Table 2 Dialectical behavior therapy trials for adolescent eating disorders
Authors (year) | Study design | Population | Therapy (n) | Attrition (%) | Tx length | FU | Summary of relevant findings | Quality appraisal | |
|---|---|---|---|---|---|---|---|---|---|
Dx(s) | Age M [range] | ||||||||
DBT (outpatient settings) | |||||||||
Accurso et al. (2018) [62] | Cohort study | AN | 15.5 [11–18] | FBT + DBT skills (11) | 27.3 | 19 sessions over 19 wks (≈ 4 mo) | None | By EOT, 36.4% (n = 4) of participants were weight-restored, with significant increase in weight over treatment (d = 1.39); 54.5% (n = 6) reported an EDE global score within 1 SD of community norms; and 18.2% (n = 2) achieved both weight restoration and EDE Global scores within community norms. Decrease in ED pathology was corroborated by parent accounts (PEDE; d = 0.55). Small improvements in distress tolerance (DTS; d = 0.14) and emotion regulation (DERS; d = 0.14) were also demonstrated. Of those with secondary amenorrhea (n = 5), 100% resumed menses during the course of treatment. Treatment was perceived as “appropriate” and “acceptable” by all patients and their families (TSPE). Patients reported therapeutic alliance as moderate, while parents rated it highly (HAq) | Faira |
Burton et al. (2020) [64] | Case study | BED | 18 [N/A] | DBT skills group (1) | 0 | 10 sessions over 10 wks (≈ 2 mo) | None | Throughout treatment, statistically significant decline in urges to engage in binge eating and mindless eating, with abstinence from mindless eating by week 2. At post-treatment, clinically significant improvement in depressive symptoms (RCI = 3.13), but no change in anxious or somatic symptoms. Decrease in binge eating was observed by EOT (BES), but not statistically significant (RCI = 1.64). Patient reported that radical acceptance was a particularly useful DBT skill | Includeb |
Fischer and Peterson (2015) [61] | Cohort study | BED, EDNOS | 16.2 [14–17] | Full-model DBT (10) | 30 | 6 mo | 6 mo | At post-treatment, seven treatment completers reported significantly reduced self-harm (DSHQ; d = 1.35); frequency of OBEs (d = 0.46), purging episodes (d = 0.66); and global eating psychopathology (EDE; d = 0.64). At FU, 85.7% of participants (n = 6/7) were abstinent from self-injury (DSHQ); 50.0% of participants (n = 3/6) were abstinent from binge eating; and 66.7% of participants (n = 2/3) were abstinent from purging. EDE scores continued to improve through follow-up (d = 1.13) | Faira |
Kamody et al. (2019) [65] | Cohort study | BED | 15.4 [14–18] | DBT skills group (15) | 0 | 10 sessions over 10 wks (≈ 2 mo) | None | Patients meeting criteria for BED decreased from BL (n = 6, 40%) to EOT (n = 3, 20%); and among those who completed follow-up, only 1 individual (9.1%) met criteria for BED. Youth and caregiver reports showed reductions in emotional eating (EES-C) and binge-eating post-treatment (EDE-Q). Acceptability ratings were high among treatment completers: 86.7% (n = 13) reported they would be willing to participate again; 93.3% (n = 14) reported they would suggest the intervention to someone else with eating problems; all participants (100%, n = 15) reported feeling confident in their ability to use learned skills to combat emotional overeating | Faira |
Kamody et al. (2020) † [67] | Secondary analysis of cohort study data (Kamody et al., 2019; [65]) | BED | 15.4 [14–18] | DBT skills group (15) | 0 | 10 sessions over 10 wks (≈ 2 mo) | None | Statistically significant increases in distress tolerance appraisal (DTS; d = 0.23), cognitive reappraisal (ERQ-CA; d = 0.38), and expressive suppression (ERQ-CA; d = 0.27) from BL to EOT. DBT was evaluated as both acceptable and feasible by patients (DBT-SRS), with radical acceptance possessing the highest mean rating, followed by mindful eating and three mind states | Faira |
Mazzeo et al. (2016) [70] | RCT | BED, LOC eating | 15.4 [13–17] | DBT skills group (28), versus weight mgmt. group (17) | 31.1 | Wave 1 = 12 wkly sessions (≈ 3 mo); waves 2–5 = 8 wkly sessions (≈ 2 mo) | None | Feasibility rated highly by therapists (therapist feasibility questionnaire), and feasibility and acceptability rated highly by patients (participant satisfaction questionnaire) for both conditions; neither condition was superior to the other. Statistically significant improvements in EDE-Q global scores, and eating, shape, and restraint subscales by EOT for both conditions; again, neither condition was superior to the other. Negative affect (EES-C) and EDE-Q weight concerns significantly improved by EOT, only for the weight management group. No changes in eating in the absence of hunger (EAH-C) for either condition | Poora |
Murray et al. (2015) [63] | Cohort study | BN | 15.7 [14–17] | FBT + DBT skills (35) | 0 | Varied (M = 77.2 days) (≈ 3 mo) | None | From intake to discharge, significant improvements in EDE-Q global eating scores, OBEs, SBEs, vomiting episodes, and DERS emotion regulation strategies. Improvements in parental efficacy were observed at EOT (PVA). No improvements in the remaining DERS subscales, EDE restraint and eating concerns, or BMI | Gooda |
Peterson et al. (2020) [68] | Cohort study | AN, OSFED | 15.3 [13–18] | FBT + DBT skills (18) | 33.3 | 26 sessions over 6 mo | None | From BL to EOT, large effect sizes for increases in adaptive skills (DBT-WCCL; d = 0.71) and decreases in dysfunctional coping strategies (DBT-WCCL; d = 0.85); medium effect sizes for decreases in binge eating (d = 0.40) and increase in %EBW (d = 0.32); and small effect sizes for decreases in EDE-Q global scores (d = 0.26), EDE-Q restraint subscales (d = 0.29), and CDI scores (d = 0.28). Post-treatment, 92% of the participants were abstinent from OBEs, compared to 75% pre-treatment | Faira |
Safer et al. (2007) [66] | Case study | BED | 16 [N/A] | DBT-informed individual therapy (1) | 0 | 21 sessions over 21 wks (≈ 5 mo) | 3 mo | Reduction in OBEs over the past 28 days, from 22 episodes pre-treatment, to 4 episodes post-treatment. Substantial reduction in EDE restraint subscale, though EDE weight, shape, and eating concerns either increased or remained the same. 3 lb weight gain by EOT. Only 1 OBE was reported 1 mo post-treatment, with no OBEs over the last 2 mos of FU | Includeb |
Salbach-Andrae et al. (2008) [69] | Cohort study | AN, BN | 16.5 [12–18] | Full-model DBT (12) | 8.3 | 50 sessions over 25 wks (≈ 6 mo) | None | Significant improvements in ED symptoms and global ED psychopathology post-treatment, with reductions on all EDI-2 subscales (d range: 0.43–1.10). Significant reduction in the Global Severity Index of the SCL-90-R by EOT (d = 0.57). Of the 11 treatment completers, 45.5% (n = 5) no longer met criteria for an ED by EOT. Over half (54.5%, n = 6) of treatment completers reported reduction in vomiting frequency (d = 1.7); all patients (100%; n = 5) who reported binge eating at BL were abstinent at EOT (d = 1.9); and 81.8% (n = 9) of treatment completers reported reduction in food restriction (d = 1.2). Significant increases in BMI for patients with AN (d = 2.60) | Faira |