Exploring skill utilization as a mechanism of dialectical behavioral therapy among adults with eating disorders in a partial hospitalization program

Research supports the use of dialectical behavior therapy (DBT) for patients with eating disorders (EDs). The DBT skills deficit model suggests that individuals engage in maladaptive behaviors to reduce or avoid strong emotions due to lack of knowledge or mastery of more effective methods to regulate distress. A primary component of DBT is teaching patients skills to cope with emotional dysregulation. Building upon previous research, this study examined whether change in DBT skills use frequency mediated the relationship between emotion dysregulation and ED symptoms across ED diagnoses, in a sample of treatment-seeking adults with EDs (N = 454). Variables were measured at treatment admit, one-month post-admission, and discharge. Bootstrapped mediation analyses were used and biased-corrected 95% confidence intervals (CIs) were computed. Increases in DBT skills use mediated the association between emotion dysregulation and ED psychopathology (95% CI [−.0022, −.0002]), but not change in binge eating (95% CI [−.0034, .0001]) or self-induced vomiting (95% CI [−.0032, .0006]). The index of moderated mediation for all outcomes indicated the simple mediation model did not significantly differ as a function of diagnosis type. Results provide support for the DBT skills deficit model in an ED sample and suggest that DBT improves ED psychopathology by increasing frequency of using effective coping skills.