Targeting maladaptive overcontrol with radically open dialectical behaviour therapy in a day programme for adolescents with restrictive eating disorders: an uncontrolled case series

Abstract

Background Radically Open Dialectical Behaviour Therapy (RO-DBT) was developed to target maladaptive overcontrol, a proposed core difficulty of restrictive eating disorders. RO-DBT is now the main group treatment model at the Intensive day Treatment Programme (ITP), Maudsley Hospital. This ITP case series aimed to investigate whether overcontrol is associated with restrictive eating disorder symptoms in adolescents and to evaluate ITP outcomes since RO-DBT skills classes were introduced. Method Self-report measures of eating disorder symptoms and temperament, personality and social characteristics linked to overcontrol were collected at assessment and discharge from ITP for all consecutive adolescents who attended between February 2015 and January 2019 (N = 131). Weight change, global outcomes and treatment needs post-ITP were also recorded. Results Eating disorder symptoms at assessment were significantly correlated with overcontrol factors, including social connectedness (r = −.67), reward responsivity (r = −.54), and cognitive inflexibility (r = .52). Adolescents stayed in ITP on average 13.40 weeks. 70.8% had a Good-Intermediate outcome on Morgan-Russell scale. 4.6% did not respond and were referred to inpatient treatment from ITP. Significant improvements in drive for thinness (d = .33), depressive mood (d = .41), social connectedness (d = .48), and emotional expressiveness (d = .97) were reported at discharge. No changes were observed in perfectionism or negative temperament. Conclusions This study offers preliminary evidence that eating disorder symptoms are associated with overcontrol factors in adolescence and that they can improve with RO-DBT informed day programme treatment. RO-DBT is a promising treatment that offers a new way of conceptualising treatment targets and recovery for adolescent restrictive eating disorders.

Adolescent Eating Disorder Day Programme Treatment Models and Outcomes: A Systematic Scoping Review

“…Similarly, adolescents report improvements in emotion regulation, emotional expression, cognitive flexibility, attachment relationships and social functioning at end of treatment ( 69 , 71 ), although cognitive flexibility did not improve after a brief 4-week cognitive remediation group offered within the DP context ( 70 ). Significant improvements in self-esteem have been reported ( 67 , 71 ).…”

“…From the available data, it has been consistently reported that DP treatment is associated with improvements in symptoms of depression ( 35 – 37 , 48 , 56 , 58 , 62 , 64 , 69 , 73 ), as well as anxiety and worry ( 36 , 48 , 58 , 59 , 62 , 71 , 73 ). There are some individual differences between studies in the pattern of improvements.…”

“…When reported, rates of admission to inpatient from DP treatment range from ~5–35% ( 42 , 49 , 50 , 54 , 55 , 59 , 65 , 68 , 69 , 71 , 72 ) and readmission rates to DP range from ~3–20% ( 49 , 66 , 68 , 69 , 71 ). Huryk et al ( 49 ) observed that the readmission rate to their DP significantly reduced from 12 to 3% after the integration of FBT principles into their DP.…”

“…One other study referred to potential improvements in outcomes due to a change in treatment model. In their discussion, Baudinet et al ( 69 ) noted that after changing the therapeutic group programme from being predominantly informed by Dialectical Behavior Therapy ( 81 ) to Radically Open Dialectical Behavior Therapy ( 82 ) they had far fewer referrals to inpatient treatment (18 vs. 5%).…”

“…It may also be associated with better weight and mood outcomes ( 61 ), although the latter findings are from a very small study ( N = 16) with methodological limitations. Being more focused on specific personality predispositions associated with restrictive eating disorders may also reduce the need for inpatient treatment for this particular group ( 69 ). In addition, the largest study included in this review ( N = 1,200) reported that younger people may have worse outcomes in all age, non-family focused DP treatment ( 37 ).…”