رفتار درمانی دیالکتیکی اصلاح شده برای اختلال پرخوری افراطی نوجوانان: گزارش یک مورد
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|31308||2007||11 صفحه PDF||سفارش دهید||محاسبه نشده|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Cognitive and Behavioral Practice, Volume 14, Issue 2, May 2007, Pages 157–167
Given the lack of empirically supported treatments available for adolescents with eating disorders, it is important to investigate the clinical utility of extending treatments for adults with eating disorders to younger populations. Dialectical behavior therapy for binge eating disorder, based on the affect-regulation model, conceptualizes binge eating as a behavioral attempt to influence, change, or control painful emotional states. With promising research findings in adult women, it is of clinical interest whether the dialectical behavior therapy for binge eating disorder treatment manual could be usefully adapted for an adolescent population. This report describes adolescent-specific modifications (including the use of family sessions) to standard dialectical behavior therapy for binge eating disorder, with an illustrative case study. While more rigorous case studies are needed prior to establishing justification for a randomized trial, this pilot case provides preliminary support for a modified version of dialectical behavior therapy for binge eating disorder as a therapeutic option for adolescents with binge eating disorder.
Binge eating disorder (BED) and bulimia nervosa are common disorders in adolescents, with estimates of between 1% to 2% meeting diagnostic thresholds for BED and bulimia nervosa and an additional 3% to 5% with significantly disordered eating and weight and shape concerns (see, for example, reviews by Chamay-Weber et al., 2005 and Schneider, 2003). Although effective treatments for these problems have been identified in adults (e.g., cognitive behavior therapy, interpersonal psychotherapy, dialectical behavior therapy, antidepressant medications; Hay et al., 2004, Pederson et al., 2003 and Telch et al., 2001), few reports include adolescents. In this article we describe how we have adapted a treatment model of dialectical behavior therapy (DBT) for adults with BED to an adolescent population. A case study illustrating our application of the adapted model is included. DBT for BED is based on the affect-regulation model of binge eating. Drawing on an extensive literature linking negative affect and disordered eating (Abraham and Beumont, 1982, Arnow et al., 1992, Arnow et al., 1995 and Polivy and Herman, 1993), the affect-regulation model conceptualizes binge eating as a behavioral attempt to influence, change, or control painful emotional states (Chen and Linehan, 2005, Wiser and Telch, 1999 and Wisniewski and Kelly, 2003). Neither cognitive behavior therapy nor interpersonal psychotherapy, the best-studied treatments for BED to date, focuses on the role of dysregulated emotions in binge eating. While effective, both treatments leave about 40% to 50% of patients symptomatic at the end of therapy (e.g., Fairburn, Marcus, & Wilson, 1993). Because of the number of patients left unremitted, there is interest in developing and researching other theoretical conceptualizations and treatment models for BED. DBT for BED, with its grounding in affect regulation and direct focus on the link between dysregulated emotion and dysregulated eating behaviors, is one such model. DBT, originally developed by Linehan (1993a, 1993b) as a treatment for borderline personality disorder, is currently the most comprehensive and empirically supported affect-regulation treatment for borderline personality disorder (American Psychiatric Association, 2001). Researchers (Chen and Linehan, 2005, Waller, 2003, Wiser and Telch, 1999 and Wisniewski and Kelly, 2003) 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 as an emotion-regulation behavior in patients with disordered eating. To date, preliminary studies investigating the adaptation of DBT to target disordered eating have been promising (Safer, Telch, & Agras, 2001a; Safer, Telch, & Agras, 2001b; Telch, 1997a; Telch, Agras, & Linehan, 2000,2001). For example, 82% of the adult women in an uncontrolled study of DBT for BED were abstinent (e.g., no objective binge episodes within the last 4 weeks of treatment) after 20 sessions, with none dropping out after commencing treatment (Telch et al., 2000). A subsequent randomized trial found 89% of the participants assigned to 20 sessions of DBT were abstinent compared to 12.5% in the wait-list condition, with 9% dropping out after commencing treatment (Telch et al., 2001). Given the lack of empirically supported treatments available for adolescents with eating disorders, it is important to investigate the clinical utility of extending adult treatments to younger populations. The decision was made to pilot DBT for BED based on several factors. First, the very promising published findings in adult women with BED coupled with the generally low dropout rates (Telch et al., 2000 and Telch et al., 2001) suggested the treatment model to be highly acceptable, an important attribute given the notorious difficulty engaging adolescents in individual treatment. Second, researchers have shown adolescents to be developmentally capable of responding to modified versions of DBT for borderline personality disorder in the outpatient setting (Katz et al., 2004, Miller et al., 2002 and Rathus and Miller, 2002). Finally, while cognitive behavior therapy and interpersonal psychotherapy for BED have received more empirical support in adults than DBT for BED, none of these treatments have been systematically researched in adolescents with BED.