Dialectical Behavior Therapy for Binge Eating and Bulimia (57 page)

in Mindfulness module, 110–111, 119a,

Anger, Acting Opposite skill, 144–145
Anxiety, anxiety disorders, 3t, 9–10

Acting Opposite skill with, 141–143
Apparently irrelevant behaviors (AIBs)
as treatment target, 37, 54–55, 82a, 85a
Assessments, in DBT for BED/BN research
studies, 223–224

Avoid Avoiding skill, 140, 153a

Avoidant personality disorder, 10

Awareness exercises, purpose of, 161–162
Axis I diagnosis, comorbid, 3, 3t, 7, 10
Axis II disorders, comorbid, 3, 3t, 7, 10

B

Bariatric surgery, 7

Behavioral chain analysis

case illustration, 196

in depth review with client, 61–65

guidelines for flling out, 57, 78a
introduction to, 57–59

problem behavior identifcation in, 57–58

sample of, 57, 75a–77a

sample of (blank copy), 79
a–81a

troubleshooting, 63–65

Behavioral weight-loss therapy, 13

Binge-eating disorder (BED)

dialectical behavior therapy rationale, 5–15

distinguishing characteristics, 5–6

emotion and affect regulation, 8–9, 18–19

gender ratio, 6

physiological consequences, 8

social/occupational impairment, 7–8
Bingeing (and purging). See also
Binge-eating

disorder; Bulimia nervosa

biosocial model, 18–20, 50–52

case illustration, group format, 203–213

case illustration, individual format, 190–203

chain analysis, 57–59

and commitment to abstinence, 43–48,
65–67, 88a

dialectical abstinence approach, 20–21,
65–67, 88a

in emotion regulation model, 13, 18–19,
33–34, 36, 48–49, 53–55

as emotional “quick fx,” 134–135

mindfulness incompatibility, 92–94
Biosocial model, binge eating (and purging),
18–20, 50–52

Body mass index, binge-eating disorder, 8
“Booster” group sessions, 218–219

Borderline personality disorder
and binge-eating disorder, 7

and bulimia nervosa, 10

dialectical behavior therapy effectiveness,
3–4, 17–18

Breathing exercises, 157–159

Building mastery activities, 137, 139f, 153a
Bulimia nervosa (BN). See also
Bingeing (and

purging)

case illustration, 190–214

diagnosis, 9

dialectical behavior therapy rationale, 13–14

emotions and affect regulation, 12–13, 18–

onset and course, 10

physiological consequences, 11–12

prevalence and symptomatology, 10–11
Burning Your Bridges homework sheet, 178a
Burning Your Bridges skill, 167–169

case illustration, 202

experiential exercise, 167–168

homework practice, 169, 178a

C

Capitulation, as treatment target, 37, 54
Case examples

group format, binge-eating disorder, 204–

individual format, bulimia nervosa, 190–203

CD-ROM support, 219

Chain analysis

case illustrations, 196–197, 208–209

dysfunctional links identifcation, 61, 87a
and egregious-behavior protocol, 58n
in group homework review, 26–29

guidelines for flling out, 57, 78a
in-depth review with client, 61–65

introduction to, 57–59

problem behavior identifcation, 57–58

sample of, 57, 75a–77a, 79a–81a
in skills practice report, 60–61

troubleshooting, 63–65

Chain-analysis monitoring form, 23, 75
a–77a,

79a–81a

Chinese “fnger puzzle,” 129

Cognitive-behavioral therapy

abstinence rates, DBT comparison, 15

versus DBT, rationale, 13

Commitment to abstinence from bingeing (and
purging)

case illustration, group format, 206

case illustration, individual format, 193–196

dialectical abstinence in, 20–21, 65–67, 88

eliciting and obtaining verbal commitment,
43–44, 45–47

homework practice, 47–48, 67

maintenance of, future directions, 218–219

renewing commitment, 179–180

therapist techniques, 24–25, 43–48
Commitment, motivational strategies, 24–25,
43–44, 46–47

Commitment to treatment, pretreatment
interview, 32

Communication, emotions function, 130–133
Comorbid psychopathology

in DBT for binge-eating disorder study, 3, 3t
as treatment contraindication, 3–4

Confdentiality, 56

Connecting Present Commitments to Prior
Commitments, 25

Contraindications to Adapted DBT treatment,
3–4

“Conveyer belt” exercise, 101

Coping Ahead skill, 184–185

Cost-effectiveness of DBT adapted for BED/BN,
improving, 221–222

Counting Your Breaths skill, 158–159
Cravings

as treatment target, 37, 54

Urge Surfng skill in, 108–110, 118a
Crisis Survival skills, 169–176

case illustration, 201–202

Distraction skills, 170–171

experiential exercise, 173–174

function, 155, 169

Index

homework practice, 176

Improving the Moment in, 172–173

overview, 170

review of, 184

Self-Soothing in, 171–172

Thinking of Pros and Cons in, 174–175

troubleshooting, 175

Current emotion

Acting Opposite to skill, 141–146

Mindfulness of, 126–130

D

Deep breathing. See
Diaphragmatic breathing
Dental complications, bulimia nervosa, 11
Depression

