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Abstract

Dialectical Behavior Therapy (DBT) has been shown to effectively target binge eating disorder (BED). This study pilots the effectiveness of group DBT for obese "emotional eaters" to reduce eating psychopathology and achieve weight maintenance. Thirty-five obese male and female emotional eaters receiving 20 group psychotherapy sessions of DBT adapted for emotional eating were assessed at end-of-treatment and 6 month follow-up for reductions in eating psychopathology and weight maintenance. DBT resulted in significant reductions in emotional eating and other markers of eating psychopathology at the end-of-treatment that were maintained at follow-up. The drop-out rate was very low, with only 1 participant dropping from treatment. Thirty-three (94%) of the sample provided data at every assessment point. Of these, 80% achieved either weight reduction or weight maintenance after treatment and throughout the follow-up period. The effect size for weight reduction was small. This pilot study demonstrates group DBT targeting emotional eating in the obese to be a highly acceptable and effective intervention for reducing eating related psychopathology at both at end-of-treatment and during follow-up. The ability of DBT to limit the upward trajectory of weight gain in obese patients with high degrees of emotional eating suggests that DBT may also help limit the increase or even prevent onset of obesity related morbidity in these patients.
1141
Nutr Hosp. 2012;27(4):1141-1147
ISSN 0212-1611 • CODEN NUHOEQ
S.V.R. 318
Original
Group dialectical behavior therapy adapted for obese emotional eaters;
a pilot study
M. A. Roosen
1
, D. Safer
2
, S. Adler
2
, A. Cebolla
3
and T. van Strien
4,5
1
Outpatient clinic for eating disorders and obesity at the Mental Health Care Centre region Oost Brabant. The Netherlands.
2
Stanford University School of Medicine. Department of Psychiatry & Behavioral Sciences. Stanford. California. U.S.A.
3
Universitat Jaume I. Spain.
4
Behavioural Science Institute. Radboud University Nijmegen. The Netherlands.
5
Institute for
Gender Studies. Radboud University Nijmegen. The Netherlands.
TERAPIA DIALECTICO-COMPARTIMENTAL
GRUPAL ADAPTADA PARA EL TRATAMIENTO
“COMEDORES EMOCIONALES” OBESOS;
UN ESTUDIO PILOTO
Resumen
La Terapia Dialéctico-Conductual (TDC) es una tera-
pia eficaz para el tratamiento del trastorno por atracón
(TA). Este estudio piloto pretende estudiar la eficacia de
la TDC grupal para la reducción de psicopatología ali-
mentaria y el logro el mantenimiento del peso, para obe-
sos “comedores emocionales”. Treinta y cinco obesos
“comedores emocionales” de ambos sexos fueron evalua-
dos al final del tratamiento y en seguimiento a los seis
meses en psicopatología alimentaria y reducción de peso
tras recibir 20 sesiones de TDC en grupo adaptado para el
tratamiento del comer emocional. La TDC dio lugar a
reducciones significativas en comer emocional y otros
marcadores de la psicopatología alimentaria al terminar
el tratamiento, que se mantuvieron durante el segui-
miento. La tasa de abandonos fue muy baja, sólo una par-
ticipante abandonó el tratamiento. Treinta y tres (94%)
participantes de la muestra proporcionaron datos en
todos los puntos de la evaluación. De éstos, el 80% obtuvo
una reducción de peso o el mantenimiento del mismo al
finalizar el tratamiento y durante todo el período de
seguimiento. El tamaño del efecto de la reducción de peso
fue pequeño. Este estudio piloto demuestra que el uso de
la TDC para el comer emocional en personas obesas es
una intervención altamente aceptable y eficaz para la
reducción de estilos de ingesta relacionados con psicopa-
tología, tanto al final del tratamiento como en el segui-
miento. La capacidad de la TDC para limitar la trayecto-
ria ascendente de la ganancia de peso en pacientes obesos
con alto grado de comer emocional sugiere que la TCD
también puede ayudar a limitar el aumento o incluso pre-
venir la aparición de morbilidad relacionada con la obesi-
dad en estos pacientes.
(Nutr Hosp. 2012;27:1141-1147)
DOI:10.3305/nh.2012.27.4.5843
Palabras clave: Terapia dialéctica-compartimental. Comer
emocional. Mantenimiento de peso. Psicopatología.
Abstract
Dialectical Behavior Therapy (DBT) has been shown to
effectively target binge eating disorder (BED). This study
pilots the effectiveness of group DBT for obese “emotional
eaters” to reduce eating psychopathology and achieve
weight maintenance. Thirty-five obese male and female
emotional eaters receiving 20 group psychotherapy
sessions of DBT adapted for emotional eating were
assessed at end-of-treatment and 6 month follow-up for
reductions in eating psychopathology and weight mainte-
nance. DBT resulted in significant reductions in
emotional eating and other markers of eating psychopat-
hology at the end-of-treatment that were maintained at
follow-up. The drop-out rate was very low, with only 1
participant dropping from treatment. Thirty-three
(94%) of the sample provided data at every assessment
point. Of these, 80% achieved either weight reduction or
weight maintenance after treatment and throughout the
follow-up period. The effect size for weight reduction was
small. This pilot study demonstrates group DBT targe-
ting emotional eating in the obese to be a highly accep-
table and effective intervention for reducing eating
related psychopathology at both at end-of-treatment and
during follow-up. The ability of DBT to limit the upward
trajectory of weight gain in obese patients with high
degrees of emotional eating suggests that DBT may also
help limit the increase or even prevent onset of obesity
related morbidity in these patients.
(Nutr Hosp. 2012;27:1141-1147)
DOI:10.3305/nh.2012.27.4.5843
Key words: Dialectical behaviour therapy. Emotional
eating. Weight maintenance. Psychopatology.
Correspondence: Tatjana van Strien.
Behavioural Science Institute. Radboud University Nijmegen.
P.O.Box 9104, 6500 HE Nijmegen. The Netherlands.
E-mail: T.vanstrien@psych.ru.nl
Recibido: 7-III-2012.
Aceptado: 13-III-2012.
23. GROUP DIALECTICAL:01. Interacción 04/06/12 12:05 Página 1141
Introduction
Obesity, an increasingly prevalent disorder, is asso-
ciated with severe and often life-threatening medical
co-morbidities.
1
Reduction of body weight can have a
substantial positive impact, such as reversing the
development of diabetes.
2
However, obesity is well-
known as being difficult to treat; calorie restricting
diets, even when combined with behavioural tech-
niques and exercise, seldom result in lasting weight
loss.
