Group dialectical behavioral therapy for binge‐eating disorder: Outcomes from a community case series

Abstract

Objective: Whilst there is evidence to support the use of group dialectical behavioral therapy (DBT) in the treatment of binge-eating disorder (BED), few studies have reported on its effectiveness when delivered in routine clinical practice. This study addressed this gap by exploring the effectiveness of group DBT for BED when delivered in a community eating disorder service. Method: Participants were 56 adults who presented with BED, and were offered a 20-week DBT group. Eight groups were conducted. Measures of eating disorder pathology, anxiety, depression and emotion regulation were completed at start and end of treatment, and one-month follow-up. Results: The attrition rate was 16.1%. Abstinence rates (no objective binges in the previous month) were approximately 60% at the end of treatment and 50% at follow-up. There were significant reductions in eating disorder psychopathology (but not in mood) by end of treatment and improvements were maintained at follow-up. Discussion: Group DBT is an acceptable and effective treatment for adults with BED when delivered in a routine community setting. Findings are broadly comparable with those from research trials. The lack of significant effect on mood suggests that DBT can be effective by teaching new emotion-regulation skills, rather than changing mood per se.

Effectiveness of a brief form of group dialectical behavior therapy for binge‐eating disorder: Case series in a routine clinical setting

“…While this is higher than rates reported in previous RCTs (e.g., Wilfley et al, 2002), it is notably lower than that reported by Klein, Skinner, and Hawley (2012) for DBT, and was lower than attrition rates typically reported in routine community settings for CBT (e.g., Byrne, Fursland, Allen, & Watson, 2011). The outcomes were broadly comparable with previous studies (Blood et al, 2020; Safer et al, 2010; Telch et al, 2001). In the current study, 60% were abstinent from binge eating at the end of treatment and 65.38% (34/52) were abstinent at 1‐month follow‐up.…”

“…Uncontrolled and controlled trials have shown positive outcomes from DBT guided and unguided self‐help, as well as group‐based interventions (Carter, Kenny, Singleton, Van Wijk, & Heath, 2020; Safer, Robinson, & Jo, 2010; Telch, Agras, & Linehan, 2001). More recently, the effectiveness of group‐based DBT for BED (Safer et al, 2009) has been tested in a routine community setting (Blood, Adams, Turner, & Waller, 2020), yielding outcomes that closely mirror those from previous studies. The attrition rate was similar to that reported by a controlled trial (Telch et al, 2001; 16 vs. 18%), and there were medium to large improvements in eating pathology, binge eating, and emotional eating.…”

“…This study tested the effectiveness of a brief, 10‐session version of group DBT for BED. Attrition was marginally higher (26.1%) than for the 20‐session version (16.1%; Blood et al, 2020). While this is higher than rates reported in previous RCTs (e.g., Wilfley et al, 2002), it is notably lower than that reported by Klein, Skinner, and Hawley (2012) for DBT, and was lower than attrition rates typically reported in routine community settings for CBT (e.g., Byrne, Fursland, Allen, & Watson, 2011).…”

“…Group members were given clear guidance regarding what constitutes an objective binge episode, and written criteria were provided with each weekly diary card, used to record target behaviors. The same self‐report measures were used as in Blood et al (2020), to ensure comparability. Self‐reported weight and height were used to calculate body mass index (BMI).…”

“…In parallel with that development in CBT, it is clearly important to consider Safer et al's (2009) suggestion that DBT for BED should be trialled with fewer sessions, potentially improving cost‐effectiveness, to determine whether clinical effectiveness can be maintained. Therefore, this study aimed to investigate the effectiveness of a 10‐week group‐based DBT intervention for BED, delivered in a routine out‐patient community eating disorders service, comparing outcomes with those previously reported (e.g., Blood et al, 2020).…”