Effectiveness of DBT for Anorexia Nervosa: A Research Proposal Study

This research proposal explores the effectiveness of Dialectical Behavior Therapy (DBT) as a treatment for Anorexia Nervosa (AN). The proposal highlights the severity and treatment challenges associated with AN, noting the limitations of existing treatments. It introduces DBT as a promising intervention, particularly due to its success in treating emotional dysregulation, a common issue in individuals with AN. The proposal evaluates existing evidence supporting DBT's use in treating eating disorders, addresses research gaps, and poses a research question focused on determining DBT's effectiveness in treating AN. The hypothetical study outlines a quasi-experimental design with structured interviews to assess participants, ethical considerations to ensure confidentiality, and appropriate data analysis methods to evaluate the outcomes of DBT for individuals with AN.

Running head: RESEARCH PROPOSAL 1
Research Proposal
Name:
Institution Affiliation:

RESEARCH PROPOSAL 2
Abstract/overview of the project
The aim of this study is to highlight the effectiveness of Dialectical Behavioural Therapy as the
treatment to eating disorder especially Anorexia Nervosa (AN). Case studies have shown that
Anorexia Nervosa has been life threatening disorder which has been extremely difficult to deal
with. There has been evidence that family dependent treatments are very effective for the AN but
generally there has no treatment that has been shown to be clearly effective for the AN (Hay,
2013). The methodological issues that have been related to studying the disorder have resulted to
recommendation to new treatment which has been undergoing preliminary testing before it has
been examined in the randomized clinical trial (Hay, 2013). Within this research proposal study
would be to offer some preliminary proof on the effectiveness to the treatment program that is
depending on the novel of adapting Dialectical Behavior Therapy for Anorexia Nervosa which
conceptualizes AN as a disorder to over control.
Condition Anorexia Nervosa and intervention (DBT)
Anorexia Nervosa (AN) is an extremely severe psychiatric illness that has been characterized by
low body weight and intense fear of being overweight (Kahl, Winter & Schweiger, 2012). With
regards to the adult the course of AN is chronic, and is considered difficult with regards to
treatment (Kahl, Winter & Schweiger, 2012). The rates of mortality in AN usually are high than
any psychological condition, with death that might result from cardiac issues or suicide. Based
on study it recommend that less than half of the adults with the AN, develop although many
continue on the chronic course or maybe partially improve (Hay, 2013). With regards to adults
that have AN, there have been absolutely no particular treatment that has shown to be much
superior in place since there us dearth adequately designed and has been powered randomized

RESEARCH PROPOSAL 3
managed trials (Hay, 2013). There are numerous treatment that have failed to deal with on the
core symptoms related to AN. Therefore, there has been new theoretical as well as treatment
techniques which are required for this disorder (Kahl, Winter & Schweiger, 2012). There has
been numerous psychological treatments which have been tested in outpatient setting, however,
based on the reviews as well as meta analyzes there no evidence which has been shown in the
superiority of one treatment approach over the other (Baer, Fischer & Huss, 2005). Nonetheless,
treatment which has shown some degree of improvement of the condition has been DBT
intervention. This intervention was initially created for the people with borderline personality
disorder , but lately it has demonstrated to be effective in two RCTs focusing on binge purge
eating disorder especially with the uncontrolled problems for example serious emotion
dysregulation (Hay, 2013). The interest in the DBT has grown and experts they have actually
begun to use DBT to other clinical populations (Baer, Fischer & Huss, 2005). The adaptation of
the DBT to treatment of the patient who experience AN, remains to be modified via the biosocial
theory and it continues proposed that people who develop eating disorders they might have
certain biological susceptibility to regulate emotions (Kahl, Winter & Schweiger, 2012). In case
the biological susceptibility interacts with precise kind of environment, they patient might
develop an eating disorder. The invalidating environment could take place across a spectrum
from the poor fit between temperament of a person and also their environment.
Evaluate evidence
Currently, DBT is regarded as the frequently looked into psychosocial intervention for the AN
treatment. It is an extensive treatment plan that has been targeted at promoting motivation
alterations by comprehensive chain evaluates validation techniques and management of
reinforcement contingencies in person treatment (Kahl , Winter & Schweiger , 2012). Based on

