Control Binge Eating Disorder with Mindfulness
By John M. de Castro, Ph.D.
“Psychotherapy approaches, including DBT, have been shown to be effective in helping a person with binge eating disorder overcome abnormal eating behaviors.” – Jacquelyn Ekern
Around 30 million people in the United States of all ages and genders suffer from an eating disorder; either anorexia nervosa, bulimia, or binge eating disorder. 95% of those who have eating disorders are between the ages of 12 and 26. Eating disorders are not just troubling psychological problems, they can be deadly, having the highest mortality rate of any mental illness. Binge eating disorder involves eating a large amount of food within a short time-period while experiencing a sense of loss of control over eating.
Eating disorders can be difficult to treat because eating is necessary and cannot be simply stopped as in smoking cessation or abstaining from drugs or alcohol. One must learn to eat appropriately not stop. So, it is important to find methods that can help prevent and treat eating disorders. Contemplative practices, mindfulness, and mindful eating have shown promise for treating eating disorders. Acceptance and Commitment Therapy (ACT) is a mindfulness-based therapy that has also been shown to alter eating behavior. Dialectical Behavior Therapy (DBT) produces behavior change by focusing on changing the thoughts and emotions that precede problem behaviors, as well as by solving the problems faced by individuals that contribute to problematic thoughts, feelings and behaviors. In DBT five core skills are practiced; mindfulness, distress tolerance, emotion regulation, the middle path, and interpersonal effectiveness.
In today’s Research News article “Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: a controlled study.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7285554/), Lammers and colleagues recruited obese (BMI>30) adults who were diagnosed with binge eating disorder and engaged in emotional eating. They were randomly assigned to receive once a week for 20 weeks of either 3.75 hours of Cognitive Behavioral Therapy (CBT) or 2 hours of Dialectical Behavior Therapy (DBT). They were measured before and after treatment and 6 months later for eating disorders, emotion regulation, general psychopathology, depression, and body size.
They found that both groups had reduced eating disorder psychopathology after treatment and 6 months later with the Cognitive Behavioral Therapy (CBT) group having better outcomes with 65% of the patients shifting from dysfunctional to functional at follow-up as compared to 46% for the Dialectical Behavior Therapy (DBT) group.
These results were contrary to the researchers’ expectation that Dialectical Behavior Therapy (DBT) would be more efficacious than Cognitive Behavioral Therapy (CBT). One possible explanation for the superiority of CBT was that it contained a greater amount of therapeutic contact hours, 3.75 hours per week, than DBT, 2 hours per week. But the results clearly show that both treatments were effective in treating binge eating disorder in obese patients with emotional eating.
So, control binge eating disorder with mindfulness.
“Integrating mindfulness techniques in binge eating disorder treatment has been shown to reduce binge eating, improve nutritional outcomes, improve weight management, as well as enhance diabetes management.” – Jacquelyn Ekern
CMCS – Center for Mindfulness and Contemplative Studies
This and other Contemplative Studies posts are also available on Google+ https://plus.google.com/106784388191201299496/posts and on Twitter @MindfulResearch
Lammers, M. W., Vroling, M. S., Crosby, R. D., & van Strien, T. (2020). Dialectical behavior therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: a controlled study. Journal of Eating Disorders, 8, 27. https://doi.org/10.1186/s40337-020-00299-z
Current guidelines recommend cognitive behavior therapy (CBT) as the treatment of choice for binge eating disorder (BED). Although CBT is quite effective, a substantial number of patients do not reach abstinence from binge eating. To tackle this problem, various theoretical conceptualizations and treatment models have been proposed. Dialectical behavior therapy (DBT), focusing on emotion regulation, is one such model. Preliminary evidence comparing DBT adapted for BED (DBT-BED) to CBT is promising but the available data do not favor one treatment over the other. The aim of this study is to evaluate outcome of DBT-BED, compared to a more intensive eating disorders-focused form of cognitive behavior therapy (CBT+), in individuals with BED who are overweight and engage in emotional eating.
Seventy-four obese patients with BED who reported above average levels of emotional eating were quasi-randomly allocated to one of two manualized 20-session group treatments: DBT-BED (n = 41) or CBT+ (n = 33). Intention-to-treat outcome was examined at post-treatment and at 6-month follow-up using general or generalized linear models with multiple imputation.
Overall, greater improvements were observed in CBT+. Differences in number of objective binge eating episodes at end of treatment, and eating disorder psychopathology (EDE-Q Global score) and self-esteem (EDI-3 Low Self-Esteem) at follow-up reached statistical significance with medium effect sizes (Cohen’s d between .46 and .59). Of the patients in the DBT group, 69.9% reached clinically significant change at end of the treatment vs 65.0% at follow-up. Although higher, this was not significantly different from the patients in the CBT+ group (52.9% vs 45.8%).
The results of this study show that CBT+ produces better outcomes than the less intensive DBT-BED on several measures. Yet, regardless of the dose-difference, the data suggest that DBT-BED and CBT+ lead to comparable levels of clinically meaningful change in global eating disorder psychopathology. Future recommendations include the need for dose-matched comparisons in a sufficiently powered randomized controlled trial, and the need to determine mediators and moderators of treatment outcome.
Plain English summary
Binge eating disorder (BED) is mostly treated with cognitive behavior therapy (CBT). The treatment focusses on reducing efforts to diet. Yet, a substantial number of patients still suffer from binge eating after this treatment. We suggest that patients with BED are better served with a treatment that helps them cope with negative emotions in a healthier way. Dialectical behavior therapy for BED (DBT-BED) is one such treatment. To test this, we compared outcomes of DBT-BED to the intensive CBT program that is common in our treatment center. We did so, in individuals with BED who might especially benefit from DBT-BED: those who are overweight and eat in response to emotions. Greater improvements were observed in the CBT group regarding the number of objective binge eating episodes at the end of treatment, and regarding global eating disorder psychopathology and self-esteem 6 months after treatment. Yet, patients in the CBT group received more therapy hours than in the DBT-BED group, which may have advantaged the CBT treatment. Concurrently, in both groups a comparable percentage of patients showed clinically meaningful changes in global eating disorder psychopathology. In conclusion, our results overall support the intensive CBT program over DBT-BED. Yet, given the fact that DBT-BED is less time-consuming (so cheaper) and presents similar percentages of meaningful change in global eating disorder psychopathology, it is worthwhile to further test the effects of DBT-BED in future studies.