Probleem 2
- Welke behandelingen zijn effectief bij ED?
- Welke factoren spelen mee of een behandeling aanslaat?
- Welke toegevoegde waarde kunnen apps hebben bij het behandelen van ED?
- Mag iemand met AN tegen haar wil worden opgenomen?
https://docs.google.com/document/d/1X_EjzVykn-CysKr82xlQ5MF0-pvkism4SUcbShyIkFY/edit
https://docs.google.com/document/d/1dDGgtlVFW8HYEYQYIrxNh4I8_0pppMCedAYSHz317YE/edit?
usp=sharing
https://docs.google.com/document/d/1TvII3iBSHqw4Eg8rwoxstufHUBhzkkHHFd0KNvokBBU/edit?
usp=sharing
Chen 2017 - Dialectical Behavior Therapy and Emotion-
Focused Therapies for Eating Disorders
Dialectical behavior therapy DBT
Introductie
DBT is origineel voor outpatients cbt voor vrouwen met borderline die problemen ervaren met
emotie dysregulatie en herhalende suïcidale gedragingen.
Dialectical behavior therapy is a comprehensive skills-based treatment and emphasizes the
integration of opposing principles (the dialectic) such as behavior change (problem solving,
contingency management, exposure-based procedures, cognitive modification) with acceptance-
based practices such as Zen and contemplation practice (such as mindfulness and validation). The
dialectical framework within DBT stresses wholeness, interrelatedness, and process. Over time,
standard DBT has been adapted to address a variety of problem behaviors associated with emotion
dysregulation, including eating disorders (EDs).
Standard Dialectical Behavior Therapy Treatment
- DBT is georganiseerd rond de cliënt zijn ernstigheid en chronicity, met verschillende
behandelfases bij verschillende behandelingsdoelen.
- The DBT stages involve (1) Pretreatment, orientation and commitment to treatment; (2)
Stage I, stopping out-of-control behaviors; (3) Stage II, replacing “quiet desperation” with
nontraumatic emotional experiencing; (4) Stage III, reducing ongoing disorders and problems
in living; and (5) Stage IV, resolving a sense of incompleteness to achieve freedom. Each
stage of treatment is associated with a target hierarchy.
- Dialectical behavior therapy is unique from other therapies, as an overall target hierarchy,
rather than a prescribed session agenda, dictates the content of individual sessions.
- Standard DBT functions to enhance a client’s use of skillful behavior both within and outside
of therapy sessions, as well as both client and therapist’s motivation to engage with and
deliver the treatment. This is accomplished by reducing reinforcement for dysfunctional or
ineffective client behavior (which may include restructuring the environment to support
progress and adaptive change), and generalizing behavior from the therapy setting to the
natural environment. To fulfill these functions, the modes of treatment in standard DBT
involve (1) weekly individual psychotherapy; (2) weekly group skills training; (3) 24-hour
telephone consultation; and (4) a weekly therapist consultation team.
- Behandelingstrategieën:
o Dialectical strategies: highlight dichotomous relationships, such as feelings/beliefs
versus wise mind and good versus bad, and assist clients in finding balanced and
synthesized responses. Dialectical strategies include the use of metaphors, stories,
paradox, playing devil’s advocate, fluctuating between ambiguity and certainty, using
cognitive restructuring, highlighting continual change, and validating a client’s
intuitive wisdom.
, o Core strategies: balance acceptance (bijv validation) and behavioral change
(problem-solving) strategies to built and maintain a strong therapeutic
relationship.
o Stylistic strategies: balance acceptance and change.
o Case management strategies: managing the environment.
Adapting DBT for ED
- DBT kan effectief zijn voor patiënten die niet behandeld kunnen worden door CBT en IPT.
- Het zou kunnen werken voor patiënten met comorbide psychopathologie.
- DBT is uniek want zij zeggen dat BED komt door emotie dysregulatie i.p.v. gewichtszorgen
zoals CBT of interpersoonlijke problemen zoals IPT. Het focust dus zich alleen op affect als
trigger voor ED. De gedragingen van ED (overgeven) zijn dus gedragingen hoe individuelen
hun emoties reguleren.
