Reduced Contact Cognitive-Behavioral Interventions for Adult Depression: A Review.

Depression is a highly prevalent and debilitating mental health condition. Evidence suggests that there is a widening gap between the demand for and availability of effective treatments. As such, there is a vast need for the development and dissemination of accessible and affordable treatments for depression. In the past decade, there has been a proliferation of reduced client-therapist contact protocols for depression. In this article, the authors review and compare the efficacy of reduced contact cognitive-behavioral interventions for adult depression across two degrees of therapist-client contact (i.e., no therapist-client contact versus minimal therapist-client contact interventions). The authors also discuss the methodological and theoretical limitations of this research base. The present review suggests that a) reduced contact interventions for depression can be effective in remediating the symptoms of depression; b) the effect sizes of some reduced contact protocols may approximate those reported in traditional protocols involving significantly greater client-therapist contact; and c) protocols which employ some form of client-therapist contact, on average, generate higher effect sizes than those that are purely self-help in nature. A discussion of the theoretical and applied implications of such findings, as well as areas in need of further research, is provided.

Change in emotion regulation during the course of treatment predicts binge abstinence in guided self-help dialectical behavior therapy for binge eating disorder.

BACKGROUND: Dialectical behavior therapy (DBT), which appears to be an effective treatment for binge eating disorder (BED), focuses on teaching emotion regulation skills. However, the role of improved emotion regulation in predicting treatment outcome in BED is uncertain. METHODS: This secondary analysis explored whether change in self-reported emotion regulation (as measured by the Difficulties in Emotion Regulation Scale) during treatment was associated with abstinence from binge eating at post-treatment and 4-, 5-, and 6-month follow-up in individuals who received a guided self-help adaptation of DBT for BED. Participants were 60 community-based men and women with BED who received a self-help manual and six 20-minute support phone calls. RESULTS: Greater improvement in self-reported emotion regulation between pre- and post-treatment predicted abstinence from binge eating at post-treatment, 4-, 5-, and 6-month follow-up. However, some follow-up results were no longer significant when imputed data was excluded, suggesting that the effect of emotion regulation on binge abstinence may be strongest at 4-month follow-up but decline across a longer duration of follow-up. CONCLUSIONS: This study provides preliminary support for the theoretical role played by improved emotion regulation in achieving binge eating abstinence. If this finding is replicated with larger samples, further research should identify specific techniques to help more individuals to effectively regulate their emotions over a longer duration.

A randomized wait-list controlled pilot study of dialectical behaviour therapy guided self-help for binge eating disorder.

This study examined the efficacy of guided self-help based on dialectical behaviour therapy (DBTgsh) for binge eating disorder (BED). Individuals (88.3% female; mean 42.8 years) were randomized to DBTgsh (n=30) or wait-list (WL; n=30). DBTgsh participants received an orientation, DBT manual, and six 20-min support calls over 13 weeks. All participants were assessed pre- and post-treatment using interview and self-report; also, DBTgsh participants were re-assessed six months post-treatment. At treatment end, DBTgsh participants reported significantly fewer past-month binge eating episodes than WL participants (6.0 versus 14.4) and significantly greater rates of abstinence from binge eating (40.0% versus 3.3%). At six-month follow-up, DBTgsh participants reported significantly improved quality of life and reduced ED psychopathology compared to baseline scores. In addition, most improvements in the DBTgsh group were maintained, although binge eating abstinence rates decreased to 30%. These preliminary positive findings indicate that DBTgsh may offer an effective, low-intensity treatment option for BED.

Psychotherapies provided for eating disorders by community clinicians: infrequent use of evidence-based treatment.

