Development and Effectiveness of a Brief Dialectical Behaviour Therapy Skills Training Group for Bariatric Patients

Abstract

A brief dialectical behaviour therapy skills training (DBT-ST) group for bariatric candidates was developed and evaluated as an adjunctive intervention to bariatric surgery in the pre-surgical period to facilitate improved weight loss and address associated psychopathology. It was anticipated that a brief DBT-ST group would be an innovative adjunctive intervention for this patient population as standard DBT and variations of DBT-ST have been shown to be effective interventions for disorders characterized by emotion dysregulation such as binge eating disorder, a disorder often seen in bariatric populations. Two separate studies were conducted. The purpose of Study One was to adapt DBT-ST for implementation in the pre-surgical program at the Regina Qu'Appelle Health Region (RQHR), Bariatric Surgical Assessment Clinic, determine preliminary effectiveness (pre- and post-DBT-ST), and assess for necessary modifications to the DBT-ST group. Seven bariatric candidates (5 females and 2 males) participated in Study One. Results demonstrated trends towards effectiveness (i.e., small reductions in eating pathology, emotion dysregulation, impulsivity, personality pathology, and excess body weight [EBW]), and minor modifications were made to the intervention protocol (i.e., use of online video conferencing and survey monkey). The purpose of Study Two was to examine the effectiveness and feasibility of an adapted, brief (8 weeks) online DBT-ST group in conjunction with TAU in comparison to strictly TAU (i.e., comparison group) for bariatric candidates in the pre-surgical program at the RQHR Bariatric Surgical Assessment Clinic. Participants were 95 bariatric candidates (80% females), with 50 candidates participating in DBT-ST plus TAU (i.e., condition one) and 45 candidates taking part in strictly TAU (i.e., condition two). Effectiveness was measured in terms of reductions in eating pathology, associated psychopathology, and weight loss outcomes over time. Assessment points were consistent across groups (i.e., time one [T1]: start of the DBT-ST group/start of the Bariatric Surgical Assessment Clinic pre-surgical program; time two [T2]: post-DBT-ST group/8 weeks; and time three [T3]: 4 months post-DBT-ST group/end of the 6-month bariatric pre-surgical program). Results demonstrated that participants in the DBT-ST plus TAU condition showed statistically significant reductions in emotional eating from T1 to T2, and binge eating, emotional eating, and global eating pathology (i.e., shape and weight concerns) from T1 to T3 in comparison to TAU. The effect sizes ranged from small to medium (i.e., η2 = .041 to .071), with reductions in emotional eating over time demonstrating the largest effect size. No differences in participant satisfaction with each treatment condition were observed between the two treatment conditions. Results demonstrate that a brief DBT-ST group implemented as an adjunctive intervention to TAU in an existing bariatric surgical assessment clinic pre-surgical program represents an innovative addition to pre-surgical programs to aid in addressing eating pathology often present in a bariatric population. Albeit, no significant differences between conditions were seen in terms of weight loss at the end of the pre-surgical period. It is suspected that the bariatric participants in the DBT-ST plus TAU condition may be on a better weight loss trajectory than those receiving strictly TAU, despite lack of EBW loss differences at T3. Overall these findings may be used to inform bariatric pre-surgical program development.