Evaluating the Pilot Implementation of a Culturally Responsive Dialectical Behavior Therapy Skills Intervention for Binge Eating Behaviors Among Adolescents
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The affect regulation model conceptualizes episodes of emotional overeating and binge eating as an attempt to regulate or change ones emotions. Dialectical behavior therapy, an evidence-based treatment for individuals with severe emotion dysregulation, has shown promise as an effective treatment for individuals with eating disorders, including binge eating disorder. Dialectical behavior therapy has also been identified and supported as an effective treatment for adolescents with severe emotion dysregulation. Research has only begun to explore the application of dialectical behavior therapy as an evidence-based treatment for adolescent binge eating and related behaviors; however, use of a condensed dialectical behavior therapy skills intervenion to target binge eating is a novel area of study and yet to be explored. Further, research on how this treatment approach could be generalized to subclinical, emotional overeating behaviors is needed. The purpose of the present study was to examine the acceptability, feasibility, and preliminary efficacy of a culturally responsive dialectical behavior therapy skills group intervention to target emotional overeating behaviors in adolescents. Participants were 15 adolescents between the ages of 14-18 (100% Black, 73.3% female) endorsing emotional overeating behaviors, who participated in a condensed 10-week skills intervention to target disordered eating behaviors. The present study utilized a pre-test/post-test single group study design to compare pre-treatment, post-treatment, and follow-up changes in emotional overeating behaviors, psychological functioning, and skill acquisition in an uncontrolled pilot trial. All dialectical behavior therapy skill modules (mindfulness, distress tolerance, emotion regulation, interpersonal effectiveness) were taught in the context of emotional overeating eating behaviors. Mean changes assessed for measures of eating behaviors, psychological functioning, and skill acquisition among all participants who completed the intervention (N =15) and again among the subsample who also completed follow-up (N =11). Findings support the preliminary efficacy of the present study at decreasing disordered eating behaviors, with medium to large effect sizes found for decreases in objective binge episodes per month based on youth and caregiver report. Further, qualitative exit interviews and objective questionnaires suggest the proposed culturally responsive intervention was acceptable to participants. Participation based on attendance, homework completed, and diary completion suggest the intervention is feasible to implement. These findings support that this alternative, less-intense dialectical behavior therapy skills treatment modality may be a viable intervention approach for adolescents with subclinical binge eating behaviors, and may be a more attainable treatment approach for youth and families encountering significant barriers to treatment.