and Acting Opposite skill, 144

and binge-eating disorder, 7, 9

and bulimia nervosa, 10, 12

“Describe” skill

experiential exercise, 101

homework sheet, 116a

in Mindfulness, 100–101

in Mindfulness of Your Current Emotion,
126–128

review of, 182

troubleshooting, 102

Diabetes, 8, 12

Dialectical abstinence

in case illustration, group format, 209–210

in case illustration, individual format, 197

essence of, 20–21, 65–67

homework sheet, instructions for practicing,

in introductory sessions protocol, 65–67

Olympic athlete metaphor, 66–67, 209

versus “touchdown every time” concept, 65n
Dialectical behavior therapy (DBT)
affect regulation model, 13–14

empirical evidence for, DBT adapted for
BED/BN, 14–15

empirical evidence for, standard DBT, 17–18

philosophical infuences, 17

Dialectical behavior therapy for BED/BN

adolescent clients, 215–218

Distress Tolerance module, 155–178

Emotion Regulation module, 120–154

future directions, 215–222

group sessions structure, 26–29

Mindfulness module, 89–119

pretreatment stage, 30–68

rationale for development of, 13–14, 16–21

research evidence, 14–15

therapist strategies, 22–25

weight loss adaptation of, 220–221

Dialectical philosophy, 17

Dialectical strategies, in treatment delivery,
22–25

Diaphragmatic breathing, 67–69

Diary cards

in group homework review, 26–29

homework practice, 59

instructions for flling out, 84a–85a
introduction to, 59

sample (blank copy) of, 82a–83a
troubleshooting, 64

Dieting, treating policy rationale, 21, 40–41
Distraction skills, 170–171

Distress Tolerance module, 155–178

Accepting Reality in, 155–169

adolescent clients, 216

case illustrations, 201–202, 212–213

client orientation, 39, 55

Crisis Survival skills, 169–176

function, 155–156

list of skills in, 177a

review of, 184

session by session content, 226–227
Door-in-the-Face techniques, 25

Drug abuse. See
Substance abuse/dependence
Dysfunctional links, in chain analysis, 61, 87a
E

Effect sizes, DBT treatment, 15

“Effectively” skill, 107–108

homework sheet, 117a

in Mindfulness, 107–108

review of, 182

“Emotion diary,” 135

Emotion dysregulation model, 70a. See also
Affect regulation

and dialectical behavior therapy, 13–14,
18–19

explanation to client, 33–34, 70a, 191–193

and invalidating environments, 19–20

in orientation to treatment, 48–52

rationale of, 18–21

treatment effect size evidence, 15
Emotion Dysregulation Model of Problem
Eating, 70a

Emotion Mind

bingeing (and purging) infuence, 95, 97

defnition, 95

homework practice, 98, 114a

reducing vulnerability to, 136–138, 139f,
153a, 200–201

Emotion Mind Homework Sheet, 114
a
Emotion Regulation Model. See
Emotion

Dysregulation Model of Problem Eating

Emotion Regulation module, 120–154

adolescent clients, 217

case illustration, group format, 211–212

case illustration, individual format, 199–201

describing emotions model in, 121–126,

function of emotions in, 130–133, 152
a

Mindfulness of current emotion in, 126–130

positive emotions in, 138, 140–141

pretreatment orientation, 38, 54–55

primary and secondary emotions in, 124–
125, 150
a

reducing vulnerability to Emotion Mind,
136–138, 139f, 153a, 200–201

review of, 183

session by session content, 225–226

versus skillful emotion regulation behaviors,
more broadly defned, 38n2

skills training goals, 20–21

Wise Mind approach, 132–133

Emotional Eating Scale, 14–15, 224

Emotional sensitivity, bingeing (and purging)
link, 50

Emotions. See also
Current emotion

function of, 130–135, 152a

justifed versus unjustifed, 133–135

model for describing of, 121–126, 149a, 161

myths about, 146–147

primary versus secondary, 124–125, 150a
quotes about, 214

Empathy, balance with irreverence, therapist
stylistic strategy, 24

Evaluating Pros and Cons strategy
case illustration, 205–206

in commitment to abstinence, 43–44, 47–48

therapist role, 25

Exclusion criteria, 223

Exercise, emotional vulnerability reduction,

Extending strategy, therapist role, 23

F

Facial expressions, physiology, 161
Family sessions, adolescents, 218