3,4,5
A meta-analysis on the long-term effectiveness
of calorie restricting diets showed that between one
third and two thirds of the dieters regain more weight
than was initially lost on their diets
4
. In view of this
disheartening evidence, the World Health Organiza-
tion (WHO
6
) and others suggest clinicians advise their
patients to aim for weight constancy as a means of
preventing further development of obesity-related
morbidity.
7,8
It is therefore important to investigate how weight
constancy could be better achieved for people who fail
to maintain weight loss. One factor may be that most
current lifestyle or behavioral interventions, which
tend to highly emphasize control of food stimuli
within the obesogenic environment, may not be as
effective for individuals whose overeating is predomi-
nantly triggered by negative emotions (emotional
eating) rather than tempting food cues. Evidence is
accumulating that the pathology associated with
excessive external and emotional eating is essentially
different.
9,10,11
Very high levels of emotional eating
have been demonstrated in at least 40% of obese
community samples
12
and are associated with poor
interoceptive awareness, high alexithymia, depression
and problems with affect regulation.
9,10,13,14
Research
also suggests that individuals with high degrees of
emotional eating are especially poor at achieving
weight loss maintenance eating.
15
Originally, Dialectical Behavior Therapy (DBT) was
developed for borderline personality disorder,
16,17
and
was successfully modified to target binge eating
disorder (BED).
18,19,20,21
According to this affect regula-
tion model, binge eating is a behavioral attempt to influ-
ence, change, or control painful emotional states
22,23,24
Binge eating, particularly in obese individuals, is
highly associated with emotional eating.
25,26
This pilot
treatment included obese individuals who showed high
levels of emotional eating but did not meet criteria for
BED. The aim of the present study was to pilot a DBT
intervention focusing on“emotional eating” rather than
binge eating for obese individuals with high emotional
eating scores.
In keeping with the WHO recommendations
6
, this
study aimed to achieve weight maintenance, defined as
a weight change of < 3% of baseline body weight.
27
It
was hypothesized that DBT would successfully reduce
eating psychopathology and that over time improve-
ment in eating psychopathology would be associated
with weight stabilization.
Method
Participants
As is standard practice in the Netherlands, all
participants were directly referred from their general
practitioner to the eating disorders outpatient clinic
of the Mental Health Care Centre region Oost
Brabant in the Netherlands. Inclusion criteria were a
body mass index (BMI) > = 30 and < 40 kg/m
2
, age >
=18 and < = 65 years, and a score > = 2.38 on the
emotional eating subscale of The Dutch Eating
Behaviour Questionnaire (DEBQ),
28
indicating high
levels of emotional eating. Exclusion criteria were
meeting full clinical criteria based on the Diagnostic
and Statistical Manual of Mental Disorders (DSM-
IV) (APA
29
) for binge eating disorder (BED). Sixty-
seven applicants were screened. Of these, 32 (47%)
were excluded for BED. The final pilot group
consisted of 35 patients.
The Medical Ethical Committee (METiGG, Kamer
Zuid) approved the design of the study, and all partici-
pants signed informed consent.
Procedure
Participants completed questionnaires and had their
body weights measured at the Centre at pre-treatment,
post treatment and at the 6 month follow-up. Complete
data are available at all 3 time points for all but 2 of the
35 participants (n = 33; 94%).
Intervention
A therapist manual for treating binge eating with
Dialectical Behaviour Therapy (DBT) was obtained
from Stanford University (USA) and was translated
into Dutch. The published treatment manual in
English is now available
20
. The principal adaptation
from the BED version was the substitution of
“emotional eating” as a treatment target instead of
binge eating. The highly structured treatment
included an initial brief pre-treatment interview
followed by 20 weekly group sessions of 2 hour
group therapy. Groups were led by two trained co-
therapists and included a maximum of 9 patients per
group.
The pre-treatment interview oriented participants to
the goals of treatment, which involved reducing eating
pathology by teaching emotion regulation skills.
During this session, emphasis was placed on the impor-
tance of maintaining body weight (versus a focus on
weight reduction). Also highlighted was the impor-
tance of developing and maintaining a healthy eating
pattern (e.g., three meals a day with healthy snacks in
between) and obtaining sufficient physical exercise.
Because the specifics of developing a healthy pattern
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Nutr Hosp. 2012;27(4):1141-1147
23. GROUP DIALECTICAL:01. Interacción 04/06/12 12:05 Página 1142
of eating are not given special attention in DBT for
eating disorders, participants were given a brochure of
the National Nutrition Centre (available upon request
to the authors) to use as a reference.
Briefly, the focus of the twenty DBT group sessions
was to teach adaptive emotion regulation skills through
the use of three modules (Mindfulness, Emotion Regu-
lation, and Distress Tolerance), with two final sessions
devoted to review and relapse prevention. Mindfulness
skills include the ability to observe and describe
moment-to-moment emotional experiences, thoughts,
and action urges and respond non-judgmentally.
Emotion regulation skills encourage understanding of
how emotions function, decreasing vulnerability to
negative emotions, increasing positive emotions, and
changing specific emotional states (e.g., fear and
anxiety) by acting opposite to one’s current emotion.
Distress-tolerance skills teach adaptive and effec-
tive means for tolerating life’s unavoidable stresses
and pain without turning to emotional eating,
thereby facilitating acceptance of the current
moment’s realities.
Measures
The Dutch Eating Behaviour Questionnaire (DEBQ)
28
was used to measure Emotional, External and Restrained
eating. Response categories range from 1 (“never”) to
5 (“very often”). The scales display good internal
consistency and factorial validity
29
in addition to
adequate predictive validity
30,31,32
for food consumption.
The Revised Eating Disorder Inventory (EDI-II)
33
was
used to measure eating psychopathology. The EDI-II is
a self-report measure of attitudes and behaviours
concerning eating, weight and shape, and psycholog-
ical traits clinically relevant to eating disorders. For the
present study, 5 subscales were used: body dissatisfac-
tion, drive for thinness, bulimia (i.e., the tendency to
binge and purge), poor interoceptive awareness (i.e.,
difficulties adequately identifying emotions and sensa-
tions of hunger or satiety )and impulsivity (i.e., tenden-
cies toward substance abuse, recklessness, hostility,
self-destructiveness). Possible responses ranged from
1 ‘never’ to 6 ‘always’. In contrast with the EDI-
manual
33
, in which a transformation of responses into a
4-point scale is advocated, the present study utilised
untransformed responses, as scale transformation was
found to damage the validity of the EDI among non-
clinical populations
34,35
. The depression subscale of the
validated version of the Hopkins Symptom Checklist-
90 (SCL-90)
36,37
was used as a measure of depressive
symptoms. Body weight was assessed on a balance
beam scale by a trained research assistant, with the
participant being in lightweight clothing and having
shoes removed. Height was measured with a
stadiometer. Body Mass Index (BMI) was calculated as
weight (in kilograms) divided by the square of height
(in meters).
