Dialectical Behavior Therapy for Binge Eating and Bulimia (58 page)

Fear, Acting Opposite skill, 143

Feedback session, 187

Final session, 187

“Finger puzzle” lesson, 129

Food preoccupation. See
Preoccupation with

food

Foot-in-the-Door techniques, 25, 46
Function of Emotions. See Emotions
Future directions, 215–222

G

Gender ratio

binge-eating disorder, 6

bulimia nervosa, 10

Glycemic control, binge-eating disorder, 8
Goals of Treatment, Goals of Skills Training,
and Treatment Targets

handout, 71a

introductory sessions approach, 53–55

orienting the client to, as part of
pretreatment interview, 34–35

Group Member Treatment Agreements
copy of, 72a

in introductory sessions, 56–57

in pretreatment interview, 31, 42

Group sessions

homework review, 26–28, 86a

orientation, 55–56

skills instruction, 28–29

structure, 26–29, 55–56

Guidelines for Filling Out a Behavioral Chain
Analysis of a Problem Behavior, 78a
Guilt, 143–144

H

Half-smiling skill, 159–161

experiential exercise, 160

homework practice, 161

physiology, 161

Health status, binge-eating disorder, 8
Highlighting Freedom to Choose in the
Absence of Alternatives, 25, 47

Homework

case illustration, group format, 206–210

case illustration, individual format, 196–197

commitment to binge (and purge) abstinence,
47–48

review in group sessions, 26–28, 86a
troubleshooting, 63–65

“How Skills.” See
Mindfulness “How” skills
Hypnosis, mindfulness differences, 92
Hypokalemia, bulimia nervosa, 11–12

I

Imaginal mindful eating, 107

Improving the Moment skill, 172–173
Inclusion and exclusion criteria, 223
Individual Client Treatment Agreements
copy of, 73a

in pretreatment interview, 31, 42

Index

Individual therapy, group skills combination,

Instructions for flling out a diary card,
84a–85a

Interpersonal effectiveness skills, 2, 38n3

adolescents, 217

Interpersonal psychotherapy

abstinence rates, DBT comparison, 15

versus DBT, rationale, 13

Interpretations, emotional experiencing role,

Introductory sessions, 42–69

adolescent clients, 216

case illustrations, group format, 204–210

case illustrations, individual format,
193–197

chain analysis introduction, 57–63

commitment to abstinence, 43–48

and dialectical abstinence, 65–66

diary card introduction, 59

orientation to treatment, 48–55

session by session content, 224

treatment agreements in, 56–57

Invalidating environments

consequences, 19–20, 50–52

illustration of, 51–52

therapeutic approach, 52

Irreverence. See
Stylistic strategies

J

Judgmental thinking. See
“Nonjudgmental”

skill

Justifed versus unjustifed emotions, 133–135

L

Lateness to sessions, 40

Laxative use, 12

List of Distress Tolerance Skills, 177a
List of Emotion Regulation Skills, 148a
List of Mindfulness Core Skills, 112a
Loving Your Emotions skill, 128–130

M

Making Lemonade Out of Lemons strategy, 23
Malt balls, in Urge Surfng exercise, 109,
197–198

Matching clients, preliminary
recommendation, 3

Meditation, mindfulness differences, 92

Men, binge-eating disorder, 6

“Mental Stimulation,” 184n. See also
Coping

Ahead skill

Mindful eating. See also
Mindfulness module;

Path to Mindful Eating

experiential exercises, 103, 107

homework practice, 104, 116a

imaginal exercises, 107

path to, 71a, 221f

review of, 182

troubleshooting, 104

in weight-loss oriented adaptation, 220

“What” skills, 102, 103

Mindfulness “How” skills

homework sheet, 117a

orientation to, 104–108

review of, 181–182

troubleshooting, 108

Mindfulness “How” Skills Homework Sheet,

Mindfulness module, 89–119

adolescent clients, 216–217

alternate rebellion, 110–111, 119a
and Awareness Exercises, 162

binge-eating (and purging) incompatibility,
92–94, 98

case illustration, group format, 210–211

case illustration, individual format, 197–199

core skills, 89–119

list of, 112a

and current emotion, 126–128

defnitions, 90–92

function of, 38, 54

“How” skills, 104–108, 117a

meditation differences, 92

mindful eating, 102–104

session by session content, 225

states of mind infuence, 94–98

troubleshooting diffculties, 91–92

urge surfng, 108–110, 118a

“What” skills, 99–102, 116a

Mindfulness of Your Current Emotion skill,
126–128

Mindfulness “What” skills

homework, 104, 116a

orientation to, 99–101

review of, 181–182

troubleshooting diffculties, 102

Mindfulness “What” Skills Homework Sheet,

treatment target, orienting the client to,
36–37, 71a

treatment target, therapist review of, 53,

group member agreements, 56–57

pretreatment interview orientation, 32, 32n
Model for Describing Emotions, 121–126, 149a
Mood states

