Radically open dialectical behavior therapy for anorexia nervosa: A multiple baseline single-case experimental design study across 13 cases

Abstract

Background and objectives: No treatment for adult anorexia nervosa (AN) has shown sufficient effectiveness or superiority to other treatments. Overcontrol has been suggested as a viable mechanism to target in the treatment of patients with AN. Radically open dialectical behavior therapy (RO DBT) is developed for disorders related to maladaptive overcontrol. Our objective was to evaluate the outcome of RO DBT for AN in a clinical outpatient setting.

Methods: Thirteen adult female patients with mild to moderate AN provided written consent and entered a multiple baseline single-case experimental design study. Median age at eating disorder (ED) onset was 15 years and the median duration of the ED was 10 years. Individual changes were assessed weekly during a baseline phase (A) of four to six weeks, and during the subsequent 40-week RO DBT phase (B). Additional assessments were conducted before and after treatment, and at a six-month follow-up. Primary outcome was ED psychopathology. Secondary outcomes were psychosocial impairment, quality of life, social connectedness, and adaptive control strategies.

Results: Eight patients (62%) completed treatment. All completers were in full remission after treatment, with BMI ≥18.5 kg/m2 and ED psychopathology within one standard deviation of the community mean. Improvements occurred after introducing RO DBT, not during baseline.

Limitations: Participants were female with mild to moderate AN, limiting generalizability to severe AN or males.

Conclusions: The study provides preliminary support for using RO DBT in adult outpatients with AN and overcontrol. Further studies should replicate these findings.

Keywords: Anorexia nervosa; Eating disorders; Overcontrol; Radically open dialectical behavior therapy; Single-case experimental design.

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