Key result
Contextual emotion regulation strategies, particularly self-compassion, were more efficacious than waiting and cognitive restructuring in improving short-term emotion regulation and eating disorder symptoms in patients with bulimia nervosa.
Why the study?
Do contextual emotion regulation strategies and cognitive restructuring improve emotional and eating disorder related outcomes compared to waiting in inpatients with bulimia nervosa?
RCT (n=48)
Open-label
Permuted repeated measures design (complete counterbalancing)
No
Do contextual emotion regulation strategies and cognitive restructuring improve emotional and eating disorder related outcomes compared to waiting in inpatients with bulimia nervosa?
Mean Difference: 9.94 (95% CI 3.25–16.63)
p-value: p=0.004
Contextual emotion regulation strategies, particularly self-compassion, are more effective than cognitive restructuring or waiting for short-term emotion regulation in patients with bulimia nervosa.
Supports self-compassion integration into bulimia nervosa care pathways; extends RCT evidence favoring contextual over cognitive strategies.
BACKGROUND: While improving emotion regulation (ER) is a central goal in the therapy of bulimia nervosa (BN), there is no experimental evidence on the efficacy of different ER strategies. (1) We hypothesized that mindfulness as well as self-compassion as contextual strategies and cognitive restructuring as classical cognitive behavioral strategy would outperform waiting in improving emotional and eating disorder related outcomes after an unpleasant mood induction. Further, we explored (2) whether contextual strategies outperformed cognitive restructuring and (3) whether comorbid mental disorders and previous treatment for BN influenced the efficacy of contextual ER strategies compared to cognitive restructuring. METHODS: Within their first 2 weeks of treatment, inpatients with BN were instructed to utilize mindfulness, self-compassion, and cognitive restructuring or to wait after a pre-induced sadness in a permuted repeated measures design. Patients further rated different emotional and cognitive outcomes on a visual analogue scale at baseline, and before and after each ER strategy. Multiple linear regression analyses were employed to compare (1) the active conditions to waiting, (2) the contextual strategies with cognitive restructuring, and (3) the latter analysis again, but separated according to comorbidity and previous treatment. RESULTS: = 6.64) completed the study. (1) Contextual ER strategies were more efficacious than waiting for eating disorder symptoms. Cognitive restructuring did not differ from waiting for any outcome. (2) Contextual strategies were more efficacious than cognitive restructuring for emotional outcomes. (3) Self-compassion was more efficacious than cognitive restructuring in patients with comorbid mental disorders and previous treatment in increasing control over the present feeling. CONCLUSIONS: Contextual strategies, especially self-compassion, seem more efficacious than waiting and cognitive restructuring in improving short-term ER in patients with BN in an experimental setting.
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Heese et al. (2020) conducted an RCT in Bulimia nervosa (n=48). Contextual emotion regulation strategies (mindfulness and self-compassion) vs. Waiting and cognitive restructuring was evaluated on Feeling valuable (VAS 0-100) after unpleasant mood induction (Self-compassion vs. Waiting) (b 9.94, 95% CI 3.25-16.63, p=0.004). Contextual emotion regulation strategies, particularly self-compassion, were more efficacious than waiting and cognitive restructuring in improving short-term emotion regulation and eating disorder symptoms in patients with bulimia nervosa.
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