by other, more well-studied
approaches, RO-DBT should be considered. It is important to note that
since this model does not focus on eating and weight gain, this treatment,
if attempted even experimentally, should be offered in the context of medical
management. With any of these recommendations, the clinician is advised to
adhere to a scientist-practitioner approach: Begin with what is known
empirically to be effective, offer it to patients, evaluate progress, make
changes in the context of consultation from other professionals, and present
the outcomes. In doing so, the field continues to move forward and improved
treatments options become available to adults with EDs.
ORCID
Fragiskos Gonidakis © htp://orcid.org/0000-0001-8212-280X.
Emilio J. Compte @ http://orcid.org/0000-0002-6803-5950
References
Arnow, B. Kenardy, J, & Agras, W. S. (1992). Binge eating among the obese: A descriptive
study. Journal of Behavioral Medicine, 18, 155-170. doi:10.1007/BE00848323
Bankolf, 8. M, Karpel, M. G., Forbes, HL E, & Pantalone, D. W. (2012). A systematic review
of dialectical behavior therapy for the treatment of eating disorders. Bating Disorders; The
Journal of Treatment and Preventions, 20, 196-215. doi:10,1080/10640266,2012. 668478
Ben-Porath, D., Wisniewski, L, & Warren, M. (2009). Outcomes of a DBT day treatment
program for eating disorders: Clinical and statistical significance. Journal of Contemporary
Psychotherapy, 40, 115-123. doi10.1007/s10879-009-9125-5
Ben-Porath, D. D,, Federici, A., Wisniewski, L,, & Warren, M. (2014), Dialectical behavior
therapy: Does it bring about improvements in affect regulation in individuals with eating
disorders? Contemp Psychotherapy, 44, 245-251, doisl0.1007/810879-014-9271.2
Brown, T. A, Cusack, A, Anderson, L., Reilly, ‘A, Wierenga, C. E.
Kaye, W. H, (2019), Early versus later improvements in dialectical behavior therapy skills EATING DISOR
OQ»
use and Ueatment outcome in eating disorders. Cognitive Therapy and Research, 434),
739-768. do:10-1007/s10608-019-10006-1
Brown, T. A. Cusack, A Anderson, L. K, Trim, J, Nakamura, T, Trunko, M. E &
Kaye, W. IL (2018). Hifcacy of a partial hospital programme for adults with eating
