Implementation of Dialectical Behavior Therapy in a Day Hospital Setting for Adolescents with Eating Disorders.

OBJECTIVE: This article discusses the implementation and preliminary outcomes of a Dialectical Behaviour Therapy (DBT) informed program integrated with Family Based Therapy (FBT) for adolescents with eating disorders within a day hospital program (DHP). METHOD: A retrospective analysis of hospital records between 2013-2015 provided descriptive characteristics of patients. Weight and percentage ideal body weight at admission and discharge, frequency of binge and purge episodes at discharge and readmissions were analysed. RESULTS: Analysis of patient characteristics indicated a broad range of eating disorder and comorbid psychiatric diagnoses among patients. Preliminary outcomes revealed increased weight and percentage of ideal body weight, decreased binge-purge status and few readmissions to the program over the two-year period studied. CONCLUSIONS: The implementation of a DBT informed DHP with integration of FBT is associated with improved patient outcomes. Ongoing challenges with respect to the implementation of DBT include modifying DBT to address varying developmental levels, ages and diagnoses and promoting adherence to the program by patients and families. Limitations include small sample size, uncontrolled chart review and the nature of DHP, which include a variety of components that may influence outcomes. This research will help to inform future implementation of treatment programs for adolescents with eating disorders.

OBJECTIF: Cet article discute de la mise en oeuvre et des résultats préliminaires d'un programme éclairé de thérapie comportementale dialectique (TCD) intégré à la thérapie familiale (TF) pour des adolescents souffrant de troubles alimentaires dans le cadre d'un programme d'hôpital de jour (PHJ). MÉTHODE: Une analyse rétrospective des dossiers de l'hôpital entre 2013 et 2015 a livré les caractéristiques descriptives des patients. Le poids et le pourcentage du poids corporel idéal à l'admission et au congé, la fréquence des épisodes d'hyperphagie et de purge lors du congé et les réadmissions ont été analysés. RÉSULTATS: L'analyse des caractéristiques des patients a indiqué une vaste gamme de troubles alimentaires et des diagnostics psychiatriques comorbides chez les patients. Les résultats préliminaires ont révélé un poids et un pourcentage accrus du poids corporel idéal, un état diminué de l'hyperphagie-purge, et peu de réadmissions dans le programme sur les deux ans de la période de l'étude. CONCLUSIONS: La mise en oeuvre d'un PHJ éclairé par la TCD intégrée dans la TF est associée à de meilleurs résultats chez les patients. Les difficultés actuelles à l'égard de la mise en oeuvre de la TCD consistent à modifier la TCD pour tenir compte des niveaux de développement variés, de l'âge et des diagnostics, et pour promouvoir l'adhésion au programme par les patients et les familles. Les limitations comprennent la petite taille de l'échantillon, un examen des dossiers incontrôlé et la nature du PHJ, qui englobe une variété de composantes susceptibles d'influer sur les résultats. Cette recherche aidera à éclairer la future mise en oeuvre des programmes de traitement pour les adolescents souffrant de troubles alimentaires.

Targeting premeal anxiety in eating disordered clients and normal controls: a preliminary investigation into the use of mindful eating vs. distraction during food exposure.

OBJECTIVE: Studies have demonstrated that negative affect increases prior to food intake in individuals diagnosed with an eating disorder. Mindfulness has been supported empirically to treat experiential avoidance stemming from anxiety. Thus, the current objective in this study is to empirically compare mindfulness vs. thought suppression invention during a food exposure in both clinical and nonclinical samples. METHOD: In a 2 (Group: clinical vs. nonclinical) × 2 (INTERVENTION: mindfulness vs. distraction) counterbalanced within treatment design, the current investigation sought to determine the differential effectiveness of a brief mindfulness intervention vs. a brief distraction intervention in women diagnosed with AN and BN in a clinical and nonclinical sample during a food exposure. RESULTS: Results indicated that the eating disorder group reported a significant increase in negative affect after the mindfulness intervention as compared to the distraction intervention, whereas the nonclinical group reported a significant decrease in negative affect after the mindfulness intervention as compared to the distraction intervention. DISCUSSION: Preliminary findings suggest that clinicians may want to proceed cautiously when using mindful eating in those with severe eating disorders during the early stages of food exposure. Limitations and future directions are discussed.

An intensive DBT program for patients with multidiagnostic eating disorder presentations: a case series analysis.

OBJECTIVE: This study presents case-series data on a novel outpatient program that blends dialectical behavior therapy (DBT) with standard eating disorder (ED) interventions (i.e., food exposure, weight monitoring, cognitive modification, ED psychoeducation) for patients with complex and multidiagnostic ED presentations. METHOD: Quantitative and qualitative data was collected on a sample of seven consecutively admitted women who presented with a severe ED, a history of several failed treatment attempts, pervasive emotion dysregulation, and significant Axis I or II psychiatric comorbidity (e.g., PTSD, borderline personality disorder). RESULTS: Treatment was associated with reductions in ED symptoms, suicidal and self-injurious behaviors, treatment interfering behaviors, psychiatric and medical hospitalizations, and clinician burnout. DISCUSSION: Overall, the results suggest that this blended DBT/cognitive behavior therapy for ED treatment model is a promising intervention for this complex and "hard to treat" population.

Consistency between self-report and clinician-administered versions of the Yale-Brown Obsessive-Compulsive Scale.

BACKGROUND: Preliminary efforts to demonstrate the utility of a self-rated version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) have been promising; however, earlier reports are based on small clinical samples. The objective of the present study was to evaluate the level of agreement between the clinician-administered Y-BOCS and a self-report version. METHODS: Participants included 86 individuals with a principal diagnosis of obsessive-compulsive disorder (OCD). All participants were given the self-report version of the Y-BOCS to complete offsite and instructed to return it at a second assessment session (within a 2-week time frame), at which time a trained and experienced clinician administered the Y-BOCS interview. RESULTS: The two versions were moderately correlated with the highest correlation observed for the Compulsions subscale. Comparison of scores for individual items revealed several inconsistencies between the two measures: level of agreement was low for resistance items, and the interview version generated higher compulsion severity ratings. CONCLUSIONS: The study provided moderate support for the convergence of the self-report and clinician-administered version of the Y-BOCS, however, important difference were detected between the two assessment methods.

Recent advances in psychosocial treatments for borderline personality disorder.

In the past three years, several psychosocial treatments for borderline personality disorder have received empirical support. This review highlights findings from recent treatment studies and discusses how these findings have dramatically altered clinical practice for this disorder.

The patient's account of relapse and recovery in anorexia nervosa: a qualitative study.

OBJECTIVE: The purpose of this study was to explore the subjective accounts of weight-recovered female patients, who met DSMIV criteria for anorexia nervosa (AN), regarding their views of their illness following weight restoration. METHOD: Qualitative semi-structured interviews were administered to 15 participants to ascertain their perspective of the factors that either contributed to their maintaining a healthy weight, or the factors involved in their having relapsed over the follow-up period. RESULTS: Qualitative analyses revealed six core categories: internal motivation to change, recovery as a work in progress, the perceived value of the treatment experience, developing supportive relationships, awareness and tolerance of negative emotion and self-validation. DISCUSSION: This study provides valuable information about the way in which AN patients experience their illness and highlight the factors that help or hinder recovery. These findings may help enhance relapse prevention programs and potentially enhance our ability to identify and target those individuals at the greatest risk of relapsing.