RESEARCH PROPOSAL 4
the practice guideline for the therapy of the patient with the eating disorder of United States
Psychiatric Association (2006), both males and females with ED for instance AN must evaluated
for individuality disorders. Depending on the earlier studies, demonstrate that comorbidity rate
for the ED was 3% for the Anorexia nervosa when accessed through diagnostic interviews.
When thinking about the feasible confounding impact of malnutrition at intake, personality
pathology could possibly be challenging regarding detecting samples with AN (Bankoff, Karpel ,
Forbes & Pantalone, 2012). However, women who retrieved from anorexia nervosa, restricting
type AN-R, they showed significantly low and equivalent rate as those of cluster B issues. DBT
concentrates in assisting patients to much more efficiently regulate on their feelings. Given that
the patients with ED often display particular degree of difficulties with regards to regulating their
emotions so they often display an eating pathology (Navarro-Haro et al 2018). DBT might be
deemed as methods to deal with that facet of the emotional susceptibility. The deficits in impacts
regulation in the eating disorders patients are wide when it comes to the scope so they differ in
AN.
Patients with AN have difficulties in terms of the identification as well as awareness of the
emotions, and avoiding of the feelings to some scope. The inherent framework of the DBT is
evidently a great model employed to treat ED (Lenz, Taylor, Fleming & Serman, 2014). It
provides certain distinct behavioral hierarchy which acts as guides to the therapists especially in
focusing on the interventions. Elements for example suicidal and non-suicidal self destructive
behaviors components which are not common in AN are sorted out first (Waller, 2016). On the
second elements are the habits that could inter with the therapy and then mentioned after which
followed by the quality of life interfering behaviors. DBT consists of particular methods with
regards to working with the variables commitment to change (Kröger et al 2010). The AN

RESEARCH PROPOSAL 5
patients normally have some problems with regards to modifying symptoms, so they could be
less responsive to the usage of the traditional therapeutic interventions that are thought to be
controlling ( Kahl , Winter & Schweiger , 2012 ) . DBT telephone skill coaching might be
utilized with ED patients to assist with averting dysregulated eating routine. Moreover, the
weekly consultation team meeting could aid clinicians to be motivated and allow helpful input
and feedback to the therapy utilized. Regarding AN treatment, there have been deficiency of
research outside the subject of FBT (Linehan et al 2015). In the literature it has described
psychodynamic treatment and CBT, but there is absolutely no methodical evaluation which has
been carried out (Bankoff, Karpel, Forbes & Pantalone, 2012). There is certainly need for the
systematic trials which look at the psychotherapy in AN. With regards to DBT continues to be
empirical supported treatment there is however no much study done on the clinical trials on AN.
Areas required for further research
There has been little research outside the field of FBT. Thus, the researchers in other field need
to do more research in relation to the DBT treatment of AN (Ozier & Henry, 2011).
Additionally, DBT was initially developed for the treatment of the female multi-problem
outpatients who were diagnosed with the borderline personality disorder. There should more
interest in the DBT and research done in order to apply to the other clinical populations with and
without the Axis (Ozier & Henry, 2011). Presently, there is certainly just one research which
exists on the effectiveness for the adolescent patients who are afflicted with AN. Within this pilot
research it only evaluated the effectiveness of the DBT which seems to be promising treatment
especially to the inpatients adolescents with ED (Ozier & Henry, 2011). There have been
absolutely no research yet which examined whether the outpatient DBT interventions has been

RESEARCH PROPOSAL 6
feasible and effective to reduce symptoms of AN (Palmer et al 2003). This is a research gap and
further research could be done on this research area.
Research question
The research question for this proposal is as follows;
1. To find out the effectiveness of Dialectical Behavioural Therapy (DBT) as treatment for
the eating disorder Anorexia Nervosa?
In this research study the principle variables which are being examined were on the demographic
variables and the Body mass index. At the therapy admission, the participants filled demographic
form that composed information on their gender, age, ethnicity and the admissions to date (Safer,
Couturier & Lock, 2007).
Hypothetical research study
In this proposed study is feasible and carried out to answer on the research question the follows
are the sections which describe on this hypothetical study.
Design methodology
In this proposed study it would utilize quasi-experimental design methodology. Within this
research all the subjects in this research have the same chance of being assigned to the
intervention group or perhaps the comparison group (Navarro-Haro et al 2018). The use of this
methodology is ideal for this research given that the researcher is enthusiastic about the
independent variables which could not be randomly assigned (Hayes et al 2004). It has
something which is an innate characteristic of the participants who are involved since it focuses
on the emotions of the participants (Salbach-Andrae et al 2008). The method which would be

