The purpose of this study was to study the effects of an augmented DBT program intended for adults with anorexia nervosa (AN) compared to standard DBT on adult patients with AN. 

Boston University

•Purpose

•Method

•Results

•Conclusion 

•Limitations

Adapting Dialectical Behavior Therapy For Outpatient Adult Anorexia Nervosa—A Pilot Study: Article Summary

Chen, E.Y., Segal, K., Weissman, J., Zeffiro, T.A., Gallop, R., Linehan, M.M., Bohus, M. and Lynch, T.R. (2015), Adapting dialectical behavior therapy for outpatient adult anorexia nervosa—A pilot study. Int. J. Eat. Disord., 48: 123-132. https://doi-org.ezproxy.bu.edu/10.1002/eat.22360

Adapting Dialectical Behavior Therapy For OutpatientAdult Anorexia Nervosa—A Pilot Study

•A first case series was carried out on a group of 6 adult women diagnosed with AN at an outpatient eating disorder clinic. The treatment for this group was based around the standard DBT manual, as well as the DBT for binge eating manual. It involved individual standard DBT psychotherapy. Treatment goals were set using the standard DBT target hierarchy that ranks target behaviors in this order: life-threatening behavior, therapy-interfering behavior, quality-of-life interfering behavior and other client goals. Weight was taken at each therapy session.

•For the second case series, an adapted form of DBT was used as treatment for 9 adult women diagnosed with AN at an outpatient eating disorder clinic. The treatment for this group used standard DBT augmented by an early version (October, 2010) of a skills module addressing an over controlled style developed by Lynch et al., to standard DBT. This module focused on overcontrolled emotions and behaviours. It taught: (1) mindfulness mind states for over control; (2) identiﬁcation of habitual ways of coping; (3) how to change social behavior by changing physiology; (4) engagement in novel behaviors, including playful behavior and disinhibited expression; (5) openness to others’ feedback; (6) trusting others and revealing feelings and thoughts; and (7) practicing Loving-Kindness Meditation to prolong the activation of social-safety mood states. As in case series one, the second case series also utilized individual standard DBT psychotherapy. Lynch’s 8-week module addressing over controlled emotions and behaviors was taught individually after the standard DBT skills training.


Adapting Dialectical Behavior Therapy For Outpatient Adult Anorexia Nervosa—A Pilot Study: Method

•The group treated with standard DBT in the first case series saw a retention of 5/6 patients and a body mass index (BMI) effect size increase of d 520.5 from pre- to post-treatment.

•The group treated with the augmented DBT program in the second case series saw a retention of 8/9 patients with an effect size increase in BMI at post-treatment that was maintained at 6- and 12-months follow-up (d= -1.12, d= -0.87, and d= -1.12).


Adapting Dialectical Behavior Therapy For Outpatient Adult Anorexia Nervosa—A Pilot Study: Results

•The sample sizes for both case series one and case series two were small. This study should be replicated with a larger sample size to validate its findings.

•No follow-up data was collected for case series one so the effectiveness of standard DBT in treating AN long term was not studied.


Adapting Dialectical Behavior Therapy For Outpatient Adult Anorexia Nervosa—A Pilot Study: Limitations

This study demonstrates the preliminary feasibility, acceptability, and efficacy of two iterative case series using outpatient dialectical behavior therapy (DBT) for adults with anorexia nervosa (AN). Case series one had a low patient dropout rate of 16% and a modest effect size increase in body mass index (BMI) of $$d = -0.50$$. Case series two showed the effectiveness of an augmented DBT program for patients with AN focusing on overcontrolled emotions and behaviors, evidenced by a low treatment dropout rate of 11% and high patient ratings for suitability. Case series two resulted in effect sizes for BMI of $$d = -1.12$$ from baseline to post-treatment, which were sustained at 6-month ($$d = -0.87$$) and 12-month ($$d = -0.21$$) follow-ups. In summary, both standard and augmented DBT are effective for treating AN, with the augmented program potentially encouraging better long-term results.

https://doi.org/10.1002/eat.22360

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