The effects of psychotherapy treatment on outcome in bulimia nervosa: Examining indirect effects through emotion regulation, self‐directed behavior, and self‐discrepancy within the mediation model

Abstract

Objective The purpose of this investigation was to examine the indirect effects of Integrative Cognitive-Affective Therapy (ICAT-BN) and Cognitive-Behavioral Therapy-Enhanced (CBT-E) on bulimia nervosa (BN) treatment outcome through three hypothesized maintenance variables: emotion regulation, self-directed behavior, and self-discrepancy. Method Eighty adults with BN were randomized to 21 sessions of ICAT-BN or CBT-E. A regression-based bootstrapping approach was used to test the indirect effects of treatment on outcome at end of treatment through emotion regulation and self-directed behavior measured at mid-treatment, as well as the indirect effects of treatment at follow-up through emotion regulation, self-directed behavior, and self-discrepancy measured at end of treatment. Results No significant differences in outcome between treatment conditions were observed, and no significant direct or indirect effects were found. Examination of the individual paths within the indirect effects models revealed comparable treatment effects. Across treatments, improvements in emotion regulation and self-directed behavior between baseline and mid-treatment predicted improvements in global eating disorder scores but not binge eating and purging frequency at end of treatment. Baseline to end of treatment improvements in emotion regulation and self-directed behavior also predicted improvements in global eating disorder scores at follow-up. Baseline to end of treatment improvements in emotion regulation predicted improvements in binge eating and baseline to end of treatment increases in positive self-directed behavior predicted improvements in purging at follow-up. Discussion These findings suggest that emotion regulation and self-directed behavior are important treatment targets and that ICAT-BN and CBT-E are comparable in modifying these psychological processes among individuals with BN.

Rapid improvements in emotion regulation predict intensive treatment outcome for patients with bulimia nervosa and purging disorder

“…Additionally, in a secondary analysis of data from a randomized controlled trial comparing the efficacy of outpatient CBT and integrative cognitive affective therapy for BN, indirect mediational effects of treatment via early changes in emotion regulation and positive and negative self‐directed behaviors were examined (Peterson et al, ). Although there were no significant differences with respect to treatment outcomes, examination of the individual pathways within indirect effects models revealed that for both treatments, early improvements (i.e., between baseline and mid‐treatment) in overall emotion regulation difficulties, and in both positive self‐directed behavior and negative self‐directed behavior, separately predicted overall eating disorder psychopathology at posttreatment and 4‐month follow‐up.…”

“…Although there were no significant differences with respect to treatment outcomes, examination of the individual pathways within indirect effects models revealed that for both treatments, early improvements (i.e., between baseline and mid‐treatment) in overall emotion regulation difficulties, and in both positive self‐directed behavior and negative self‐directed behavior, separately predicted overall eating disorder psychopathology at posttreatment and 4‐month follow‐up. Additionally, although early changes in these variables did not mediate binge‐eating or purging behaviors at posttreatment, improvements in emotion regulation and positive self‐directed behavior over the entire course of treatment predicted total binge‐eating and purging frequencies, respectively, at 4‐month follow‐up (Peterson et al, ). These findings extend the current literature by demonstrating that changes in emotion regulation and behavioral variables may be mechanistically related to eating disorder treatment outcome, and provide the impetus for further investigation of this relationship.…”

Emotion dysregulation and eating disorders—Associations with diagnostic presentation and key symptoms

“…Forsén Mantilla, & Birgegård, 2015;Svaldi, Griepenstroh, Tuschen-Caffier, & Ehring, 2012), symptom maintenance in anorexia nervosa (AN; Racine & Wildes, 2015), and outcome in bulimia nervosa (BN; MacDonald, Trottier, & Olmsted, 2017;Peterson et al, 2017). Generally, patients with EDs report more emotion dysregulation than controls (Brockmeyer et al, 2014;Mallorqui-Bague et al, 2018).…”

Just‐in‐time adaptive interventions: A novel approach for enhancing skill utilization and acquisition in cognitive behavioral therapy for eating disorders

“…Although less well-studied, failing to respond adaptively to ED cues (particularly difficulty regulating negative affect) is associated with the maintenance of BN and BED symptoms (Leehr et al, 2015; Wilson, Fairburn, Agras, Walsh, & Kraemer, 2002). Additionally, emerging evidence suggests that improving management of negative affect during CBT predicts symptom remission (Peterson et al, 2017; Wilson et al, 2002). …”