RESEARCH PROPOSAL 7
used to collect would be interviews. There would be use of the structured clinical interview. The
interviewers would be trained in the administering ads well as scoring of the instruments by
clinician who had been trained (Hay, 2013).
Participants
In this research it will use twenty four individuals (12 young and 12 adolescent) of who would be
selected from the child and adolescent outpatient psychiatric division of the major university
hospital in Australia. All would certainly be required to meet the criteria outlined in diagnostic as
well as statistical manual of the mental disorder. The participants who are included in this
research are between the age of 12 and 18 years of age. To undertake on the research permission
would need to be granted by the Institutional Review Board (Kristeller, Baerm & Quillian-
Wolever, 2006). All themes will require a written notification form which indicates the project
and inclusion as well as exclusion requirements to the study. Participants that are under age of 18
can simply be a part of the study in case the parent provides them written informed consent.
Materials/ measures
The organized inventory for the Anorectic syndrome could be utilized to evaluate the prevalence
and severity to particular eating relevant pathology for over three months based on the DSM-IV
diagnostic criteria to individual who were between 12 to 18 years. The semi-structured interview
might supply general probes to each item to evaluate if the item for the investigation is true for
the individuals who would be questioned (Lock, 2015). There would be measurement of the
demographic variable along with the BMI on the patients.
Data analysis

RESEARCH PROPOSAL 8
Due to the small sample size which would be used for this research as well as the requirements
of the statistical procedures, the proposed research would use distribution free methods. There is
comparisons of categorical data at the pre treatment that will be analysed employing exact tests
bases on Fisher-Yates (Hay, 2013). There would be two tailed permutation tests especially for
the unpaired samples based on the Fisher-Pitman that will be conducted to be able to compare
frequencies of disorders at the pre-treatment. For the proposed study to look at on the indices of
eating disorder which are relevant complaints through use of the two- tailed permutation test for
the purpose of the group comparison (Peterson et al 2016).
Ethical issues
There are various ethical issues which would be encountered in this research study they are as
follows;
 Respect to confidentiality and the anonymity. It is crucial for the researchers to protect
data which is shared by the respondent it should always protect the subject identity.

RESEARCH PROPOSAL 9
References
Baer, R. A., Fischer, S., & Huss, D. B. (2005). Mindfulness and acceptance in the treatment of
disordered eating. Journal of rational-emotive and cognitive-behavior therapy, 23(4),
281-300. Accessed At:
https://www.researchgate.net/profile/Sarah_Fischer/publication/225413776_Mindfulness
_and_Acceptance_in_the_Treatment_of_Disordered_Eating/links/09e41509174f600e940
00000/Mindfulness-and-Acceptance-in-the-Treatment-of-Disordered-Eating.pdf
Bankoff, S. M., Karpel, M. G., Forbes, H. E., & Pantalone, D. W. (2012). A systematic review of
dialectical behavior therapy for the treatment of eating disorders. Eating disorders, 20(3),
196-215.
Hay, P. (2013). A systematic review of evidence for psychological treatments in eating disorders:
2005–2012. International Journal of Eating Disorders, 46(5), 462-469. Accessed At:
https://s3.amazonaws.com/academia.edu.documents/37203697/Hay-2013-
International_Journal_of_Eating_Disorders.pdf?
AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1532690235&Signature=P6%2B
FyY9ntSBCmboDZH0KxJ%2B327E%3D&response-content-disposition=inline%3B
%20filename%3DA_Systematic_Review_of_Evidence_for_Psyc.pdf
Hayes, S. C., Masuda, A., Bissett, R., Luoma, J., & Guerrero, L. F. (2004). DBT, FAP, and ACT:
How empirically oriented are the new behavior therapy technologies?. Behavior Therapy,
35(1), 35-54. Accessed At: scholarworks.gsu.edu/cgi/viewcontent.cgi?
article=1082&context=psych_facpub
Kahl, K. G., Winter, L., & Schweiger, U. (2012). The third wave of cognitive behavioural
therapies: what is new and what is effective?. Current opinion in psychiatry, 25(6), 522-
528.
Kristeller, J. L., Baer, R. A., & Quillian-Wolever, R. (2006). Mindfulness-based approaches to
eating disorders. Mindfulness-based treatment approaches: Clinician's guide to evidence
base and applications, 75. Accessed At:
https://www.researchgate.net/profile/Ruth_Wolever/publication/259297093_Mindfulness
-
Based_Approaches_to_Eating_Disorders/links/0c9605293ebb40514b000000/Mindfulnes
s-Based-Approaches-to-Eating-Disorders.pdf
Kröger, C., Schweiger, U., Sipos, V., Kliem, S., Arnold, R., Schunert, T., & Reinecker, H.
(2010). Dialectical behaviour therapy and an added cognitive behavioural treatment
module for eating disorders in women with borderline personality disorder and anorexia
nervosa or bulimia nervosa who failed to respond to previous treatments. An open trial
with a 15-month follow-up. Journal of behavior therapy and experimental psychiatry,
41(4), 381-388. Accessed At:
https://www.researchgate.net/profile/Soeren_Kliem/publication/44575049_Dialectical_be