Statistical analysis
To study the effect of the DBT intervention, a General
Linear Model (GLM) with a within subject design (Time:
pre-treatment versus post-treatment) was conducted.
Likewise, to study whether the effects of the treatment
were maintained, a GLM with a within subject design
(Time: post-treatment versus follow-up) was conducted.
Cohen’s d was used to assess the size of the treatment
effect (d = 0.20 stands for a small; d = 0.50 for a medium
and d = 80 for a large effect). Partial eta squared was also
reported (< 0.10 = small, > 0.10 and < 0.20 = median and
> 0.20 = large effect). Primary analyses were run using an
intent to treat (n = 35) sample.
Complete data, including objectively measured body
weights, were available for 33 (94%) of the sample. Of
the two with missing data, a total of 3 assessments were
missing (1 post-treatment assessment and 2 follow-up
assessments). Last observation carried forward was used
for the 2 participants with missing data (i.e., the pre-treat-
ment assessment was carried forward for the participant
with two missing assessments and the post-treatment
assessment was carried forward for the participant
missing the follow-up assessment).
Results
Pre-treatment characteristics
The DBT group consisted of 35 patients (30 females
(86%) and 5 males (4%)) with a mean age of 39.20 (SD =
11.02) years. The mean BMI was 35.42 kg/m
2
(SD =
2.62). The average DEBQ Emotional Eating Score was
3.85 (SD = 0.66). The other DEBQ subscales were:
External Eating 3.58 (SD = 0.58), and Restrained
Eating 3.02 (SD = 0.59), The 5 EDI-II subscales were
reported as: Body Dissatisfaction 47.10 (SD = 7.44),
Drive for Thinness 29.74 (SD = 5.94), Bulimia 23.94
(SD = 7.24), Poor Interoceptive Awareness 32.99 (SD
= 7.24), and Impulsivity 25.89 (SD = 5.69). The
average depression subscale score from the SCL-90
was 2.04 (SD = 0.77) (table I).
Drop-outs from treatment and/or assessment
One patient dropped out of treatment (3%), stating
that learning the mindfulness skills was sufficient for
her. One patient (3%) did not provide a follow-up
assessment. Complete data for all 3 assessment points
were available for n = 33 (94%) of the sample.
Eating style, eating psychopathology
and depressive symptoms
DBT resulted in significant post-treatment reduc-
tions in the DEBQ Emotional Eating scale (3.85 ± 0.66
Treatment for obese emotional eaters 1143Nutr Hosp. 2012;27(4):1141-1147
23. GROUP DIALECTICAL:01. Interacción 04/06/12 12:05 Página 1143
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M. A. Roosen et al.
Nutr Hosp. 2012;27(4):1141-1147
Table I
Results of the intention-to treat sample (n = 35) before and after treatment and at the 6 month follow-up
Pre-treatment Post-treatment Follow-up Cohens Treatment effectiveness Maintenance
(n = 35) (n = 35) (n = 35) d
Measure M SD M SD M SD
Pre- Pre-
F (1,35)
Partial
F (1,35)
Partial
Post Follow-up éta squared éta squared
BMI 35.42 2.62 34.82 3.33 34.56 3.80 -0.20 0.26 6.26* 0.16 0.73 0.02
Emotional eating 3.85 0.66 2.75 0.49 2.81 0.62 -1.89 1.63 82.96*** 0.71 0.35 0.01
External eating 3.58 0.58 2.66 0.50 2.76 0.54 -1.70 1.46 64.55*** 0.65 2.32 0.06
Restrained eating 3.02 0.59 3.26 0.57 3.12 0.50 -0.41 -0.18 4.41* 0.12 4.43* 0.12
Body dissatisfaction 47.10 7.44 43.30 8.84 44.03 8.94 -0.47 0.37 9.59** 0.22 0.78 0.02
Drive for thinness 29.74 5.94 24.28 6.84 24.23 6.78 -0.85 0.86 28.62*** 0.46 0.004 0.00
Bulimia 23.94 6.05 14.73 4.43 15.94 4.66 -1.73 1.48 64.36*** 0.65 4.570* 0.12
Poor interceptive awareness 32.99 7.24 26.23 6.24 25.46 5.89 -1.00 1.14 19.66*** 0.37 0.99 0.03
Impulsivity 25.89 5.69 23.92 5.34 23.47 4.72 -0.36 0.46 3.66 0.097 0.31 0.01
Depression 2.04 0.77 1.68 0.65 1.61 0.49 -0.51 0.67 8.74** 0.205 0.99 0.03
*p < 0.05; **p < 0.01; ***p < 0.001
23. GROUP DIALECTICAL:01. Interacción 04/06/12 12:05 Página 1144
vs. 2.75 ± 0.49, F(1, 34) = 82.96 , p < 0.001 ) and in the
External Eating (3.58 ± 0.58 vs. 2.66 ± 0.50, F(1, 34) =
64.55, p < 0.001). DEBQ Restraint significantly
increased (3.02 ± 0.59 vs. 3.26 ± 0.57, F(1, 34) = 4.41,
p = 0.043). Four of the 5 EDI-II subscales of eating
psychopathology as well as depressive symptoms
showed significant decreases: Body Dissatisfaction
(47.10 ± 7.44 vs. 43.30 ± 8.84, F(1, 34) = 9.59, p =
0.004), Drive for Thinness (29.74 ± 5.94 vs. 24.28 ±
6.84, F(1, 34) = 28.62, p < 0.001), Bulimia (23.94 ±
6.05 vs. 14.73 ± 4.43, F(1, 34) = 64.36, p < 0.001), Poor
Interoceptive Awareness (32.99 ± 7.24 vs. 26.23 ±
6.24, F(1, 34) = 19.66 , p < 0.001) and Depressive
symptoms (2.04 ± 0.77 vs. 1.68 ± 0.65, F(1, 34) = 8.74,
p = 0.006). There was no significant change in Impul-
sivity (25.89 ± 5.69 vs. 23.92 ± 5.34, F(1, 34) = 3.66, p
= 0.064).
