Examining the role of emotion regulation in dialectical behaviour therapy self-help for binge-eating disorder

Singleton, Christopher William (2020) Examining the role of emotion regulation in dialectical behaviour therapy self-help for binge-eating disorder. Doctoral (PhD) thesis, Memorial University of Newfoundland.

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Abstract

Background: Dialectical behavior therapy (DBT) for binge-eating disorder (BED) is based on an emotion regulation (ER) model of BED. This model suggests that individuals with BED struggle with ER and engage in binge-eating in an attempt to manage difficult emotions (e.g., numbing, distracting). Thus, DBT for BED focuses on the development of more adaptive ER skills so that individuals are less likely to binge eat to cope with uncomfortable feelings. While DBT is an evidence-based treatment for BED, little research has examined whether ER acts as a mechanism of change in DBT for BED. The goal of the present study was to examine the role of ER in DBT self-help (DBT-SH) for BED outcome. Methods: A secondary analysis of data from a recent randomized controlled trial (RCT) of DBT-SH was conducted. A community sample of 71 adults diagnosed with BED took part in the trial. Participants were randomized to receive either DBT-SH or an active SH control condition for 12 weeks. Assessments of BED symptoms, difficulties in ER, and global distress were conducted at baseline and post-treatment. Results: Participants in both conditions demonstrated sizable improvements in binge-eating and medium-magnitude improvements ER from pre-to-post-treatment. However, there were no significant between-group differences in outcome and the associated effect sizes were small. Contrary to expectations, within the DBT-SH group, pre-post ER change did not significantly predict pre-post binge frequency change or post-treatment remission status and treatment condition did not significantly moderate the strength of this relationship. Effect sizes for these analyses were small. Discussion: The current study failed to provide evidence that ER is a mechanism of change in DBT-SH. Certain methodological limitations including small sample size and low statistical power should be considered when interpreting these results. However, it is also possible that other mechanisms of change besides ER explain how DBT-SH works for BED. Clinical implications and future directions are discussed.

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