Examination of the Effectiveness of a Brief, Adapted Dialectical Behavior Therapy-Skills Training Group for Bariatric Surgical Candidates.

BACKGROUND: Bariatric surgery is the most effective treatment for morbid obesity, yet 20 to 30% of such patients regain weight approximately 2 years post-surgery. A psychological intervention adjunctive to bariatric surgery that addresses eating pathology often observed in bariatric populations may improve outcomes. In the present study, a brief, adapted DBT-ST group for bariatric surgical candidates was evaluated as an adjunctive intervention to bariatric surgery in the pre-surgical period to reduce eating pathology and clinical impairment. METHODS: Participants included 95 bariatric surgery candidates, with 50 candidates in the DBT-ST plus treatment as usual (TAU) group and 45 candidates in the TAU (i.e., comparison) group. Participants completed measures of eating pathology at three time points (i.e., T1 = pre-DBT-ST program; T2 = post-DBT-ST program; T3 = 4 months post-DBT-ST; comparable time points employed for TAU group). Average wait time for surgery following the pre-surgical program was approximately 2 to 4 months. RESULTS: A series of 2 (group: DBT-ST + TAU versus TAU) × 3 (assessment time: T1, T2, and T3) mixed-model ANOVAs were completed. Participants in the DBT-ST plus TAU group showed significant reductions in binge eating, emotional eating, global eating pathology, and clinical impairment related to eating difficulties over time in comparison to TAU. CONCLUSIONS: Findings demonstrated that a brief DBT-ST group integrated as an adjunctive intervention to TAU in a bariatric pre-surgical program could aid in addressing eating pathology. Bariatric participants in a DBT-ST plus TAU group may be on a better weight loss trajectory than those who only receive TAU.

"Am I Becoming a Serial Killer?" A Case Study of Cognitive Behavioral Therapy for Mental Illness Anxiety.

BACKGROUND: Although mental illness anxiety is described in the literature, there is very little information on which to draw when treating individuals who present with fears and worries about mental health. In fact, we identified no previous case descriptions focused on this form of anxiety and treated from a cognitive behavioral perspective. AIMS: The current case study aims to advance the understanding of the clinical picture of mental illness anxiety, and facilitate the understanding of how cognitive behavioral techniques for health anxiety can be effectively adapted and implemented for such a case. METHOD: A case study approach was adopted in which a baseline condition and repeated assessments were conducted during an 8-week treatment and 2-month follow-up period. In the current case study, we discuss the assessment, conceptualization, and cognitive behavioral treatment of a 24-year old woman who presented with mental illness anxiety. Several common health anxiety assessment tools and cognitive behavioural techniques were adapted for her particular clinical presentation. RESULTS: Consistent with research evidence for health anxiety, significant improvements in health anxiety and anxiety sensitivity were seen after eight sessions of therapy and maintained at 2-month follow-up. CONCLUSIONS: The results provide preliminary evidence that cognitive behavioral techniques for health anxiety can be effectively and efficiently adapted for mental illness anxiety. However, the lack of available research pertaining to mental illness anxiety contributes to challenges in conceptualization, assessment and treatment.

Problematic eating behaviors among bariatric surgical candidates: a psychometric investigation and factor analytic approach.

Psychological factors (e.g., anxiety, depression) are routinely assessed in bariatric pre-surgical programs, as high levels of psychopathology are consistently related to poor program outcomes (e.g., failure to lose significant weight pre-surgery, weight regain post-surgery). Behavioral factors related to poor program outcomes and ways in which behavioral and psychological factors interact, have received little attention in bariatric research and practice. Potentially problematic behavioral factors are queried by Section H of the Weight and Lifestyle Inventory (WALI-H), in which respondents indicate the relevance of certain eating behaviors to obesity. A factor analytic investigation of the WALI-H serves to improve the way in which this assessment tool is interpreted and used among bariatric surgical candidates, and subsequent moderation analyses serve to demonstrate potential compounding influences of psychopathology on eating behavior factors. Bariatric surgical candidates (n =362) completed several measures of psychopathology and the WALI-H. Item responses from the WALI-H were subjected to principal axis factoring with oblique rotation. Results revealed a three-factor model including: (1) eating in response to negative affect, (2) overeating/desirability of food, and (3) eating in response to positive affect/social cues. All three behavioral factors of the WALI-H were significantly associated with measures of depression and anxiety. Moderation analyses revealed that depression did not moderate the relationship between anxiety and any eating behavior factor. Although single forms of psychopathology are related to eating behaviors, the combination of psychopathology does not appear to influence these problematic behaviors. Recommendations for pre-surgical assessment and treatment of bariatric surgical candidates are discussed.

The cessation of deliberate self-harm in a university sample: the reasons, barriers, and strategies involved.

Information on how individuals cease deliberate self-harm behaviors, and what they experience as helpful and hindering to this process, was sought in order to optimize and inform treatment. University students (N = 54) with a past history of self-harm were queried about their experience with DSH cessation. Qualitative analysis revealed 6 themes of reasons for DSH cessation, 5 themes of strategies used to cease DSH behaviors, and 4 themes of barriers to cessation. Treatment can be informed by the motivations, strategies, and barriers that individuals experience during the cessation process. The positive strategies that individuals naturally use to cease DSH should be capitalized on in treatment, and the negative strategies should be minimized.