An Open Trial Examining Dialectical Behavior Therapy Skills and Behavioral Weight Loss for Adults With Emotional Eating and Overweight/Obesity

Third-wave cognitive behavioral interventions for weight loss have shown promise. However, sparse data exists on the use of dialectical behavior therapy for weight loss. Adapted dialectical behavior therapy skills programs may be especially well suited for adults who engage in emotional eating and are seeking weight loss. Dialectical behavior therapy is skills-based, shares theoretical links to emotional eating, and is effective in treating binge eating. The current study examined the feasibility, acceptability, and preliminary efficacy of Live FREE: FReedom from Emotional Eating, a 16-session group-based intervention. A total of 87 individuals expressed interest in the program, and 39 adults with overweight/obesity (BMI ≥25) and elevated self-reported emotional eating were enrolled. Live FREE targeted emotional eating in the initial sessions 1–9, and sessions 10–16 focused primarily on behavioral weight loss skills while continuing to reinforce emotion regulation training. Assessments were administered at baseline, posttreatment, and 6-month follow up. Enrolled participants were primarily female (97.4%) and Caucasian (91.7%). Treatment retention was strong with participants attending an average of 14.3 sessions and 89.7% of participants completing the intervention. On average, participants lost 3.00 kg at posttreatment, which was maintained at follow-up. Intent-to-treat analyses showed improvements in key outcome variables (self-reported emotional eating, BMI, emotion regulation) over the course of the intervention. Combining dialectical behavior therapy skills with conventional behavioral weight loss techniques may be an effective intervention for adults with overweight/obesity who report elevated emotional eating.     

“Nothing was lost sailing-wise and lots is gained on a personal level”: Practitioners’ behaviors and athletes’ perceptions of working in online environments

ObjectivesThe purpose of this study was to explore the perceptions of expert practitioners and their British sailing team athletes concerning effective, athlete-centered online delivery during a period of COVID-19 restrictions between March and June 2020. In particular, we explored how psychosocial behaviors of practitioners and inherent attributes of online environments influenced the overall wellbeing of the athletes.MethodsUsing appreciative inquiry (AI), which adopts a social constructionist viewpoint, we interviewed nine expert practitioners, which included technical and strength and conditioning coaches, physiologists, and physiotherapists, and 18 elite athletes.ResultsOur results highlight that when delivering sessions online, practitioners expressed psychosocial behaviors that helped build effective relationships, with expression of care and empathy developing closeness, active participation exhibiting commitment, and psychosocial behaviors such as promoting a holistic mindset supporting an athlete-centered approach. Key to these positive outcomes was the connection that practitioners developed with their athletes in these online sessions. Our results suggest that the online environment provide opportunities for practitioners and athletes to reveal part of their personalities and identities that go beyond focusing on performance due to the change in the contextual setting (i.e., restrictions called for a ‘people first’ approach).ConclusionThe findings offer a novel contribution to the literature in highlighting how online environments provide the opportunity to deliver athlete-centered sessions.     

辩证认识氯胺酮

氯胺酮又称K粉,为苯环己哌啶的衍生物,非竞争性NMDA受体拮抗剂,起初作为分离性麻醉剂应用于临床,后因其具有致幻性和精神依赖性,作为一种新型毒品在世界范围内广泛流行。氯胺酮由药品变成毒品,引发了一系列哲学的思考,只有用发展的、辩证的、矛盾的哲学思维去认识氯胺酮,才能正确对待其被赋予的双重身份。     

围手术期应激性高血糖管理

由于手术应激原影响,外科大手术围术期发生应激性高血糖屡见不鲜。围手术期血糖监测与控制对临床治疗意义重大。本文概括了围手术期应激性高血糖的发病机制、主要危害,从辩证思维的角度,归纳出灵活掌握控制标准,注意“度”的原则、整体性原则及动态性原则,从而有效控制围手术期发生的应激性高血糖。     

Pragmatic Democracy: Inquiry,Objectivity, and Experience

This essay argues that to understand Dewey's vision of democracy as “epistemic” requires consideration of how experiential and communal aspects of inquiry together produce what is named here “pragmatic objectivity.” Such pragmatic objectivity provides an alternative to absolutism and self‐interested relativism by appealing to certain norms of empirical experimentation. Pragmatic objectivity, it is then argued, can be justified by appeal to Dewey's conception of primary experience. This justification, however, is not without its own complications, which are highlighted with objections regarding “radical pluralism” in political life, and some logical problems that arise due to the supposedly “ineffable” nature of primary experience. The essay concludes by admitting that while Dewey's theory of democracy based on experience cannot answer all of the objections argumentatively, it nevertheless provides potent suggestions for how consensus building can proceed without such philosophical arguments.     

Description of an Intensive Dialectical Behavior Therapy Program for Multidiagnostic Clients With Eating Disorders

The authors describe an intensive outpatient dialectical behavior therapy (DBT) program for multidiagnostic clients with eating disorders who had not responded adequately to standard, empirically supported treatments for eating disorders. The program integrates DBT with empirically supported cognitive behavior therapy approaches that are well established for the treatment of eating disorders. Attention is given to inclusion and exclusion criteria, how the program differs from standard treatments for eating disorders, and the application of specific DBT treatment components for multidiagnostic clients with eating disorders.     

A systematic review and meta-analysis of dropout rates from dialectical behaviour therapy in randomized controlled trials

ABSTRACT

Dropout is an important factor that may compromise the validity of findings from randomized controlled trials (RCTs) of dialectical behaviour therapy (DBT). We conducted a targeted meta-analytic review of dropout from RCTs of DBT, with the aims of (1) calculating average rates of dropout from DBT; (2) investigating factors that moderate dropout; (3) examining whether dropout rates from DBT differ to control interventions; (4) synthesising reasons for dropout. Forty RCTs of DBT met full inclusion criteria. The weighted mean dropout rate was 28.0% (95% CI = 23.6, 32.9). Dropout rates were not related to target disorder, dropout definition, delivery format, therapist experience, and therapist adherence. Unexpectedly, dropout rates were significantly higher in trials that offered telephone coaching and utilized a therapist consultation team. DBT dropout rates did not significantly differ to dropout rates from control interventions. Few trials reported reasons for dropout, and there was little consistency in the reported reasons. Findings suggest that over one in four patients drop out from DBT in RCTs. This review highlights the urgency for future trials to explicitly report detail pertaining to patient dropout, as this may assist in the development of strategies designed to prevent future dropouts in RCTs of DBT.