- DBT is protocol driven en de sessies zijn zo georganiseerd dat ze de hoogste doel als eerst
aanpakken.
- DBT is gebaseerd op een theorie. Biosocial theory: dysfunctionele ED gedragingen zijn
ontwikkeld door een transactie tussen biologische kwetsbaarheid van een individu en daarbij
een slechte match met de omgeving.
DBT for ED
Affect regulation model for ED
- Stress and negative mood are the most frequently cited precipitants of binge eating. . Binge
eating or bulimic behaviors are understood as the result of attempts to escape from primary
or secondary aversive emotions that may be triggered by thoughts regarding food, body
image, perfectionism, negative thoughts about the self, or interpersonal situation
- Onderzoek bewijst de rol van negatieve emoties bij BED. Het blijkt dat mensen met BED
binge eten als reactie op negatieve emotie.
Adaptation of the Biosocial Theory for ED
- In DBT, ED behaviors, just like BPD behaviors, are understood as resulting from a transaction
over time between an individual biologically predisposed to be more emotionally vulnerable
and a mismatch with an environment experienced (but not necessarily intended) as
invalidating. This invalidating environment may punish emotional displays, leading individuals
to engage in ED behaviors to manage their emotions and the secondary emotion of shame
that may result. Sometimes, the invalidation may be specific to ED behaviors (e.g., “Why
can’t you just stop eating?”), or take the form of weight-related teasing or overconcern with
weight by peers and family. The invalidating environment may also be broader, including
typical Western societal messages idealizing thinness and disparaging overweight, such that
each is associated with polar moral values. Further invalidation may be introduced by the
media with the notion that weight loss should not be difficult (e.g., “lose 10 pounds in 10
days” advertisements).
- Over time, the results of these transactions may include (1) difficulties in identifying and
regulating emotional arousal; (2) difficulties in tolerating emotional distress without engaging
in ED behavior; (3) difficulties in trusting one’s own (p. 341) emotional responses as valid,
that is, engaging in self-invalidation; and (4) formation of unrealistic goals and expectations
due to oversimplification of problem solving and goal setting by the invalidating
environment. Self-invalidation may make individuals particularly vulnerable to turning to
body-image-focused environments as sources of information about what the self “should”
look like. This may increase the likelihood of establishing unrealistic expectations among
overweight or normal-weight clients regarding weight loss.
, The Stanford model
- The Stanford model of DBT was developed to target clients whose primary focus of
treatment is BED or BN symptoms that interfere with their quality of life. Niet voor
zelfmoord.
- The Stanford adaptation of DBT for BED or BN differs in three important ways from standard
DBT for BPD. First, it differs in its structure. The Stanford DBT model combines two modalities
in standard DBT (individual treatment and group skills treatment) into one modality, either a
2-hour group treatment for BED or a 50- to 60-minute individual session for BN. As opposed
to what is typically a year-long treatment in standard DBT, the Stanford DBT model is briefer
and uses 20 sessions of treatment covering three (e.g., Core Mindfulness, Emotion
Regulation, and Distress Tolerance) as opposed to four skills-training modules. Second, the
Stanford DBT model differs from standard DBT in the use of specific ED behavior targets,
resulting in adaptations to the treatment hierarchy, diary card, and behavioral chain analysis.
Third, the Stanford model involves the addition of particular concepts and skills specific to ED
clients (e.g., the concept of dialectical abstinence, use of skills such as mindful eating, urge
surfing, alternate rebellion, etc.).
- De veranderingen werden gemaakt om DBT te vergelijken met CBT en IPT omdat zij 20
sessies gebruiken.
Conclusie
In summary, this chapter briefly describes standard DBT and adaptations that have been made to
offer an alternative treatment approach for EDs that have failed to respond to existing therapies.