binge-eating disorder, 7, 8–9

bulimia nervosa, 10–11, 12–13

emotional states distinction, 121

Mortality rate, bulimia nervosa, 11

Motivation

commitment to abstinence link, 43–48

function of emotions link, 131–132

therapist role, 24–25

N

Naming an emotion, 123–124, 149a
Negative emotion/mood

binge-eating disorder, 8–9

bulimia nervosa, 12–13

emotional vulnerability link, 19
“Nonjudgmental” skill, 104–106

homework sheet, 117a

overview, 104–106

review of, 182

O

Obesity

binge-eating overlap, 6–8

correlation with binge-eating severity, 8

as treatment target, 220–221

“Observe” skill, 99–100

experiential exercises, 99, 101

homework sheet, 116a

in identifying an emotion’s trigger, model for
emotions, 121–122

in Mindfulness of Your Current Emotion,
126–128

review of, 182

Observing and Describing Emotions, 126–127

homework sheet, 127f, 152a

Observing Your Breath skill, 157–158

and Coping Ahead, 185

experiential exercise, 157–158

homework practice, 159

review of, 184

Occupational impairment, 7–8, 11

Olympic athlete metaphor, 66–67, 209
“One-Mindfully” skill, 106–107

experiential exercise, 107

homework sheet, 117a

review of, 182

Index

Online support, 219

Outcome of treatment, case example, 203
Outpatients, 2

Overweight

versus binge eating, loss of control, 93–94

as treatment target, 220–221

P

“Participate” skill, 101

homework sheet, 116a

Path to Mindful Eating, 71a, 221f

orienting client to, 35–39

Personality disorders, 3t, 7, 10

Planning for the Future, 186–187

case illustration, group format, 213

case illustration, individual format, 202–203

goal of, 186

homework practice, 186–187, 189a
Planning for the Future Homework Sheet,

Playing the Devil’s Advocate, 25, 44

Positive experiences/emotions

Adult Pleasant Events schedule, 154
a

homework practice, 139
f, 141, 153a

increasing Mindfulness of, 140–141

steps for increasing of, 138, 140–141
Preoccupation with food

treatment target, introductory sessions
review, 54, 71a

treatment target, pretreatment interview
orientation, 37, 71
a

Urge Surfng skill in, 108–110, 118
a
Pretreatment interview, 31–42

case illustration, group format, 204

case illustration, individual format, 191–193

emotion dysregulation model in, 33–34

general treatment issues, 39–42

goals, 31–32

mindful eating path orientation, 35–39
Pretreatment stage, 30–69

content, 224

introductory sessions as part of, 42–69

pretreatment interview as part of, 31–42
Primary emotions

and emotion regulation, 124–125, 150

homework sheet, 150a

versus secondary emotions, 124–125
Primary Emotions and Secondary Reactions
Homework Sheet, 150a

Problem behavior

in chain analysis, 57–59, 61–63, 75a, 78a,

in skills practice report, 60–61, 86
a

Index

Problem solving, therapist strategies, 23–24
Prompting events

bingeing and purging, 48–49

in chain analysis, 58, 62–63, 75a, 78a, 79a
in describing emotions model, 121–124,

Pros and Cons strategy. See
Evaluating Pros

and Cons strategy

Q

Quality of life, impact of BED and BN, 8, 11
Quotes about Emotions, 214a

R

Radical Acceptance, 162–167

case illustration, group format, 212–213

case illustration, individual format, 201

experiential exercises, 163–165

versus passivity, 163–164

review, 184

troubleshooting, 166–167

and Turning the Mind, 165

Willingness and Willfulness in, 165–166
Randomized controlled trials of DBT adapted
for BED/BN, 14–15

Reasonable Mind

defnition, 94–95

homework practice, 98, 115a

review of, 181

Reasonable Mind Homework Sheet, 115a
Recommitting to stop bingeing (and purging),

Reducing Vulnerability to Emotion Mind. See
Emotion Regulation module

Relapse, 10, 218

Relapse prevention, 184–189, 218–219
Remission, bulimia nervosa, 10

Research evidence, DBT adaptation for BED