Dialectical Behavior Therapy for Binge Eating and Bulimia Read Online Free PDF

development of end-organ damage at a younger age (Rydall, Rodin, Olmsted, Devenyi, & Dane— man, 1997).
    Emotions, Affect Regulation, and BN
    Aversive emotions may bring about, maintain, and be a consequence of BN behaviors. Bulimic behaviors are frequently related to negative affective states, including anxiety, depression, and anger (e.g., Abraham & Beumont, 1982; Arnow, Kenardy, & Agras, 1995; Stice, Killen, Hayward, & Taylor, 1998). In a study recording 2 weeks of data from participants with BN who were given handheld computers, lower mood (less positive affect, more negative affect, higher anger/hostility, and higher stress) was reported on days when binge eating and vomiting occurred (Smyth et al., 2007). Within single days, the researchers noted a worsened mood trajectory over the hours prior to a binge–purge episode and a sharply improved mood trajectory following the event. These fndings help explain the persistence of BN behaviors in the short run despite their not being an effective overall coping strategy. In other words, the average “best” mood on a binge–purge day was still more negative than the mood on days on which no binge–purge occurred. How— ever, within a few hours after the event, binge and purge behaviors are strongly negatively reinforced by allowing escape or avoidance of strongly negative affective states (Smyth et al., 2007). These results are supported by other researchers (e.g., Lingswiler, Crowther, & Stephens, 1989; Lynch, Everingham, Dubitzky, Harman, & Kassert, 2000; Powell & Thelen, 1996; Steiger et al., 2005). Likewise, purging or laxative use in individuals with BN has been shown to reduce negative affect prompted by binge eating (e.g., Powell & Thelen, 1996).
    Self-report studies suggest that, in addition to increased negative mood on binge–purge days, individuals with BN have higher levels of depression (Bulik, Lawson, & Carter, 1996) and anger (Waller et al., 2003) and more fuctuating moods (Johnson & Larson, 1982). Individuals with BN may also have defcits in the processing of emotions. For instance, participants with BN, compared with controls, show attentional defcits, including paying selective attention to emotionally laden words (e.g., body shape or weight and food-related words) when using the Stroop paradigm (Dobson & Dozois, 2004), the visual probe paradigm (Rieger et al., 1998), and the dichotic listening task paradigm (Schotte, McNally, & Turner, 1990). When presented food cues in experimental paradigms, participants with BN, compared with those without BN, indicate greater anxiety (Bulik et al., 1996) and have a potentiated startle refex, suggesting strong negative affect (Mauler, Hamm, Weike, & Tuschen-Caffer, 2006). In addition, participants with BN compared with normal controls, endorse greater diffculties with self-awareness of emotions (Legenbauer, Vocks, & Ruddel, 2008). Along with other eating-disordered populations, they report more diffculties with distress tolerance than do women

Why Dialectical Behavior Therapy?
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    without histories of an eating disorder (Corstorphine, Mountford, Tomlinson, Waller, & Meyer, 2007).
    For those wishing further information about eating disorders and obesity, excellent overviews are available in Fairburn and Brownell (2001) and Garner and Garfnkel (1997).
    RATIONALE FOR D EVELOPMENT OF DBT AS A DAPTED FOR BED AND BN
    Existing treatments can ameliorate symptoms of BED and BN. These include (1) CBT (Fairburn, 1995; Marcus, 1997; Wilson, Fairburn, & Agras, 1997), which focuses on normalizing disordered eating patterns (i.e., decreasing dietary restraint) and tackling overvalued ideas regarding weight and shape; (2) IPT (Klerman & Weissman, 1993; Wilfey et al., 1993; Wilfey et al., 2002), which aims to resolve interpersonal problems that maintain disordered eating; and (3) BWL (Agras et al., 1994; Marcus, Wing, & Fairburn, 1995; Munsch et al., 2007), which stresses decreasing the chaotic eating patterns and the