Results from the post-treatment vs follow-up GLM
revealed that the effects of the treatment were main-
tained through the follow-up period except for the
decrease in the DEBQ Restraint scale (p = 0.043) and
the increase in the EDI-II Bulimia subscale (p = 0.040)
(table I).
Body weight
Participants lost 0.60 BMI-points (1.69%) in the
short-term and 0.86 BMI points (2.42%) in the longer
term. The treatment effectiveness analysis showed a
significant time effect meaning that DBT resulted in a
significant weight loss though its effect size was small.
The maintenance analysis showed no significant time
effect, meaning that post-treatment results were main-
tained (table I).
Additional analyses were used to further categorize
the participants. Following Stevens and colleagues,
27
treatment completers (n = 33) were categorized as
those with a weight loss of > 3%, weight maintenance
of ± 3%, or weight gain of > 3% of baseline weight.
They were further categorised as non-gainers (weight
loss or weight maintenance) or gainers (weight gain).
At post-treatment, the percentages with weight loss,
weight maintenance, and weight gain were, respec-
tively, 31.4 %. 65.7% and 2.9%, At the 6-month follow
up, these percentages were, respectively, 40%, 40%,
and 20%. Hence, at follow-up, 80% of were non-
gainers (i.e., showed weight loss or weight mainte-
nance), whereas 20% were weight gainers, with a mean
gain of 1.90 BMI points (SD = 1.61).
Discussion
To our knowledge, DBT has not yet been investi-
gated specifically for the treatment of emotional eating
in people with obesity. Given very high levels of
emotional eating have been demonstrated in at least
40% of obese community samples
12
and that those with
high emotional eating scores appear specifically poor
at achieving weight loss maintenance eating,
15,38
emotional eating may be an especially important and
under-explored target for participants in weight loss
and weight maintenance interventions.
The findings from the present pilot study suggest
that 20 sessions of DBT group therapy targeting
emotional eating among obese individuals was
successful in reducing emotional eating and other
markers of eating psychopathology and was associated
with constancy or even reduction of body weight at
post-treatment and at the 6 month follow-up. It was
expected that DBT-treatment would be successful in
reducing eating psychopathology both in the short and
longer term. While DBT was not expected to result in
weight maintenance or a mild weight loss in the treat-
ment intervention period, improvement in eating
psychopathology did impressively result in weight
stabilization in throughout the 6 month follow-up
period.
Mild weight loss or weight maintenance after DBT
has been observed before.
18,20
However, these findings
were found with patients with BED. The present find-
ings suggest that DBT may also result in weight main-
tenance or weight loss in a large percentage of obese
people without BED who experience high degrees of
emotional eating. Teaching adaptive emotion regula-
tion skills may be a desirable missing component for
this otherwise difficult to treat population of patients
with obesity.
The very low drop-out rate suggests DBT is highly
acceptable for most obese emotional eaters, which is of
importance given typical drop-out rates of obese
patients from treatment are much higher (e.g., 16-
20%).
39,40
One contributing factor may have been the
emphasis placed during the pre-treatment interview on
weight maintenance as a goal.
The finding that many patients increased their
dietary restraint during treatment in addition to weight
loss is consistent with other findings on decreased
overeating or eating binges after dieting.
43
Unlike the
Restraint Scale literature, which links dietary restric-
tion to overeating and eating disorders,
39
the DEBQ
Restrained Eating scale measures “watching exactly
what you eat” and/or moderation of food intake in
response to occasions of overeating (e.g., “When you
have eaten too much, do you eat less than usual the
following day?”).
28
Hence, individuals with higher
DEBQ Restraint scores may have been more successful
in avoiding weight gain because of their tendency to
compensate for occasional bouts of overconsumption
by subsequently eating less.
A possible explanation for the weight gain of 20% at
the 6 month follow-up may come from a recent study in
which Blomquist and colleagues
42
assessed the weight
trajectories in the year prior to commencing treatment
for BED. Weight gainers, in contrast to the weight non-
gainers, had been on a very steep weight gain trajec-
tory, showing an average weight gain of more than 10
Treatment for obese emotional eaters 1145Nutr Hosp. 2012;27(4):1141-1147
23. GROUP DIALECTICAL:01. Interacción 04/06/12 12:05 Página 1145
kg during the year before seeking treatment.
42
It is not
known whether the weight gainers in the present study
also were following a steep pre-treatment weight gain.
However, it would be of interest to assess the pre-treat-
ment weight trajectories of patients receiving treatment
in future studies. For patients with a steep pre-treat-
ment weight gain trajectory, a more feasible treatment
goal might be to aim at a less steep weight gain trajec-
tory rather than constancy of body weight, let alone
weight loss.
A limitation of this study is the absence of a control
group. A further limitation is the relatively small
sample size and, given the chronicity of emotional
eating and obesity, the rather brief follow-up period of
6 months. A strength of the study was that body height
and body weight were obtained through by objective
measurements in 94% of the participants. A further
strength is that only one person dropped out of the DBT
treatment.
In conclusion, DBT in this study was associated with
reductions in important aspects of eating psychopathology
in the short term and at the six month follow up—
which took place 1 year after initiation of the study.
These improvements were accompanied by weight
constancy or even a reduction of body weight for the
majority of the patients. The ability of DBT to limit the
customary weight increases of obese patients with high
degrees of emotional eating suggests DBT to be a
promising strategy to inhibit the further growth of
obesity-related morbidity in these difficult to treat
obese patients.
References
1. Brownell KD, Wadden TA. Etiology and treatment of obesity:
Understanding a serious, prevalent, and refractory disorder.
Journal of Consulting and Clinical Psychology. 1992; 60 (4):
505-517.
2. Sjöström CD, Peltonen M, Wedel H, Sjöström L. Differentiated
Long-Term Effects of Intentional Weight Loss on Diabetes and
Hypertension. Hypertension 2000; 36 (1): 20-25.
3. Cooper Z, Doll HA, Hawker DM et al. Testing a new cognitive
behavioural treatment for obesity: A randomized controlled
trial with three-year follow-up. Behav Res Ther 2010; 48 (8):
706-713.
4. Mann T, Tomiyama AJ, Westling E et al. Medicare’s search for
effective obesity treatments: diets are not the answer. Am
Psychol 2007; 62 (3): 220-233.
5. Wilson GT. Behavioural treatment of obesity. Thirty years and
counting. Adv Behav Res Ther 199; 416: 31-75.
