2009 - Clinical Handbook of Mindfulness by Fabrizio Didonna- Springer

Author:Fabrizio Didonna- Springer [Unknown]
Language: eng
Format: epub, mobi

dysfunctional self-regulatory processes, allowing a shift in entrenched pat-

terns. This promising rationale is now being tested empirically in an emerg-

ing body of research that has found preliminary evidence for the efficacy

of mindfulness-based programs in reducing the core symptoms of ED. That

said, empirical clarification of the mechanisms of action in these approaches

is still in its infancy.

Mindfulness-based Interventions for Eating Disorders:

The Current State of the Evidence

Eating disorders are complex syndromes representing both specific and gen-

eralized deficits in self-regulation. These conditions frequently persist even in

the face of significant deterioration in psychological and physiological well-

ness. Given the increasing prevalence of ED coupled with the associated high

risk of relapse and concurrent psychopathology, greater attention is war-

ranted to improve the efficacy of existing treatments. In response to this

growing need, four innovative mindfulness-based therapeutic approaches

have been blended with traditional cognitive-behavioral theory: Dialecti-

cal Behavior Therapy (DBT; Linehan, 1993a), Acceptance and Commitment

Therapy (ACT; Hayes et al., 1999), Mindfulness-based Cognitive Therapy

(MBCT; Segal, Williams, & Teasdale, 2002; Baer, Fischer, & Huss, 2006), and Mindfulness-Based Eating Awareness Training (MB-EAT; Kristeller, Baer, &

Quillian-Wolever, 2006; Kristeller & Hallett, 1999).

Dialectical Behavior Therapy (DBT)

DBT was first introduced in the early 1990’s to improve the self-regulation

deficits in borderline personality disorder (BPD) (Linehan, 1993a). DBT

helps patients cultivate core mindfulness abilities in conjunction with other

emotion regulation, interpersonal effectiveness, and distress tolerance skills

(Linehan, 1993b).From an empirical standpoint, DBT has had an encouraging impact on improving clinical symptomatology in BPD (Linehan, Armstrong,

Suarez, Allmond et al., 1991; Linehan, 1993a) and is the most extensively studied mindfulness-based approach within eating disorder samples. In a

seminal analysis, Telch (1997) presented an in-depth case study of adapting DBT for an obese woman with BED. The 23-session intervention (i.e., 19

weekly meetings and 4 monthly meetings) was structured to include three

phases: (1) theoretical rationale of the program, (2) teaching principal com-

ponents of DBT and (3) reinforcing and generalizing gains (Telch, 1997). This approach yielded significant improvements in binge eating though weight

and mood symptoms did not stabilize (Telch, 1997). Telch and collaborators then tested the efficacy of the approach in a group DBT program for BED in

an initial uncontrolled trial (Telch, Agras, & Linehan, 2000); eighty-two percent of the sample attained binge-free status by the end of the 18-session pro-

gram (Telch et al., 2000; see Wiser & Telch, 1999 for a detailed description of the intervention) and abstinence rates remained high three (i.e., 80%) and

six months (i.e., 70%) post-treatment. (Telch et al., 2000). Eating, weight and shape concerns also improved, as did self-reported emotional eating urges

and negative mood regulation (Telch et al., 2000).

Chapter 14 Mindfulness-Based Approaches to Eating Disorders

269

In a more rigorous RCT (Telch, Agras, & Linehan, 2001), 44 women with BED reduced objective binge eating behaviors in both a DBT and wait-list

control condition (Telch, Agras, & Linehan, 2001). However, among the 18

that completed treatment, those in DBT showed significantly higher absti-

nence rates by the end of treatment relative to controls (i.e., 89% versus

12.5%), though sustained improvements were more modest (i.e., 56% absti-

nent at 6-month follow-up). DBT-completers were also characterized by less

weight, shape and eating concerns and on average

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