Predictors of treatment response durability in psychotherapy for binge-eating disorder: Examining the roles of self-discrepancy, self-directed style, and emotion dysregulation

Vivienne M. Hazzard, Carol B. Peterson, Ross D. Crosby, Lauren M. Schaefer, Kathryn E. Smith, Scott G. Engel, Scott J. Crow, Stephen A. Wonderlich

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To examine changes in hypothesized maintenance mechanisms during treatment as predictors of treatment response durability in binge-eating disorder (BED) treatment, using data from a randomized clinical trial comparing the efficacy of Integrative Cognitive-Affective Therapy for BED with cognitive-behavioral therapy delivered using guided self-help. Method: Adults with BED (N = 112) received 17 weeks of treatment. Regression models were conducted to examine the extent to which changes in hypothesized maintenance mechanisms from baseline to end of treatment predicted treatment outcomes at 6-month follow-up, adjusting for demographics, study site, and baseline level of treatment outcome. Results: During-treatment reductions in negative self-directed style and emotion dysregulation predicted reductions in the primary treatment outcome (i.e., binge-eating episode frequency) at follow-up. During-treatment reductions in emotion dysregulation also predicted improvements at follow-up across all three secondary treatment outcomes examined (i.e., global eating disorder [ED] psychopathology, depressive symptoms, and anxiety symptoms), as did during-treatment reductions in actual-ideal self-discrepancy and actual-ought self-discrepancy. Increases in positive self-directed style (e.g., self-affirmation) and reductions in negative self-directed style (e.g., self-blame) during treatment each predicted improvements in anxiety symptoms at follow-up. When predictors were examined simultaneously, the most salient predictors of treatment response durability identified were negative self-directed style for binge-eating episode frequency, actual-ought self-discrepancy and emotion dysregulation for depressive symptoms, and emotion dysregulation for anxiety symptoms. No predictors emerged as most salient for global ED psychopathology. Discussion: Results indicate that negative self-directed style and emotion dysregulation are particularly important treatment targets in relation to behavioral treatment outcomes in BED.

Original languageEnglish (US)
Pages (from-to)1918-1927
Number of pages10
JournalInternational Journal of Eating Disorders
Volume53
Issue number12
DOIs
StatePublished - Dec 2020

Bibliographical note

Funding Information:
This study was supported by grants from the National Institutes of Health (R34MH098995, R34MH099040, P30DK60456, and T32MH082761) and the Neuropsychiatric Research Institute.

Keywords

  • binge-eating disorder
  • emotional regulation
  • feeding and eating disorders
  • psychotherapy
  • self-concept

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