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

overconsumption of calories char— acteristic of obese clients with BED. Although such treatments address emotions (e.g., an IPT focus on interpersonal role disputes or grief would address negative emotions), none directly focuses both theoretically and specifcally on the role of negative emotions in BED and BN.
    The fact that a signifcant number of clients with BED and BN continue to suf— fer from their eating-disorder symptoms either at posttreatment with CBT, IPT, or BWL or over the period following treatment (Wilson et al., 2007) calls for other theoretical conceptualizations and/or treatment approaches for BED and BN. One such model is the affect regulation model. Drawing on an extensive literature that links negative affect and disordered eating (Abraham & Beumont, 1982; Arnow, Kenardy, & Agras, 1992, 1995; Polivy & Herman, 1993), the affect regulation model conceptualizes binge eating and other types of eating pathology (e.g., vomit— ing, restrictive eating) as behavioral attempts to infuence, change, or control pain— ful emotional states (Linehan & Chen, 2005; Waller, 2003; Wiser & Telch, 1999; Wisniewski & Kelly, 2003). The binge episodes appear to function in both BED and BN by providing negative reinforcement or momentary relief from these aversive emotions (Arnow et al., 1995; Polivy & Herman, 1993; Smyth et al., 2007; Stickney, Miltenberger, & Wolff, 1999).
    As neither CBT, IPT, nor BWL is grounded in the affect regulation model, a new treatment based on remediating the hypothesized emotion regulation def— cits in BN and BED was developed. DBT, originally developed by Linehan (1993a, 1993b), is the most comprehensive and empirically supported affect regulation treatment for borderline personality disorder to date (American Psychiatric Asso— ciation, 2001). Among others, Telch (1997a, 1997b) recognized that DBT’s conceptualization of self-injury as a functional (albeit maladaptive) affect regulation behavior in patients with borderline personality disorder might provide a helpful model for understanding the function (albeit maladaptive) of binge eating and/or purging as emotion regulation behaviors in patients with disordered eating. Given that DBT is specifcally designed to teach adaptive affect regulation skills and to

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    DIALECTICAL BEHAVIOR THERAPY FOR BINGE EATING AND BULIMIA target behaviors resulting from affect dysregulation, a theoretical rationale exists for applying DBT to treat BED and BN (see also McCabe, La Via, & Marcus, 2004; Telch et al., 2000, 2001; Wisniewski & Kelly, 2003; Wiser & Telch, 1999).
    RESEARCH E VIDENCE FOR DBT FOR BED AND BN
    To date, preliminary studies investigating the adaptation of DBT to target disordered eating have been promising but limited to single case reports (Safer et al., 2001a; Telch, 1997b), uncontrolled case series (Palmer et al., 2003; Salbach— Andrae, Bohnekamp, Pfeiffer, Lehmkuhl, & Miller, 2008), uncontrolled trials (Salbach, Klinkowski, Pfeiffer, Lehmkuhl, & Korte, 2007; Telch et al., 2000), and three randomized controlled trials (Safer, Robinson, & Jo, in press; Safer et al., 2001b; Telch et al., 2001).
    The treatment described in this book is currently the only adaptation of DBT for eating disorders that is supported through randomized trials in which clients were assigned, by chance, either to DBT as adapted for BED (Safer et al., in press; Telch et al., 2001) or BN (Safer et al., 2001b) or to a control condition (e.g., wait list or active nonspecifc psychotherapy). Because factors that may infuence outcome are distributed across groups randomly, the chance of a particular bias or factor confounding the results is minimized. Hence, randomized control trials are consid— ered the most reliable form of scientifc evidence for the effcacy of a clinical treatment (e.g., Chambless & Hollon, 1998).
    This adapted DBT treatment was originally developed for adult women (ages 18–65) who met criteria for BED, BN, or partial BN (e.g., objective binge