Change in defensive functioning over the course of group psychodynamic interpersonal psychotherapy for women with binge eating disorder

.................................................................................................................................... ii Acknowledgements .................................................................................................................. iii List of Tables .......................................................................................................................... vii List of Figures .......................................................................................................................... ix List of Appendices .................................................................................................................... x Introduction ............................................................................................................................... 1 Defence Mechanisms and Defensive Functioning ........................................................ 2 Measuring Defence Mechanisms .................................................................................. 8 Binge Eating Disorder and Defensive Functioning .................................................... 10 Attachment Theory ..................................................................................................... 13 Group Psychodynamic Interpersonal Psychotherapy ................................................. 18 Objectives ................................................................................................................... 23 Hypotheses .................................................................................................................. 23 Method .................................................................................................................................... 24 Participants .................................................................................................................. 24 Measures ..................................................................................................................... 25 Procedure .................................................................................................................... 29 DMRS Coding ............................................................................................................ 30 Data Analysis Plan ...................................................................................................... 31 Multi-level Modelling ................................................................................................. 33 Results ..................................................................................................................................... 37 CHANGE IN DEFENSIVE FUNCTIONING v Data Screening ............................................................................................................ 37 Sample Characteristics ................................................................................................ 37 Multi-level Modeling .................................................................................................. 43 Discussion ............................................................................................................................... 50 Objectives ................................................................................................................... 50 Reliability Between Raters Using the DMRS ............................................................. 51 Overall Defensive Functioning and Treatment Outcome ........................................... 52 Change in Defensive Functioning During Group Treatment ...................................... 52 Change in Defensive Functioning Associated with Change in Treatment Outcomes ........................................................................................................ 54 Change in Defensive Functioning and Change in Treatment Outcomes Moderated by Attachment Anxiety. .................................................................................. 55 Clinical Implications ................................................................................................... 56 Limitations .................................................................................................................. 57 Generalizability and Future Directions ....................................................................... 60 Conclusion .................................................................................................................. 61 References ............................................................................................................................... 62 Appendix A: ............................................................................................................................ 72 Appendix B: ............................................................................................................................ 73 Appendix C ............................................................................................................................. 74 Appendix D ............................................................................................................................. 75 Appendix E ............................................................................................................................. 77 CHANGE IN DEFENSIVE FUNCTIONING vi Appendix F.............................................................................................................................. 79 Appendix G ............................................................................................................................. 80 CHANGE IN DEFENSIVE FUNCTIONING vii List of Tables Table 1: List of defences and associated function from the DMRS ......................................... 4 Table 2: Mean, Standard Deviation, and Range of the Number of Coded Defences by Therapy Session .......................................................................................................... 32 Table 3: Sample Characteristics .............................................................................................. 38 Table 4: Defence level ICC Values and Total Number of Defences Coded Between Rating Pairs. ................................................................................................................ 40 Table 5: Mean and Standard Deviations for Attachment Style Questionnaire Subscales at Pre-treatment and Post-treatment by Attachment Anxiety Condition ........................ 41 Table 6: Correlations Between Session Three ODF Scores and Pre-treatment Measures of Depression, Interpersonal Problems, Self Esteem, and Binge Frequency .................. 42 Table 7: Correlations Between Session 3 ODF Scores with Pre-treatment Subscales from the Attachment Styles Questionnaire .......................................................................... 42 Table 8: Correlations Between Session 16 ODF Scores with Post-treatment Measures of Depression, Interpersonal Problems, Self Esteem, and Binge Episodes .................... 43 Table 9: Correlations Between Session 16 ODF Scores with Post-treatment Subscales from the Attachment Styles Questionnaire ................................................................. 43 Table 10: Mean and SD Values for ODF Scores at Sessions 3, 8, and 16 ............................. 45 Table 11: Mean and SD for Treatment Outcome Variables from Pre-treatment to 12Months Post-treatment ................................................................................................ 46 Table 12: Multilevel Modelling of Change in Overall Defensive Functioning, Depressive Symptoms, Interpersonal Problems, Self Esteem and Binge Frequency Over Treatment .................................................................................................................... 47 CHANGE IN DEFENSIVE FUNCTIONING viii Table 13: Change in Overall Defensive Functioning Scores Predicting Change in Treatment Outcome on Measures of Depression, Interpersonal Problems, Self Esteem, and Binge Frequency..................................................................................... 48 Table 14: 2-Level Model Results Testing the Moderating Effect of Attachment Anxiety Condition on the Relationship Between Change in Overall Defensive Functioning and Change in Treatment Outcomes. .......................................................................... 49 Table 15: A 2-Level Model Testing Change in Overall Defensive Functioning and Change in Interpersonal Problems and Self-Esteem Outcomes by Treatment Condition..................................................................................................................... 50 CHANGE IN DEFENSIVE FUNCTIONING ix List of Figures Figure 1. Triangle of Adaptation and Object Relations. ......................................................... 20 CHANGE IN DEFENSIVE FUNCTIONING x List of Appendices Appendix A:Defence Mechanism Rating Scale Scoring Sheet .............................................. 72 Appendix B:DSM-IV-TR Diagnostic Criteria for Binge-Eating Disorder .............................. 73 Appendix C: Attachment Style Questionnaire ........................................................................ 74 Appendix D: Beck Depression Inventory ............................................................................... 75 Appendix E: Inventory of Interpersonal Problems ................................................................. 77 Appendix F: Rosenberg Self-Esteem Scale ............................................................................ 79 Appendix G: Multi-Level Model Equations ........................................................................... 80 CHANGE IN DEFENSIVE FUNCTIONING 1 Change in Defensive Functioning Over the Course of Group Psychodynamic Interpersonal Psychotherapy for Women with Binge Eating Disorder Freud first conceptualized defense me