RESEARCH PROPOSAL 10
haviour_therapy_and_an_added_cognitive_behavioural_treatment_module_for_eating_di
sorders_in_women_with_borderline_personality_disorder_and_anorexia_nervosa_or_bul
imia_nervosa_who_failed_/links/5677e3ae08aebcdda0eb9a41.pdf
Lenz, A. S., Taylor, R., Fleming, M., & Serman, N. (2014). Effectiveness of dialectical behavior
therapy for treating eating disorders. Journal of Counseling & Development, 92(1), 26-
35.
Linehan, M. M., Korslund, K. E., Harned, M. S., Gallop, R. J., Lungu, A., Neacsiu, A. D., ... &
Murray-Gregory, A. M. (2015). Dialectical behavior therapy for high suicide risk in
individuals with borderline personality disorder: a randomized clinical trial and
component analysis. JAMA psychiatry, 72(5), 475-482. Accessed At:
https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2205835
Lock, J. (2015). An update on evidence-based psychosocial treatments for eating disorders in
children and adolescents. Journal of Clinical Child & Adolescent Psychology, 44(5), 707-
721. Accessed At: https://www.tandfonline.com/doi/full/10.1080/15374416.2014.971458
Navarro-Haro, M. V., Botella, C., Guillen, V., Moliner, R., Marco, H., Jorquera, M., ... &
Garcia-Palacios, A. (2018). Dialectical Behavior Therapy in the Treatment of Borderline
Personality Disorder and Eating Disorders Comorbidity: A Pilot Study in a Naturalistic
Setting. Cognitive Therapy and Research, 1-14.
Ozier, A. D., & Henry, B. W. (2011). Position of the American Dietetic Association: nutrition
intervention in the treatment of eating disorders. Journal of the American Dietetic
Association, 111(8), 1236-1241. Accessed At: https://jandonline.org/article/S0002-
8223%2811%2900712-7/pdf
Palmer, R. L., Birchall, H., Damani, S., Gatward, N., McGrain, L., & Parker, L. (2003). A
dialectical behavior therapy program for people with an eating disorder and borderline
personality disorder—description and outcome. International Journal of Eating
Disorders, 33(3), 281-286.
Peterson, C. B., Becker, C. B., Treasure, J., Shafran, R., & Bryant-Waugh, R. (2016). The three-
legged stool of evidence-based practice in eating disorder treatment: research, clinical,
and patient perspectives. BMC medicine, 14(1), 69.Accessed At:
https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0615-5
Safer, D. L., Couturier, J. L., & Lock, J. (2007). Dialectical behavior therapy modified for
adolescent binge eating disorder: A case report. Cognitive and behavioral practice, 14(2),
157-167.
Salbach-Andrae, H., Bohnekamp, I., Pfeiffer, E., Lehmkuhl, U., & Miller, A. L. (2008).
Dialectical behavior therapy of anorexia and bulimia nervosa among adolescents: A case
series. Cognitive and behavioral practice, 15(4), 415.Accessed At:
http://elsevierscitech.com/pdfs/CBPRA-DialectalBehaviorTherapy.pdf

RESEARCH PROPOSAL 11
Waller, G. (2016). Treatment protocols for eating disorders: Clinicians’ attitudes, concerns,
adherence and difficulties delivering evidence-based psychological interventions. Current
psychiatry reports, 18(4), 36. Accessed At:
https://link.springer.com/article/10.1007/s11920-016-0679-0

RESEARCH PROPOSAL 12
Appendices
Eating Disorder (ED)
Anorexia Nervosa (AN)
Dialectical Behavioural Therapy (DBT)