An investigation of the role of values and shame in binge eating

Abstract

Binge Eating Disorder (BED) is a chronic and distressing eating disorder that is characterised by episodes of eating objectively large amounts of food and experiencing loss of control over eating behaviour. Several psychological interventions have received empirical support for the treatment of BED and although these treatments are efficacious, collectively they are ineffective for approximately 50% of individuals who undertake them. Given that, after treatment, a significant proportion of individuals continue to experience binge eating symptoms either at posttreatment or over the period following treatment, it has been suggested that other theoretical conceptualisations and/or treatment approaches for BED be examined. One area that has been suggested as a major aetiological and maintenance factor in BED is the role of affect regulation in the urge to binge. None of the main treatment approaches (Cognitive Behaviour Therapy, Interpersonal Therapy, or Behavioural Weight Loss) comprehensively address the role of affect dysregulation in the aetiology and/or maintenance of binge eating. In contrast, central to Dialectical Behaviour Therapy (DBT) is the comprehensive targeting of affect dysregulation. DBT is considered a viable treatment for BED, however, in its traditional format, is a lengthy treatment. Finding ways to refine and enhance emotion-focused treatments, such as DBT, therefore has the potential to improve treatment outcomes for binge eating. DBT focuses on assisting individuals to better manage overwhelming affect without binge eating, however this is often experienced as very difficult to do. As one potential refinement to DBT, values clarification and values consistent behaviour are potential ways of strengthening commitment to accept emotion dysregulation without using binge eating as a coping mechanism. Drawing on the Acceptance and Commitment literature, the first part of this thesis examines the utility of enhancing DBT for BED with a values and committed action component, as well as examining the feasibility of delivering the treatment over a shorter duration than standard DBT for BED. The first study is a preliminary examination of the efficacy, feasibility, and acceptability of a values-enhanced group DBT program over a shorter duration (14 weeks) than standard DBT-BED (20 weeks). The intervention resulted in a significant reduction in binge eating at posttreatment that was at least comparable to that achieved using the longer, standard DBT programs for BED. A significant increase in tolerance of negative affect and urges to binge eat were also observed. Additionally, participants reported increased connection to personal values, acceptance, and committed action. Participants also endorsed the treatment as highly acceptable. It became apparent during treatment that outcomes measures were not adequately assessing the full range of affect (specifically shame) experienced by participants. As such, a revision of the Emotional Eating Scale (EES) incorporating Shame and Body Shame subscales is the basis of the latter part of the thesis. Both Shame and Body Shame subscales were developed, and the psychometric properties of the revised EES (EES-R) were examined. The results provide support for the psychometric properties of the EES-R. Additionally the Shame and Body Shame subscales were unique predictors of a range of eating psychopathology and highly related to a number of key psychological constructs related to binge eating. In conclusion, this thesis highlights the potential role of values in augmenting emotion-based treatments such as DBT. Furthermore, it provides additional support for the role of emotion, and importantly, complex and self-conscious emotions such as shame, that need further attention in binge eating assessment and treatment.