Dialectical behavior therapy is uniquely based on an affect regulation model, and fuses behavior
change strategies with novel acceptance-based strategies such as mindfulness. Dialectical behavior
therapy also includes distinctive protocols for addressing suicidal behavior, nonsuicidal self-injury,
and therapy-interfering behaviors, such as drop out, homework incompletion, and lack of
attendance.
Standard DBT is an efficacious evidence-based treatment for BPD (borderline), with promising
treatment development data for use with individuals with BPD and EDs. For individuals with BED or
BN that primarily affects quality-of-life, an adaptation of standard DBT for individuals with BED and
BN by researchers at Stanford University has been found to be efficacious in randomized controlled
trials. The Stanford University DBT model involves 20 group (for BED) or individual (for BN) sessions.
These sessions teach mindfulness, emotion regulation and distress tolerance skills, integrating these
with the use of chain analyses (careful step-by-step behavioral analyses) for problem behaviors. This
model uses a unique hierarchy of ED behaviors (the “Path to Mindful Eating”) to target, including (1)
stopping binge eating (and purging, for clients with BN); (2) eliminating mindless eating (eating
without awareness); (3) decreasing cravings, urges, preoccupation with food; (4) decreasing
capitulating (i.e., giving in to binge eating); and (5) decreasing apparently irrelevant behaviors (i.e.,
behaviors that appear not to matter but play a role in leading to a binge). Finally, the Stanford DBT
model for BED and BN adds ED-specific concepts and skills to the standard treatment. The ED-
specific DBT concepts include dialectical abstinence, which teaches clients to focus on attaining
binge abstinence while simultaneously being aware that if one slips, this can be addressed
effectively. Additional ED-specific DBT skills include mindful eating, urge surfing (i.e., surfing urges
to binge eat), alternative rebellion (effectively managing urges to rebel without binge eating), and
burning bridges (radical acceptance of a commitment to cease ED behavior).
https://www.directievetherapie.nl/artikelen/jaargang26/dialectisch-gedragstherapeutische-
principes-bij-eetstoornissen-26-2-162/
- Welke behandelingen zijn effectief bij ED?
- Welke factoren spelen mee of een behandeling aanslaat?
- Welke toegevoegde waarde kunnen apps hebben bij het behandelen van ED?
- Mag iemand met AN tegen haar wil worden opgenomen?
https://docs.google.com/document/d/1X_EjzVykn-CysKr82xlQ5MF0-pvkism4SUcbShyIkFY/edit
https://docs.google.com/document/d/1dDGgtlVFW8HYEYQYIrxNh4I8_0pppMCedAYSHz317YE/edit?
usp=sharing
https://docs.google.com/document/d/1TvII3iBSHqw4Eg8rwoxstufHUBhzkkHHFd0KNvokBBU/edit?
usp=sharing
Chen 2017 - Dialectical Behavior Therapy and Emotion-
Focused Therapies for Eating Disorders
Dialectical behavior therapy DBT
Introductie
DBT is origineel voor outpatients cbt voor vrouwen met borderline die problemen ervaren met
emotie dysregulatie en herhalende suïcidale gedragingen.
Dialectical behavior therapy is a comprehensive skills-based treatment and emphasizes the
integration of opposing principles (the dialectic) such as behavior change (problem solving,
contingency management, exposure-based procedures, cognitive modification) with acceptance-
based practices such as Zen and contemplation practice (such as mindfulness and validation). The
dialectical framework within DBT stresses wholeness, interrelatedness, and process. Over time,
standard DBT has been adapted to address a variety of problem behaviors associated with emotion
dysregulation, including eating disorders (EDs).
Standard Dialectical Behavior Therapy Treatment
- DBT is georganiseerd rond de cliënt zijn ernstigheid en chronicity, met verschillende
behandelfases bij verschillende behandelingsdoelen.
- The DBT stages involve (1) Pretreatment, orientation and commitment to treatment; (2)
Stage I, stopping out-of-control behaviors; (3) Stage II, replacing “quiet desperation” with
nontraumatic emotional experiencing; (4) Stage III, reducing ongoing disorders and problems
in living; and (5) Stage IV, resolving a sense of incompleteness to achieve freedom. Each
stage of treatment is associated with a target hierarchy.