6. WHO. Obesity: Preventing and managing the global epidemic:
In WHO Technical report Series 894 Volume 8894. Issue i-xii
Geneva, World Health Organisation. 2000; 1-253.
7. Pryke R, Docherty A. Obesity in primary care: evidence for
advising weight constancy rather than weight loss in unsuc-
cessful dieters. Br J Gen Pract 2008; 58 (547): 112-117.
8. Brownell KD. The humbling experience of treating obesity:
Should we persist or desist? Behav Res Ther 2010; 48 (8): 717-719.
9. Spoor STP, Bekker MHJ, Van Strien T, van Heck GL. Rela-
tions between negative affect, coping, and emotional eating.
Appetite. 2007; 48 (3): 368-376.
10. Ouwens MA, van Strien T, van Leeuwe JFJ. Possible pathways
between depression, emotional and external eating. A structural
equation model. Appetite 2009; 53 (2): 245-248.
11. Safer DL, Robinson AH, Jo B. Outcome from a randomized
controlled trial of group therapy for binge eating disorder:
comparing dialectical behavior therapy adapted for binge
eating to an active comparison group therapy. Behav Ther
2010; 41 (1): 106-120.
12. Van Strien T. Dutch Eating Behaviour Questionnaire. Manual.
Amsterdam, Boomtestuitgevers. 2012.
13. Van Strien T, Ouwens MA. Effects of distress, alexithymia and
impulsivity on eating. Eat Behav 2007; 8 (2): 251-257.
14. Baños R, Cebolla, A, Etchemendy E, Rasal P, Felipe S, Botella
C. Spanish validation of the Dutch Eating Behavior Scale for
children (DEBQ-C). Nutr Hosp 2011; 26 (4): 890-898.
15. Blair AJ, Lewis VJ, Booth DA. Does emotional eating interfere
with success in attempts at weight control? Appetite 1990; 15
(2): 151-157.
16. Linehan MM. Cognitive-behavioral treatment of borderline
personality disorder. New York: Guilford. 1993.
17. Linehan MM. Skills training manual for treating borderline
personality disorder. New York: Guilford. 1993.
18. Safer DL, Robinson AH, Jo B. Outcome from a randomized
controlled trial of group therapy for binge eating disorder:
comparing dialectical behavior therapy adapted for binge
eating to an active comparison group therapy. Behav Ther
2010; 41 (1): 106-120.
19. Telch CF, Agras WS, Linehan MM. Group dialectical behavior
therapy for binge-eating disorder: A preliminary, uncontrolled
trial. Behav Ther 2000; 31 (3): 569-582.
20. Safer DL, Telch CF, Chen E. Dialectical Behavior Therapy for
Binge Eating and Bulimia. New York: Guilford Press. 2009.
21. Telch CF. Skills training treatment for adaptive affect regula-
tion in a woman with binge-eating disorder. Int J Eat Disord
1997; 22 (1): 77-81.
22. Linehan MM, Chen EY. Dialectical behavior therapy for
eating disorders. In Freeman (Ed.). Encyclopedia of cogni-
tive behavior therapy (pp. 168-171). New York: Springer.
2005.
23. Wiser S, Telch CF. Dialectical behavior therapy for Binge-
Eating Disorder. J Clin Psychol 1999; 55 (6): 755-768.
24. Wisniewski L, Kelly E. The application of dialectical behavior
therapy to the treatment of eating disorders. Cog Behav Prac
2003; 10 (2): 131-138.
25. Van Strien T, Engels RCME, Van Leeuwe J, Snoek HM. The
Stice model of overeating: tests in clinical and non-clinical
samples. Appetite 2005; 45 (3): 205-213.
26. Ricca V, Castellini G, Lo Sauro C et al. Correlations between
binge eating and emotional eating in a sample of overweight
subjects. Appetite 2009; 53 (3): 418-421.
27. Stevens J, Truesdale KP, McClain JE, Cai J. The definition of
weight maintenance. Int J Obes (Lond) 2006; 30 (3): 391-399.
28. Van Strien T, Frijters JER, Bergers GPA, Defares PB. The
Dutch Eating Behavior Questionnaire (DEBQ) for assessment
of restrained, emotional, and external eating behavior. Int J Eat
Disord 1986; 5 (2): 295-315.
29. American Psychiatric Association. Diagnostic and statistical
manual of mental dirsorders. Washington DC, 1994.
30. Van Strien T, Peter Herman C, Anschutz D. The predictive
validity of the DEBQ-external eating scale for eating in
response to food commercials while watching television. Int J
Eat Disord 2012; 45 (2): 257-262.
31. Van Strien T, Herman CP, Anschutz DJ, Engels RCME, de
Weerth C. Moderation of distress-induced eating by emotional
eating scores. Appetite 2012; 58 (1): 277-284.
32. Van Strien T, van de Laar FA. Intake of energy is best
predicted by overeating tendency and consumption of fat is
best predicted by dietary restraint: a 4-year follow-up of
patients with newly diagnosed Type 2 diabetes. Appetite
2008; 50 (2-3): 544-547.
33. Garner DM. Eating Disorder Inventory-2 manual. Odessa, FL:
Psychological Assessment Resources. 1991.
34. Schoemaker C, van Strien T, van der Staak C. Validation of the
eating disorders inventory in a nonclinical population using
transformed and untransformed responses. Int J Eat Disord
1994; 15 (4): 387-393.
1146
M. A. Roosen et al.
Nutr Hosp. 2012;27(4):1141-1147
23. GROUP DIALECTICAL:01. Interacción 04/06/12 12:05 Página 1146
Treatment for obese emotional eaters 1147Nutr Hosp. 2012;27(4):1141-1147
35. Van Strien T, Ouwens M. Validation of the Dutch EDI-2 in One
Clinical and Two Nonclinical Populations. Eur J Psychol
Assess 2003; 19 (1): 66–84.
36. Derogatis LR. The SCL-90 manual: I Scoring, administration
and procedures for the SCL-90. MD: Clinical Psychometric
Research. 1977.
37. Arrindell WA, Ettema JMH. Dimensionele structuur, betrouw-
baarheid en validiteit van de Nederlandse bewerking van de
Symptom Checklist (SCL-90); gegevens gebaseerd op een
fobische en een normale populatie [Dimensional structure,
reliability and validity of the Dutch version of the SCL-90;
analyses based on phobic and normal population]. Nederlands
Tijdschrift voor de Psychologie 1991; 14: 77-108.
