Dialectical Behavior Therapy Skills and Behavioral Weight Loss for Emotional Eating and Obesity: A Case Study

  • Abby BradenEmail author
  • Emily Ferrell
  • Rachel Redondo
  • Tanya Watford
Original Paper


Live FREE is a 16-week group intervention for adults with emotional eating and obesity that combines Dialectical Behavior Therapy skills (sessions 1–9) with standard behavioral weight loss strategies (sessions 10–16). Traditionally, behavioral weight management programs yield inconsistent outcomes, particularly for emotional eaters. Live FREE is predicated on the premise that improved emotion regulation will facilitate greater success in adopting weight management techniques among emotional eaters. Outcomes are presented with a case study of Amy, a woman who completed Live FREE. Amy reported a history of unsuccessful weight loss attempts, and she initially presented as timid, with limited awareness of her emotions. During the Dialectical Behavior Therapy portion of treatment, Amy learned to identify emotional eating triggers (e.g., feeling inadequate and anxious) and useful strategies for effectively responding to emotions (e.g., nonjudgmental awareness and checking the facts). Subsequently, during the weight loss sessions, Amy’s use of emotion regulation skills expanded as she encountered and overcame barriers to implementing conventional weight loss techniques. Post-treatment assessment results indicated that Amy’s emotional eating decreased from baseline to post-treatment, and was maintained at follow-up. Furthermore, her weight slightly decreased toward the end of the treatment (during the behavioral weight loss sessions), and she continued to lose additional weight over the 6-month follow-up. Adults seeking weight loss who also struggle with emotional eating may benefit from initially decreasing emotional eating behavior prior to focusing on weight loss.