This study describes the psychological interventions used for eating disorders (EDs) by community practitioners. Of 573 clinicians we screened across Alberta, 130 (22.7%) had treated EDs; 118 (90.8%) were interviewed. Clinicians reported varied reasons for psychotherapy choice and diverse training experiences; the primary approaches used varied by education and field. The most common primary approach was eclectic (43.2%), followed by cognitive-behavior therapy (CBT; 22.9%). However, self-reported CBT clinicians used specific CBT techniques infrequently. Half of clinicians incorporated addictions-based techniques. These results indicate that ED treatment provided by community clinicians is varied and generally does not align with evidence-based practice guidelines.

Eating disorders, substance use disorders, and impulsiveness among disordered gamblers in a community sample.

Disordered gambling and many eating disorders (EDs) involve recurrent loss of impulse control. We examined rates of specific EDs, ED psychopathology, substance use disorders, and their interrelationships with impulsiveness among community members with disordered gambling. Community-recruited adults with pathological (n = 95) or problem (n = 9) gambling (N = 104; 51% female) completed structured interviews and questionnaires. We observed high rates of substance dependence, lifetime EDs, and current ED psychopathology; 20.8% of women (vs 1.9% of men) had a DSM-IV ED, and 37.8% (vs 3.9%) had an ED according to proposed DSM-5 criteria. Although disordered gambling severity was not associated with ED diagnosis or severity of ED psychopathology, greater disordered gambling severity and an ED diagnosis were both associated with increased impulsiveness. These findings suggest that impulsiveness might constitute a common personality characteristic that underlies disordered gambling and EDs.

Adding thin-ideal internalization and impulsiveness to the cognitive-behavioral model of bulimic symptoms.

This study evaluated the cognitive-behavioral (CB) model of bulimia nervosa and an extension that included two additional maintaining factors - thin-ideal internalization and impulsiveness - in 327 undergraduate women. Participants completed measures of demographics, self-esteem, concern about shape and weight, dieting, bulimic symptoms, thin-ideal internalization, and impulsiveness. Both the original CB model and the extended model provided good fits to the data. Although structural equation modeling analyses suggested that the original CB model was most parsimonious, hierarchical regression analyses indicated that the additional variables accounted for significantly more variance. Additional analyses showed that the model fit could be improved by adding a path from concern about shape and weight, and deleting the path from dieting, to bulimic symptoms. Expanding upon the factors considered in the model may better capture the scope of variables maintaining bulimic symptoms in young women with a range of severity of bulimic symptoms.

Perceptions and use of empirically-supported psychotherapies among eating disorder professionals.

Despite growing support for the dissemination of empirically-supported treatments (ESTs), treatment providers have been slow to take up using ESTs. This study explored eating disorders (EDs) professionals' views of empirical support for psychotherapies for EDs and the role of empirical evidence in ED treatment selection. We distributed a web-based survey to members of two international organizations of ED practitioners and researchers; 402 members (32.7%) were eligible and participated. Most providers reported they used ESTs in treating EDs, but these ESTs were often folded into eclectic approaches rather than used in forms that had been evaluated in research trials. Use of ESTs and perceptions of empirical support for psychotherapies differed between participants who were and were not recently involved in research. We conclude that perceptions of available research evidence may be important to target in efforts to increase the uptake of ESTs in clinical practice and to help close the research-practice gap.

Treatment manuals: use in the treatment of bulimia nervosa.

As psychology has moved toward emphasizing evidence-based practice, use of treatment manuals has extended from research trials into clinical practice. Minimal research has directly evaluated use of manuals in clinical practice. This survey of international eating disorder professionals examined use of manuals with 259 clinicians' most recent client with bulimia nervosa. Although evidence-based manuals for bulimia nervosa exist, only 35.9% of clinicians reported using a manual. Clinicians were more likely to use a manual if they were younger; were treating an adult client; were clinical psychologists; were involved in research related to eating disorders; and endorsed a cognitive-behavioral orientation. Clinicians were less likely to use a manual if they provided eclectic psychotherapy that incorporated multiple psychotherapeutic approaches. We conclude that psychotherapy provided in clinical practice often does not align with the specific form validated in research trials, and "eclecticism" is at odds with efforts to disseminate manuals into clinical practice.