- Dialectical behavior therapy is unique from other therapies, as an overall target hierarchy,
rather than a prescribed session agenda, dictates the content of individual sessions.
- Standard DBT functions to enhance a client’s use of skillful behavior both within and outside
of therapy sessions, as well as both client and therapist’s motivation to engage with and
deliver the treatment. This is accomplished by reducing reinforcement for dysfunctional or
ineffective client behavior (which may include restructuring the environment to support
progress and adaptive change), and generalizing behavior from the therapy setting to the
natural environment. To fulfill these functions, the modes of treatment in standard DBT
involve (1) weekly individual psychotherapy; (2) weekly group skills training; (3) 24-hour
telephone consultation; and (4) a weekly therapist consultation team.
- Behandelingstrategieën:
o Dialectical strategies: highlight dichotomous relationships, such as feelings/beliefs
versus wise mind and good versus bad, and assist clients in finding balanced and
synthesized responses. Dialectical strategies include the use of metaphors, stories,
paradox, playing devil’s advocate, fluctuating between ambiguity and certainty, using
cognitive restructuring, highlighting continual change, and validating a client’s
intuitive wisdom.
, o Core strategies: balance acceptance (bijv validation) and behavioral change
(problem-solving) strategies to built and maintain a strong therapeutic
relationship.
o Stylistic strategies: balance acceptance and change.
o Case management strategies: managing the environment.
Adapting DBT for ED
- DBT kan effectief zijn voor patiënten die niet behandeld kunnen worden door CBT en IPT.
- Het zou kunnen werken voor patiënten met comorbide psychopathologie.
- DBT is uniek want zij zeggen dat BED komt door emotie dysregulatie i.p.v. gewichtszorgen
zoals CBT of interpersoonlijke problemen zoals IPT. Het focust dus zich alleen op affect als
trigger voor ED. De gedragingen van ED (overgeven) zijn dus gedragingen hoe individuelen
hun emoties reguleren.
- DBT is protocol driven en de sessies zijn zo georganiseerd dat ze de hoogste doel als eerst
aanpakken.
- DBT is gebaseerd op een theorie. Biosocial theory: dysfunctionele ED gedragingen zijn
ontwikkeld door een transactie tussen biologische kwetsbaarheid van een individu en daarbij
een slechte match met de omgeving.
DBT for ED
Affect regulation model for ED
- Stress and negative mood are the most frequently cited precipitants of binge eating. . Binge
eating or bulimic behaviors are understood as the result of attempts to escape from primary
or secondary aversive emotions that may be triggered by thoughts regarding food, body
image, perfectionism, negative thoughts about the self, or interpersonal situation
- Onderzoek bewijst de rol van negatieve emoties bij BED. Het blijkt dat mensen met BED
binge eten als reactie op negatieve emotie.
Adaptation of the Biosocial Theory for ED
- In DBT, ED behaviors, just like BPD behaviors, are understood as resulting from a transaction
over time between an individual biologically predisposed to be more emotionally vulnerable
and a mismatch with an environment experienced (but not necessarily intended) as
invalidating. This invalidating environment may punish emotional displays, leading individuals
to engage in ED behaviors to manage their emotions and the secondary emotion of shame
that may result. Sometimes, the invalidation may be specific to ED behaviors (e.g., “Why
can’t you just stop eating?”), or take the form of weight-related teasing or overconcern with
weight by peers and family. The invalidating environment may also be broader, including
typical Western societal messages idealizing thinness and disparaging overweight, such that
each is associated with polar moral values. Further invalidation may be introduced by the
media with the notion that weight loss should not be difficult (e.g., “lose 10 pounds in 10
days” advertisements).
