Problematic and adaptive eating in people with obesity after a DBT-based skills training intervention: 3- and 8-month follow-up and mediation analysis

Abstract

Background: Dialectical behavior therapy conceptualizes problematic behaviors as attempts to regulate emotions that occur when the individual lacks effective skills with which to manage his or her emotions and cope with distress. Problematic eating behaviors, e.g., binge and emotional eating, may serve to alleviate aversive emotional states, being highly associated with overweight and obesity. Dialectical behavior therapy skills training has been proven effective in reducing binge eating in several clinical studies. However, few studies reveal the effects of DBT on adaptive eating behaviors or the stability of outcomes. Objectives: This study aimed to test the effect of a brief DBT-based skills training intervention, and the stability of outcomes at 3-and 8-month follow-ups. Methods: Self-report measures of binge eating, emotional eating, intuitive eating, and mindful eating were taken on 5 timepoints before and after a 10-session DBT skills training intervention (2 baseline measures, 1 post-test, and 2 follow-ups). Data were analyzed using a mixed-model intention-to-treat approach and mediation analysis was conducted with path analysis. Results: After the intervention, intuitive eating and mindful eating scores were significantly higher than before the intervention, while emotional eating and binge eating scores were lower. The results remained stable during the follow-up period, with minor fluctuations and small trends towards returning to baseline values for binge eating and emotional eating. Mindful eating partially mediated the improvements in all outcomes. Limitations: Given that results are entirely based on self-report measures and that some instruments showed poor reliability, in addition to the high attrition rates, the results should be interpreted as preliminary. Conclusions: The results provide evidence that a brief DBT intervention is effective not only in reducing problematic eating but also in increasing adaptive eating, achieving reasonably stable results. Also, the mediation analysis results support the hypothesis that mindful eating partially explains the effects of the intervention on binge and emotional eating. Future research should address the limitations of this study by investigating a more diverse sample, triangulating different measurement strategies, and including other putative mediators.

The Association between Externalizing and Internalizing Problems with Bullying Engagement in Adolescents: The Mediating Role of Social Skills

“…This may lead adolescents to use social skills, and specifically assertiveness, in non-adaptative ways and increase the probability of being involved in conflicts with their peers, making them more prone to be victims of bullying. In line with this, the internalizing–externalizing problems’ comorbidity should also be considered, as adolescents who exhibit more socioemotional maladjustment are more likely to be less accurate while reading social interactions and, consequently, in using social skills [ 4 , 87 ]. Hence, they are potentially more vulnerable to be enrolled in conflicts with their peers, namely being victimized in bullying interactions.…”

The association between distress tolerance and eating expectancies among trauma-exposed college students with obesity

“…Some work has found that dialectical behavior therapy for binge eating (DBT-BE), which include distress tolerance components, is efficacious in reducing binge eating among individuals seeking weight-management services. 42 Moreover, extant work has found that brief dialectical behavior therapy (DBT)-based skills training interventions and group DBT interventions 43,44 reduced emotional eating and other markers of eating psychopathology among individuals with obesity. Finally, acceptance-based behavioral treatment (ABBT) for obesity, which incorporates components of both Acceptance and Commitment Therapy (ACT) 45 and DBT, 46 has shown some initial efficacy for weight loss among populations with obesity.…”

Psychological Emotion-Based Interventions for the Treatment Of Eating Behaviors in Obesity: State of the Art and Future Directions/Intervenciones psicológicas basadas en la emoción para el tratamiento de las conductas alimentarias en la obesidad: estado del arte y direcciones futuras

“…Because DBT focuses on emotional regulation it may work through the mitigation of eating behaviors used to regulate emotions by encouraging alternative emotion regulation skills that do not involve eating (Frayn, 2017;Bankoff et al, 2012). In this review DBT was the most used approach; seven studies that used it were founded (Beaulac et al, 2018;Burton et al, 2020;Cancian et al, 2019;Dastan et al, 2020;De Souza et al, 2019;Delparte et al, 2018;Lammers et al, 2020); all applied the skill training mode, four in its complete form, two of them applied the mindfulness, emotional regulation and distress tolerance modules and one applied only the emotional regulation module. We could only find one study that added the individual therapy mode (Beaulac, et al, 2018); and one that added the group therapy mode (Burton et al, 2020).…”