38. Van de Laar FA, van de Lisdonk EH, Lucassen PLBJ et al.
Eating behaviour and adherence to diet in patients with Type 2
diabetes mellitus. Diabet Med 2006; 23 (7): 788-794.
39. Werrij MQ, Jansen A, Mulkens S et al. Adding cognitive
therapy to dietetic treatment is associated with less relapse in
obesity. J Psychosom Res 2009; 67 (4): 315-324.
40. Vandereycken W, Devidt K. Dropping out from a specialized
inpatient treatment for eating disorders: the perception of
patients and staff. Eat Disord 2010; 18 (2): 140-147.
41. Herman CP, Polivy J, Leone T. The psychology of overeating.
In D. Mela (Ed.). Food, diet and obesity (pp. 115-136).
Cambridge, UK: Woodhead Publishing. 2005
42. Blomquist KK, Barnes RD, White MA et al. Exploring
weight gain in year before treatment for binge eating
disorder: a different context for interpreting limited weight
losses in treatment studies. Int J Eat Disord 2011; 44 (5):
435-439.
23. GROUP DIALECTICAL:01. Interacción 04/06/12 12:05 Página 1147
... Instead, people with emotional eating benefit from learning to recognize, structure/restructure, and self-manage their emotions. Research shows that dialectical behaviour therapy (DBT) may be successful in treating emotional eating behaviour [33][34][35][36][37][38][39]. The coaching strategies within DBT are based on validation, focus-on-change, and dialecticsa fusion of the first two strategies [40]. ...
... By conducting repeated chain analyses a person can identify the pattern linking different components of a behaviour. These analyses were an integral part of several studies on people with binge-eating disorder (BED) or eating disorders in general [33,[64][65][66][67][68][69][70]. The publications indicated that the deployment of dialectical behaviour therapy in these target groups can undoubtedly be considered successful, but unfortunately the effect of specific deployment of the chain analysis was unknown. ...
... Although the effectiveness of DBT in both BED and emotional eating behaviour has been extensively published [33,[64][65][66][67][68][69][70]102], little is known about the effect of the specific coaching strategies that are a part of this therapy [43,102]. Further research is needed on which type of validating or dialectical coaching fits best with which situation. ...
Article
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Background Around 13% of the world’s population suffers from obesity. More than 40% of people with obesity display emotional eating behaviour (eating in response to negative emotions or distress). It is an alternate to more effective coping strategies for negative emotions. Our study explored the opportunities for helping adults with emotional overeating using a virtual coach, aiming to identify preferences for tailored coaching strategies applicable in a personal virtual coach environment. Three different coaching strategies were tested: a validating, a focus-on-change, and a dialectical one – the latter being a synthesis of the first two strategies. Methods A qualitative study used vignettes reflecting the two most relevant situations for people with emotional eating: 1. experiencing negative emotions, with ensuing food cravings; and 2. after losing control to emotional eating, with ensuing feelings of low self-esteem. Applied design: 2 situations × 3 coaching strategies. Participants: 71 adult women ( M age 44.4/years, range 19–70, SD = 12.86) with high scores on the DEBQ-emotional eating scale ( M emo 3.65, range 1.69–4.92, SD = .69) with mean BMI 30.1 (range 18–46, SD = 6.53). They were recruited via dieticians’ practices, were randomly assigned to the conditions and asked how they would face and react to the presented coaching strategies. Data were transcribed and a thematic analysis was conducted. Results Qualitative results showed that participants valued both the validating coaching strategy and the focus-on-change strategy, but indicated that a combination of validation and focus-on-change provides both mental support and practical advice. Data showed that participants differed in their level of awareness of the role that emotions play in their overeating and the need for emotion-regulation skills. Conclusion The design of the virtual coach should be based on dialectical coaching strategies as preferred by participants with emotional eating behaviour. It should be tailored to the different stages of awareness of their emotions and individual emotion-regulation skills.
... The ability to identify and understand emotions is a necessary prerequisite to developing adaptive emotion regulation skills (Vine & Aldao, 2014). It has J o u r n a l P r e -p r o o f been suggested that teaching emotion regulation skills could result in decreased emotional eating (Roosen et al., 2012); however, for individuals with higher levels of affective alexithymic characteristics and associated deficits, focusing on these aspects must precede targeting emotion. ...
... Psychotherapies for emotional eating such as compassion-based and dialectical behaviour therapies (Roosen et al., 2012) are rooted in emotion regulation and acceptance, with identifying emotions key to promoting efficacy as a prerequisite to developing adaptive regulation skills (Vine & Aldao, 2014). Implications may involve psychoeducation for those delivering emotion regulation-based therapeutic interventions for eating behaviours, to inform about the importance of initial successful identification and description of feelings and identify individuals who need greater support to minimise poorer therapeutic outcomes. ...
... The ability to identify and understand emotions is a necessary prerequisite to developing adaptive emotion regulation skills (Vine & Aldao, 2014). It has been suggested that teaching emotion regulation skills could result in decreased emotional eating (Roosen et al., 2012); however, for individuals with higher levels of affective alexithymic characteristics and associated deficits, focusing on these aspects must precede targeting emotion. ...
... Psychotherapies for emotional eating such as compassion-based and dialectical behaviour therapies (Roosen et al., 2012) are rooted in emotion regulation and acceptance, with identifying emotions key to promoting efficacy as a prerequisite to developing adaptive regulation skills (Vine & Aldao, 2014). Implications may involve psychoeducation for those delivering emotion regulation-based therapeutic interventions for eating behaviours, to inform about the importance of initial successful identification and description of feelings and identify individuals who need greater support to minimise poorer therapeutic outcomes. ...
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Full-text available
Emotional eating, generally defined as (over)-eating in response to negative emotions, has been associated with poor physical and psychological outcomes. During a time of heightened negative affect, it is important to understand the impact of the COVID-19 pandemic and associated lockdown measures on eating behaviours, and further elucidate the ways in which emotional eating is related to emotion dysregulation and impaired abilities to identify emotions (i.e. alexithymia). The aims of this study were to explore perceived changes in eating behaviours in relation to self-reported negative affect during the pandemic and to examine direct and indirect effects of alexithymia on emotional eating. An online questionnaire measured these constructs in the general population of the United Kingdom (n = 136). Findings demonstrated that those who reported changes to their eating behaviours during the pandemic also reported greater levels of depression during the same time frame. Mediation analyses revealed that difficulties identifying and describing feelings both predicted emotional eating indirectly via emotion dysregulation. Findings contribute to the understanding of the mechanisms underpinning the relationship between alexithymia and emotional eating and describe changes to eating behaviours during COVID-19. We discuss how these findings should be applied, and recommendations for future research.