- Over time, the results of these transactions may include (1) difficulties in identifying and
regulating emotional arousal; (2) difficulties in tolerating emotional distress without engaging
in ED behavior; (3) difficulties in trusting one’s own (p. 341) emotional responses as valid,
that is, engaging in self-invalidation; and (4) formation of unrealistic goals and expectations
due to oversimplification of problem solving and goal setting by the invalidating
environment. Self-invalidation may make individuals particularly vulnerable to turning to
body-image-focused environments as sources of information about what the self “should”
look like. This may increase the likelihood of establishing unrealistic expectations among
overweight or normal-weight clients regarding weight loss.
, The Stanford model
- The Stanford model of DBT was developed to target clients whose primary focus of
treatment is BED or BN symptoms that interfere with their quality of life. Niet voor
zelfmoord.
- The Stanford adaptation of DBT for BED or BN differs in three important ways from standard
DBT for BPD. First, it differs in its structure. The Stanford DBT model combines two modalities
in standard DBT (individual treatment and group skills treatment) into one modality, either a
2-hour group treatment for BED or a 50- to 60-minute individual session for BN. As opposed
to what is typically a year-long treatment in standard DBT, the Stanford DBT model is briefer
and uses 20 sessions of treatment covering three (e.g., Core Mindfulness, Emotion
Regulation, and Distress Tolerance) as opposed to four skills-training modules. Second, the
Stanford DBT model differs from standard DBT in the use of specific ED behavior targets,
resulting in adaptations to the treatment hierarchy, diary card, and behavioral chain analysis.
Third, the Stanford model involves the addition of particular concepts and skills specific to ED
clients (e.g., the concept of dialectical abstinence, use of skills such as mindful eating, urge
surfing, alternate rebellion, etc.).
- De veranderingen werden gemaakt om DBT te vergelijken met CBT en IPT omdat zij 20
sessies gebruiken.
Conclusie
In summary, this chapter briefly describes standard DBT and adaptations that have been made to
offer an alternative treatment approach for EDs that have failed to respond to existing therapies.
Dialectical behavior therapy is uniquely based on an affect regulation model, and fuses behavior
change strategies with novel acceptance-based strategies such as mindfulness. Dialectical behavior
therapy also includes distinctive protocols for addressing suicidal behavior, nonsuicidal self-injury,
and therapy-interfering behaviors, such as drop out, homework incompletion, and lack of
attendance.
Standard DBT is an efficacious evidence-based treatment for BPD (borderline), with promising
treatment development data for use with individuals with BPD and EDs. For individuals with BED or
BN that primarily affects quality-of-life, an adaptation of standard DBT for individuals with BED and
BN by researchers at Stanford University has been found to be efficacious in randomized controlled
trials. The Stanford University DBT model involves 20 group (for BED) or individual (for BN) sessions.
These sessions teach mindfulness, emotion regulation and distress tolerance skills, integrating these
with the use of chain analyses (careful step-by-step behavioral analyses) for problem behaviors. This
model uses a unique hierarchy of ED behaviors (the “Path to Mindful Eating”) to target, including (1)
stopping binge eating (and purging, for clients with BN); (2) eliminating mindless eating (eating
without awareness); (3) decreasing cravings, urges, preoccupation with food; (4) decreasing
capitulating (i.e., giving in to binge eating); and (5) decreasing apparently irrelevant behaviors (i.e.,
behaviors that appear not to matter but play a role in leading to a binge). Finally, the Stanford DBT
model for BED and BN adds ED-specific concepts and skills to the standard treatment. The ED-
specific DBT concepts include dialectical abstinence, which teaches clients to focus on attaining
binge abstinence while simultaneously being aware that if one slips, this can be addressed
effectively. Additional ED-specific DBT skills include mindful eating, urge surfing (i.e., surfing urges
to binge eat), alternative rebellion (effectively managing urges to rebel without binge eating), and
burning bridges (radical acceptance of a commitment to cease ED behavior).
https://www.directievetherapie.nl/artikelen/jaargang26/dialectisch-gedragstherapeutische-
principes-bij-eetstoornissen-26-2-162/