Case study Obesity Emotion eating 


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (include name of committee + reference number) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Arnow, B., Kenardy, J., & Agras, W. S. (1995). The emotional eating scale—The development of a measure to assess coping with negative affect by eating. International Journal of Eating Disorders,18(1), 79–90.;2-v.CrossRefPubMedGoogle Scholar
  2. Braden, A., Musher-Eizenman, D., Watford, T., & Emley, E. (2018). Eating when depressed, anxious, bored, or happy: Are emotional eating types associated with unique psychological and physical health correlates? Appetite,125, 410–417.CrossRefGoogle Scholar
  3. Braden, A. & O’Brien, W. (under review). Pilot study of a novel treatment using dialectical behavior therapy skills for adults with overweight/obesity and emotional eating.Google Scholar
  4. Brownell, K. (2004). The LEARN program for weight management. Dallas, TX: The American Health Publishing Company.Google Scholar
  5. Butryn, M. L., Webb, V., & Wadden, T. A. (2011). Behavioral treatment of obesity. Psychiatric Clinics of North America,34(4), 841. Scholar
  6. Canetti, L., Berry, E. M., & Elizur, Y. (2009). Psychosocial predictors of weight loss and psychological adjustment following bariatric surgery and a weight-loss program: The mediating role of emotional eating. International Journal of Eating Disorders,42(2), 109–117. Scholar
  7. Center for Disease Control and Prevention. (2018). Adults obesity facts. Retrieved April 17, 2019, from
  8. Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: Interview or self-report questionnaire? International Journal of Eating Disorders,16(4), 363–370.PubMedGoogle Scholar
  9. Geliebter, A., & Aversa, A. (2003). Emotional eating in overweight, normal weight, and underweight individuals. Eating Behaviors,3(4), 341–347. Scholar
  10. Haedt-Matt, A. A., & Keel, P. K. (2011). Revisiting the affect regulation model of binge eating: A meta-analysis of studies using ecological momentary assessment. Psychological Bulletin,137(4), 660–681. Scholar
  11. Hales, C. M., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2017). Prevalence of obesity among adults and youth: United states, 2015–2016. NCHS Data Brief,288, 1.Google Scholar
  12. Heatherton, T. F., & Baumeister, R. F. (1991). Binge eating as escape from self-awareness. Psychological Bulletin,110(1), 86.CrossRefGoogle Scholar
  13. Koball, A. M., Meers, M. R., Storfer-Isser, A., Domoff, S. E., & Musher-Eizenman, D. R. (2012). Eating when bored: Revision of the Emotional Eating Scale with a focus on boredom. Health Psychology,31(4), 521.CrossRefGoogle Scholar
  14. LeBlanc, E. S., Patnode, C. D., Webber, E. M., Redmond, N., Rushkin, M., & O'Connor, E. A. (2018). Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults updated evidence report and systematic review for the US preventive services task force. JAMA-Journal of the American Medical Association,320(11), 1172–1191. Scholar
  15. Leehr, E. J., Krohmer, K., Schag, K., Dresler, T., Zipfel, S., & Giel, K. E. (2015). Emotion regulation model in binge eating disorder and obesity—A systematic review. Neuroscience and Biobehavioral Reviews,49, 125–134. Scholar
  16. Linehan, M. M. (2014). DBT skills training manual (2nd ed.). New York: Guilford Publications.Google Scholar
  17. Niemeier, H. M., Phelan, S., Fava, J. L., & Wing, R. R. (2007). Internal disinhibition predicts weight regain following weight loss and weight loss maintenance. Obesity,15(10), 2485–2494. Scholar
  18. Peneau, S., Menard, E., Mejean, C., Bellisle, F., & Hercberg, S. (2013). Sex and dieting modify the association between emotional eating and weight status. American Journal of Clinical Nutrition,97(6), 1307–1313. Scholar
  19. Polivy, J., & Herman, C. P. (1993). Etiology of binge eating: Psychological mechanisms. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment, and treatment (pp. 173–205). New York: Guilford Press.Google Scholar
  20. Roosen, M. A., Safer, D., Adler, S., Cebolla, A., & Van Strien, T. (2012). Group dialectical behavior therapy adapted for obese emotional eaters: A pilot study. Nutrición Hospitalaria,27(4), 1141–1147. Scholar
  21. Safer, D. L., & Jo, B. (2010). Outcome from a randomized controlled trial of group therapy for binge eating disorder: Comparing dialectical behavior therapy adapted for binge eating to an active comparison group therapy. Behavior Therapy,41(1), 106–120. Scholar
  22. Safer, D. L., Telch, C. F., Chen, E. Y., & Linehan, M. M. (2009). Dialectical behavior therapy for binge eating and bulimia. New York: Guilford Publications Inc. M.U.A.Google Scholar
  23. Simon, G. E., Von Korff, M., Saunders, K., Miglioretti, D. L., Crane, P. K., van Belle, G., et al. (2006). Association between obesity and psychiatric disorders in the US adult population. Archives of General Psychiatry,63(7), 824–830.CrossRefGoogle Scholar
  24. Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology,69(6), 1061–1065. Scholar
  25. The Diabetes Prevention Program (DPP) Research Group, DPP Res Grp, Diabetes Prevention Program (DPP) Research Group, & The Diabetes Prevention Program Research Group. (2002). The diabete's prevention program (DPP)—Description of lifestyle intervention. Diabetes Care,25(12), 2165–2171. Scholar
  26. The Look AHEAD Research Group, Look AHEAD Res Grp, & Look AHEAD Research Group. (2003). Look AHEAD (action for health in diabetes): Design and methods for a clinical trial of weight loss for the prevention of cardiovascular disease in type 2 diabetes. Controlled Clinical Trials,24(5), 610–628. Scholar
  27. U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015). 2015–2020 Dietary Guidelines for Americans (8th Ed.). December 2015. Retrieved April 17, 2019, from
  28. Wiser, S., & Telch, C. F. (1999). Dialectical behavior therapy for binge-eating disorder. Journal of Clinical Psychology,55(6), 755–768.;2-r.CrossRefPubMedGoogle Scholar
  29. World Health Organization. (2018, February 16). Obesity and overweight. Retrieved April 17, 2019, from
  30. Yanovski, S. Z., & Yanovski, J. A. (2018). Toward precision approaches for the prevention and treatment of obesity. JAMA-Journal of the American Medical Association,319(3), 223–224. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2020

Authors and Affiliations

  • Abby Braden
    • 1
    Email author
  • Emily Ferrell
    • 1
  • Rachel Redondo
    • 1
  • Tanya Watford
    • 1
  1. 1.Bowling Green State UniversityBowling GreenUSA

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