... For example, women in stress management conditions may engage in cognitive restructuring (in CBT condition) or mindfulness meditation (in RT condition) when distressed as opposed to emotional eating, a common stress response that may lead to further distress [71] and which may contribute to the development and maintenance of obesity [72]. There is evidence that both behavioral [73] and mindfulness-based psychological interventions [74] decrease emotional eating behaviors. Therefore, it is plausible that in our sample, OW/OB women in the stress management conditions decreased maladaptive emotional eating and increased adaptive coping responses, thereby increasing psychological well-being, and decreasing circulating inflammatory cytokines. ...
Article
Background: Overweight and obese (OW/OB) body mass index (BMI) is associated with greater inflammation and poorer outcomes in breast cancer (BC). Stress management interventions using cognitive behavioral therapy (CBT) and relaxation training (RT) have reduced inflammation in BC patients but have not been tested specifically in OW/OB patients undergoing primary treatment. We developed brief CBT and RT-based group interventions and tested their effects (vs time-matched Health Education [HE] control) on serum inflammatory cytokines (IL-6, IL-1β and TNF-α) in OW/OB vs normal weight (NW) BC patients during primary treatment. We hypothesized OW/OB women would show higher levels of inflammatory cytokines, and that stress management would decrease these cytokines more in OW/OB women than in NW women. Methods: Stage 0 - III BC patients were enrolled post-surgery and before initiating adjuvant therapy, were randomized to either 5 weeks of CBT, RT, or HE, and provided questionnaires and blood samples at baseline and 6-months. Serum cytokine levels were measured by ELISA. Repeated measures analysis of variance tested the interaction of condition by BMI by time in predicting cytokine levels over 6 months, controlling for age, stage, ethnicity, and income. Results: The sample (N = 153) majority was OW/OB (55.6%). We found differences in baseline IL-6 and IL-1β across BMI categories, with greater IL-6 (p < 0.005) and IL-1β (p < 0.04) in OW and OB vs NW women, but no difference between OW and OB women. There were no differences in baseline TNF-α among BMI groups. BMI category moderated the effect of brief stress management interventions on IL-6 changes over 6-months (p = 0.028): CBT/RT vs HE decreased IL-6 in OW/OB (p = 0.045) but not in NW patients (p = 0.664). There were no effects on IL-1β or TNF-α. Results could not be explained by differences in receipt of adjuvant therapy, prescription medications, or changes in physical activity. Conclusions: OW/OB women with newly diagnosed BC had significantly greater serum IL-6 and IL-1β than NW women post-surgery. Brief stress management delivered with primary treatment among OW/OB patients may reduce the increases in inflammatory markers known to accompany adjuvant treatments and could thus promote better outcomes. Clinical trial registration: NCT02103387.
... Since it is a practical and simple tool to determine the level of PA in older people, this type of instrument is very appropriate to study the level of PA in large populations [13]. The ease of administration, the minimal burden on respondents, and the low cost were highlighted among other factors [14]. ...
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Knowledge of physical activity (PA) can be considered a predictor of public health for society. Thus, this study aims to show content validity of the “Knowledge Questionnaire on World Health Organization (WHO) Recommendations on PA and Health” (CUAFYS-A) and reference values on adults’ knowledge of the WHO recommendations on PA. This is a quantitative, non-experimental, descriptive, and cross-sectional study, in which 579 adults completed an online questionnaire with demographic data. The questionnaire was made up of 9 items to measure PA related to knowledge. For the elaboration of the items of the questionnaire a disciplinary team formed it and for the analysis of results, a descriptive analysis of these was applied. Then an inferential analysis was performed, content validity, construct validity, and reliability were analyzed. The CUAFYS-A after its content analysis, obtained appropriate results in terms of pertinence and relevance; additionally, it showed Cronbach’s alpha coefficient of 0.62. Thereby, it was concluded the CUAFYS-A questionnaire proved to be a valid and reliable instrument to show reference values and to evaluate the knowledge of adults of PA and health according to the WHO recommendations.
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Third-wave cognitive behavioral interventions for weight loss have shown promise. However, sparse data exists on the use of dialectical behavior therapy for weight loss. Adapted dialectical behavior therapy skills programs may be especially well suited for adults who engage in emotional eating and are seeking weight loss. Dialectical behavior therapy is skills-based, shares theoretical links to emotional eating, and is effective in treating binge eating. The current study examined the feasibility, acceptability, and preliminary efficacy of Live FREE: FReedom from Emotional Eating, a 16-session group-based intervention. A total of 87 individuals expressed interest in the program, and 39 adults with overweight/obesity (BMI ≥25) and elevated self-reported emotional eating were enrolled. Live FREE targeted emotional eating in the initial sessions 1-9, and sessions 10-16 focused primarily on behavioral weight loss skills while continuing to reinforce emotion regulation training. Assessments were administered at baseline, post-treatment, and 6-month follow up. Enrolled participants were primarily female (97.4%) and Caucasian (91.7%). Treatment retention was strong with participants attending an average of 14.3 sessions and 89.7% of participants completing the intervention. On average, participants lost 3.00 kg at post-treatment which was maintained at follow-up. Intent-to-treat analyses showed improvements in key outcome variables (self-reported emotional eating, BMI, emotion regulation) over the course of the intervention. Combining dialectical behavior therapy skills with conventional behavioral weight loss techniques may be an effective intervention for adults with overweight/obesity who report elevated emotional eating.
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Emotion dysregulation is a transdiagnostic phenomenon in Eating Disorders (ED), and Dialectical Behaviour Therapy (DBT) (which was developed for reducing dysregulated emotions in personality disorders) has been employed in patients with ED. This systematic review and meta-analysis investigated whether the effect of DBT was stronger on emotion dysregulation, general psychopathology, and Body Mass Index (BMI) in participants with ED, when compared to a control group (active therapy and waitlist). Eleven studies were identified in a systematic search in accordance with PRISMA guidelines. Most studies included participants with Binge Eating Disorder (BED) (n = 8), some with Bulimia Nervosa (BN) (n = 3), and only one with Anorexia Nervosa (AN). The pooled effect of DBT indicated a greater improvement in Emotion Regulation (ER) (g = −0.69, p = 0.01), depressive symptoms (g = −0.33, p < 0.00001), ED psychopathology (MD = −0.90, p = 0.005), Objective Binge Episodes (OBE) (MD = −0.27, p = 0.003), and BMI (MD = −1.93, p = 0.01) compared to the control group. No improvement was detected in eating ER following DBT (p = 0.41). DBT demonstrated greater efficacy compared with the control group in improving emotion dysregulation, ED psychopathology, and BMI in ED. The limitations included the small number of studies and high variability.
