CHANGE IN DEFENSIVE FUNCTIONING OVER THE COURSE OF GROUP PSYCHODYNAMIC INTERPERSONAL PSYCHOTHERAPY FOR WOMEN WITH BINGE EATING DISORDER

ii Acknowledgements . iii List of Tables . vii List of Figures . ix List of Appendices . x Introduction . 1 Defence Mechanisms and Defensive Functioning . 2 Measuring Defence Mechanisms . 8 Binge Eating Disorder and Defensive Functioning . 10 Attachment Theory . 13 Group Psychodynamic Interpersonal Psychotherapy . 18 Objectives . 23 Hypotheses . 23 Method . 24 Participants . 24 Measures . 25 Procedure . 29 DMRS Coding . 30 Data Analysis Plan . 31 Multi-level Modelling . 33 Results . 37 CHANGE IN DEFENSIVE FUNCTIONING v Data Screening . 37 Sample Characteristics . 37 Multi-level Modeling . 43 Discussion . 50 Objectives . 50 Reliability Between Raters Using the DMRS . 51 Overall Defensive Functioning and Treatment Outcome . 52 Change in Defensive Functioning During Group Treatment . 52 Change in Defensive Functioning Associated with Change in Treatment Outcomes . 54 Change in Defensive Functioning and Change in Treatment Outcomes Moderated by Attachment Anxiety. 55 Clinical Implications . 56 Limitations . 57 Generalizability and Future Directions . 60 Conclusion . 61 References . 62 Appendix A: . 72 Appendix B: . 73 Appendix C . 74 Appendix D . 75 Appendix E . 77 CHANGE IN DEFENSIVE FUNCTIONING vi Appendix F. 79 Appendix G . 80 CHANGE IN DEFENSIVE FUNCTIONING vii List of Tables Table 1: List of defences and associated function from the DMRS . 4 Table 2: Mean, Standard Deviation, and Range of the Number of Coded Defences by Therapy Session . 32 Table 3: Sample Characteristics . 38 Table 4: Defence level ICC Values and Total Number of Defences Coded Between Rating Pairs. 40 Table 5: Mean and Standard Deviations for Attachment Style Questionnaire Subscales at Pre-treatment and Post-treatment by Attachment Anxiety Condition . 41 Table 6: Correlations Between Session Three ODF Scores and Pre-treatment Measures of Depression, Interpersonal Problems, Self Esteem, and Binge Frequency . 42 Table 7: Correlations Between Session 3 ODF Scores with Pre-treatment Subscales from the Attachment Styles Questionnaire . 42 Table 8: Correlations Between Session 16 ODF Scores with Post-treatment Measures of Depression, Interpersonal Problems, Self Esteem, and Binge Episodes . 43 Table 9: Correlations Between Session 16 ODF Scores with Post-treatment Subscales from the Attachment Styles Questionnaire . 43 Table 10: Mean and SD Values for ODF Scores at Sessions 3, 8, and 16 . 45 Table 11: Mean and SD for Treatment Outcome Variables from Pre-treatment to 12Months Post-treatment . 46 Table 12: Multilevel Modelling of Change in Overall Defensive Functioning, Depressive Symptoms, Interpersonal Problems, Self Esteem and Binge Frequency Over Treatment . 47 CHANGE IN DEFENSIVE FUNCTIONING viii Table 13: Change in Overall Defensive Functioning Scores Predicting Change in Treatment Outcome on Measures of Depression, Interpersonal Problems, Self Esteem, and Binge Frequency. 48 Table 14: 2-Level Model Results Testing the Moderating Effect of Attachment Anxiety Condition on the Relationship Between Change in Overall Defensive Functioning and Change in Treatment Outcomes. 49 Table 15: A 2-Level Model Testing Change in Overall Defensive Functioning and Change in Interpersonal Problems and Self-Esteem Outcomes by Treatment Condition. 50 CHANGE IN DEFENSIVE FUNCTIONING ix List of Figures Figure 1. Triangle of Adaptation and Object Relations. 20 CHANGE IN DEFENSIVE FUNCTIONING x List of Appendices Appendix A:Defence Mechanism Rating Scale Scoring Sheet . 72 Appendix B:DSM-IV-TR Diagnostic Criteria for Binge-Eating Disorder . 73 Appendix C: Attachment Style Questionnaire . 74 Appendix D: Beck Depression Inventory . 75 Appendix E: Inventory of Interpersonal Problems . 77 Appendix F: Rosenberg Self-Esteem Scale . 79 Appendix G: Multi-Level Model Equations . 80 CHANGE IN DEFENSIVE FUNCTIONING 1 Change in Defensive Functioning Over the Course of Group Psychodynamic Interpersonal Psychotherapy for Women with Binge Eating Disorder Freud first conceptualized defense me