Examining patient's use of, intention to use, and perceived helpfulness of emotion regulation strategies in an acceptance based behavioral treatment for bulimia nervosa as predictors of treatment outcome
Authors:   , Parker Megan Nicole , Juarascio Adrienne S. 
Published: July 2021

Higher rates of emotion dysregulation appear to be cross sectionally related to more severe bulimia nervosa (BN) symptoms and predict worse outcomes from treatment. As such, Mindfulness and Acceptance-based Treatments (MABTs) may be particularly helpful for individuals with BN because they directly address emotion regulation difficulties. MABTs have been shown to improve emotion regulation in individuals with EDs, however, little is known about which emotion regulation skills are the most acceptable and effective for individuals with BN. As such, the current study examined if the total number of skills a patient was using, perceived helpfulness, and intended future use of multiple skills was related to treatment outcomes. We also characterized which skills were most frequently identified by patients as helpful. Lastly, we examined if use of any specific skill was associated with better outcomes from a 20 session, outpatient Acceptance Based Behavioral Treatment (ABBT) for BN. Patients (N=14) were all females, ages 20 to 57 (M=31.57 SD=11.23) with an average BMI of 24.99 (SD=5.65) and a full threshold BN diagnosis. Observers watched video recordings of therapy sessions 18 and 19 where the therapist and patient jointly reviewed the emotion regulation strategies taught during treatment. Observers rated patient's expressions of skill use, perceived helpfulness and intended future use of each skill. We examined the relationship between skill use and changes in behavioral (ie. frequency of binge eating and inappropriate compensatory behaviors) and cognitive (ie. Eating Disorder Examination global scores) outcomes at post-treatment and six-month follow-up. Due to the small sample, we conducted spearman rank correlations and reported relations of at least medium strength (r [greater than or equal to] .3). Unexpectedly, total number of skills a patient reported using, perceiving as helpful, and intending to use skills during future moments of need were related to improvements in cognitive symptoms, but not bulimic behaviors at end of treatment and 6 month follow-up. Consistent with hypotheses, reporting using a larger number of skill during session 18 and 19 appeared to be related to larger improvements in outcomes from end of treatment to follow up. Further, use of values appeared to be the skill most commonly associated with larger improvements from pre-treatment to end of treatment and follow up. While using experiential acceptance and self-soothing appeared to be related to larger improvements in outcomes from end of treatment to follow-up. Future treatments for BN might maximize their effectiveness by fostering patient's use of specific emotion regulation skills (eg. committing and clarifying to values and experiential acceptance). Further, studies should measure skill use across the entire course treatment to establish whether skill use precedes changes in BN symptoms and if continued skill use is necessary for maintaining improvements long term.