A Condensed Dialectical Behavior Therapy Skills Group for Binge Eating Disorder: Overcoming Winter Challenges.

Although binge eating disorder (BED) is a recent diagnostic category, research for efficacious and effective treatment is well underway. This case study describes a dialectical behavior therapy (DBT) skills group for BED implemented in an outpatient community clinic. Although based on Safer, Telch, and Chen's (2009) manual for BED and bulimia nervosa (BN), notable adaptations included shortening the group's duration from 20 to 12 weeks, adding an interpersonal effectiveness module and DBT-informed "Holiday Plan" worksheets, and providing inclement weather alternatives. Despite the added challenges associated with winter treatment of BED (e.g., holiday meals, weather-related schedule interruptions), the 3 women who completed treatment no longer met criteria for BED at termination and their feedback suggested that the treatment was highly acceptable. Group members demonstrated clinically significant reductions in disordered eating behavior and improvements in self-esteem, emotion regulation, and quality of life. Treatment gains were maintained at 1-year follow-up. Our discussion includes treatment implications and recommendations for future research.Keywords: binge eating; group therapy; dialectical behavior therapy skills; treatment; emotion regulationSince the publication of the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR), the Task Force's identification of binge eating disorder (BED) as a tentative category proposed for potential inclusion in future editions of the manual (American Psychiatric Association, 2000) has spurred a flurry of research on the diagnosis. The essential features of BED are recurrent episodes of binge eating, along with impaired control over and significant distress about these episodes. Although the criteria for binge eating episodes in BED are similar to those for bulimia nervosa (BN), individuals with BED do not engage in the compensatory behaviors seen in those with BN (e.g., self-induced vomiting, laxative abuse).Through case studies and randomized clinical trials (RCTs), dialectical behavior therapy (DBT) based treatments are recognized in the literature as efficacious approaches of treatment for BED. The purpose of this article is to describe an application of a DBT skills approach with a group of women presenting with BED. Specifically, this case study describes an adaptation of a DBT skills group manual derived from RCTs (Safer et al., 2009) based on economical and time constraints, group members' presenting concerns, and concurrent life events of individuals undergoing treatment (e.g., seasonal changes, holidays). We begin with an explanation of the empirical support for DBT as an effective treatment orientation for BED along with a rationale for the adaptations to DBT we implemented in this case study. Afterward, we present brief case histories and conceptualizations of our clients, the course of treatment, and symptom assessments pretreatment, at termination, and at 1-year follow-up. We finish with a discussion of the clinical and future research implications of our case study.EVIDENCE-BASED GROUP APROACHES FOR TREATMENT OF BEDGiven the symptomatological similarity between BED and BN, treatment approaches effective for BN have been modified for use with individuals exhibiting BED. A meta-analysis of 38 treatment studies recommended cognitive behavioral therapy (CBT) interventions as first-line treatments for BED (Vocks et al., 2010). Specifically, RCT studies demonstrated significant large effect sizes for CBT-based psychotherapy (d 5 0.82) and CBT-based structured self-help (d 5 0.84) in reducing binge eating frequency compared to waitlist conditions. In addition, analyzing pre-post changes across all psychotherapy treatments (80% CBT based), psychotherapy also had a large effect size on binge eating frequency (d 5 1.46), but no comparisons were conducted between orientations given insufficient data. Additional research supporting the efficacy of CBT for BED indicates that this approach outperforms treatment with antidepressant medication (Wilson & Fairburn, 1993). …