Radically open-dialectical behavior therapy for adult anorexia nervosa: feasibility and outcomes from an inpatient program

Abstract

BackgroundAnorexia Nervosa (AN) is a highly life-threatening disorder that is extremely difficult to treat. There is evidence that family-based therapies are effective for adolescent AN, but no treatment has been proven to be clearly effective for adult AN. The methodological challenges associated with studying the disorder have resulted in recommendations that new treatments undergo preliminary testing prior to being evaluated in a randomized clinical trial. The aim of this study was to provide preliminary evidence on the effectiveness of a treatment program based on a novel adaptation of Dialectical Behavior Therapy (DBT) for adult Anorexia Nervosa (Radically Open-DBT; RO-DBT) that conceptualizes AN as a disorder of overcontrol.MethodsForty-seven individuals diagnosed with Anorexia Nervosa-restrictive type (AN-R; mean admission body mass index = 14.43) received the adapted DBT inpatient program (mean length of treatment = 21.7 weeks).ResultsSeventy-two percent completed the treatment program demonstrating substantial increases in body mass index (BMI; mean change in BMI = 3.57) corresponding to a large effect size (d = 1.91). Thirty-five percent of treatment completers were in full remission, and an additional 55% were in partial remission resulting in an overall response rate of 90%. These same individuals demonstrated significant and large improvements in eating-disorder related psychopathology symptoms (d = 1.17), eating disorder-related quality of life (d = 1.03), and reductions in psychological distress (d = 1.34).ConclusionsRO-DBT was associated with significant improvements in weight gain, reductions in eating disorder symptoms, decreases in eating-disorder related psychopathology and increases in eating disorder-related quality of life in a severely underweight sample. These findings provide preliminary support for RO-DBT in treating AN-R suggesting the importance of further evaluation examining long-term outcomes using randomized controlled trial methodology.

Facial expression of positive emotions in individuals with eating disorders

“…Results of this study showed differences in the duration and intensity of DS between AN and BN participants, this may be explained at least in part, by the fact that BN is a disorder characterized by impulsivity while AN is characterized by overcontrol (Lynch et al, 2013). Our results are similar to findings from Claes and colleagues (2012) who did not find reduced facial expression of joy in BN participants.…”

“…DS has also been associated with social reward (Shore and Heerey, 2011), therefore, the reduced expression of DS in the AN group may reflect diminished temperamental reward sensitivity that characterizes disorders of overcontrol such as AN, autism spectrum disorders, and obsessive compulsive personality disorder (Lynch et al, 2013;Lynch, in press). …”

Emotion regulation training to reduce problematic dietary restriction: An experimental analysis

“…This suggests that training in emotion regulation may significantly reduce problematic dietary restriction at the momentary level among individuals at relatively lower BMIs. This result is consistent with findings indicating that interventions targeting emotion regulation are effective for low weight individuals with anorexia nervosa (Chen et al, 2015; Lynch et al, 2013; Wildes et al, 2014). Further, this result could provide information relevant to treatment matching according to clinical characteristics (i.e., BMI) if replicated.…”

“…Some interventions have begun targeting aspects of emotion regulation in anorexia nervosa (Chen et al, 2015; Lynch et al, 2013; Wildes, Marcus, Cheng, McCabe, & Gaskill, 2014). However, there has been no examination of emotion regulation as a specific intervention target across a range of restriction severity.…”

Examining the associations between emotion regulation difficulties, anxiety, and eating disorder severity among inpatients with anorexia nervosa

“…There is a growing interest in targeting emotion regulation difficulties in the treatment of AN 27,28 . The results of this study suggest that a treatment focus on enhancing emotion regulation abilities is likely be beneficial to at least some individuals with AN during illness.…”