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Objective Mindfulness-based interventions (MBIs) are being increasingly used as interventions for eating disorders including binge eating. This systematic review and meta-analysis aimed to assess two decades of research on the efficacy of MBIs in reducing binge eating severity. Methods We searched PubMed, Scopus and Cochrane Library for trials assessing the use of MBIs to treat binge eating severity in both clinical and non-clinical samples. The systematic review and meta-analysis was pre-registered at PROSPERO (CRD42020182395). Results Twenty studies involving 21 samples (11 RCT and 10 uncontrolled samples) met inclusion criteria. Random effects meta-analyses on the 11 RCT samples (n = 618: MBIs n = 335, controls n = 283) showed that MBIs significantly reduced binge eating severity (g = −0.39, 95% CI -0.68, −0.11) at end of trial, but was not maintained at follow-up (g = −0.06, 95% CI, −0.31, 0.20, k = 5). No evidence of publication bias was detected. On the Cochrane Risk of Bias Tool 2, trials were rarely rated at high risk of bias and drop-out rates did not differ between MBIs and control groups. MBIs also significantly reduced depression, and improved both emotion regulation and mindfulness ability. Conclusion MBIs reduce binge eating severity at the end of trials. Benefits were not maintained at follow-up; however, only five studies were assessed. Future well-powered trials should focus on assessing diversity better, including more men and people from ethnic minority backgrounds.
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Significant cross-sectional associations between mood and weight have been made in women; however, data on associated longitudinal effects and their psychological and behavioral mechanisms are required to inform obesity treatments that mostly have limited success beyond the very short term. Women participating in behavioral obesity treatments were assessed on psychological and behavioral measures, and weight change over 12 months. A treatment focused on physical activity and self-regulation (n = 67) had significantly better improvements than a treatment centered around weight-loss education (n = 64) on measures of mood (overall mood, depression, anxiety), self-regulation, emotional eating, eating behaviors, physical activity, and weight in women with obesity. Incorporating a lagged variable design, 12-month weight loss was significantly predicted (separately) by changes in overall negative mood, depression, and anxiety. When changes in measures of self-regulation, emotional eating, and eating behaviors were sequentially entered as mediators, mood change-weight change relationships were rendered non-significant. Significant mediation paths were: mood change→self-regulation change→weight change, and mood change→self-regulation change→eating behavior change→weight change. They were unaffected by the treatment group. Findings contributed to both theory and obesity intervention architectures via a design sensitive to the dynamic psychological and behavioral changes occurring within weight-loss processes.
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Objective: The growing worldwide prevalence of overweight and obesity, despite treatment strategies remain the health problem. Over the past decade, increasing attention has been paid to psychological factors and a potentially comprehensive, multimodal skills-based treatment. The purpose of this study was to evaluate the efficacy of dialectical behavior therapy (DBT) on weight loss in obese women with emotional and behavioral disorders. Materials and Methods: In this quasi-experimental study, statistical population from convenience sampling consisted of 42 obese women with body mass index (BMI) more than 29.9 kg/m2 divided in 3 groups, behavioral, emotional and control. Descriptive and analytic statistics were computed according to demographic information, emotional eating scale and Dutch eating behavior questionnaire. Intervention included 13 sessions of 1.5hr group therapy, DBT-skills training from April to September 2019. Mixed-effect modeling ANOVA with repeated measurements was performed by statistical analyses, IBM SPSS version 24 to study changes in variables over time. Results: The results demonstrated that the emotional such as anger, anxiety and depression, significantly decrease during the study period. (P-value
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Introduction: The Dutch Eating Behaviour Questionnaire for children was developed by Van Strien and Oosterveld (2008) to measure three different eating behaviors (emotional eating, restrained eating and external eating); it is an adaptation of the DEBQ for adults. Objective: The purpose of this study is to analyze the psychometric properties of the Dutch Eating Behavior Questionnaire for Children (DEBQ-C) with a Spanish sample. Method: The DEBQ-C was administered to 473 children (240 boys and 233 girls), from 10 to 14 years old. The sample included a Clinical Overweight Group (COG; n = 81) comprising children who were receiving weight loss treatments, a Non Clinical Overweight Group (NCOG, n = 31) comprising children who were overweight but not in treatment, and a Normal Weight Group (NWG, n = 280). Results: Results showed that the DEBQ-C had acceptable internal consistency (a = 0.70). Temporal stability was good for "External Eating" and "Restrained Eating" scales. Confirmatory factor analysis showed that the three-factor solution had good fit indices. Furthermore, the clinical overweight participants scored significantly higher on "External Eating" and "Restrained Eating" compared to the normal weight children. Conclusion: The DEBQ-C proved to be an effective instrument for researching children's eating behaviors.
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Dialectical behavior therapy (DBT) is a treatment that was originally designed to treat patients diagnosed with borderline personality disorder (BPD). Recent empirical evidence suggests that this treatment may also have some promise for the treatment of eating disorder patients. We propose that appropriately trained therapists may use the standard DBT model with some adjustments for an eating disorder diagnosis. These adjustments are both theoretical and practical and include broadening the biosocial theory, developing eating disorder-specific dialectics, highlighting eating disorder behaviors in the treatment targets, expanding the diary card, and adding a nutrition skills module.
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To assess the dimensional structure, reliability, and validity of the Dutch version of the SCL-90 responses of normal nonpatients and 703 noninstitutionalized phobics were factor analyzed separately. The SCL raw scores were subjected to a principal components analysis with varimax rotation to simple structure, resulting in 3 clinically meaningful factors for the normals: hostility, somatization, and agoraphobia. In addition, a 4th factor emerged for the phobics social inadequacy. The 3- and 4-factor solutions were highly stable across populations (normals vs phobics). Moreover, because of relatively high item–total correlations and validational findings, a unitary index of psychological discomfort, psychoneuroticism, was useful. In both groups of Ss, internal consistency of factored scales and global distress index proved satisfactory, while evidence for discriminant validity of the SCL was found in nonsignificant to low correlations with biographical data on the one hand and differential correlational patterns with these data on the other. Whether the SCL-90 does measure the more transient states of psychopathology has to be examined more fully. (61 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)