Changes in Defense Mechanism Functioning During Group Therapy for Binge-Eating Disorder

Abstract

Objective: This study examined change in defensive mechanism functioning during group psychodynamic interpersonal psychotherapy (GPIP) for women with binge-eating disorder (BED). Procedure: Women with BED (N = 85) received 16 weeks of GPIP. Five group therapy sessions (sessions 1, 3, 8, 12, and 16) from each of the 12 groups were video recorded and transcribed. Participants were rated on an observer-based measure of defensive functioning, the Defense Mechanism Rating Scale (DMRS). Symptom outcomes were assessed pre- and posttreatment. Results: Overall defensive functioning (ODF) scores improved significantly during group treatment, with specific defense level improvements in high adaptive, major image distorting, and action defenses. The linear increase in ODF mediated a decrease in binge-eating episodes and depressive symptoms. Reverse mediation was also noted. A cubic growth curve best modeled ODF data such that ODF improved in the early stage, followed by a slower rate of improvement in the middle stage, and a further increase in rate of improvement at the end of treatment. Discussion: Change in defense mechanism functioning may be an important aspect of group psychotherapy that is related to improved symptoms for women with BED who receive GPIP. The cubic trend that represented nonlinear growth in ODF is consistent with psychodynamic theory and a stage model of psychotherapy.

Additional information

Funding

The study was funded by grants from the Group Psychotherapy Foundation and the Canadian Institutes of Health Research grant #MOP-82752. Giorgio A. Tasca holds the research chair in psychotherapy, University of Ottawa and The Ottawa Hospital. Thanks go to Dr. Christopher Perry for his consultations during the training phase of the Defense Mechanisms Rating Scale.

Notes on contributors

Robert Hill

Robert Hill, MA, and Mary Gick, PhD, are affiliated with the Department of Psychology, Carleton University, Ottawa.

Giorgio A. Tasca

Giorgio A. Tasca, PhD, is affiliated with the Department of Psychology, Carleton University; the Department of Psychiatry and School of Psychology, University of Ottawa; and the Department of Psychology, the Ottawa Hospital.

Michelle Presniak

Michelle Presniak, PhD, is affiliated with the Department of Psychology, University of Saskatchewan.

Kylie Francis

Kylie Francis, PhD, is affiliated with the Department of Psychology, Royal Ottawa Hospital.

Melissa Palardy

Melissa Palardy, MD, and Hany Bissada, MD, are affiliated with the Department of Psychiatry, University of Ottawa.

Renee Grenon

Renee Grenon, MA, and Genevieve Hayden, BA, are affiliated with the School of Psychology, University of Ottawa.

Nancy Mcquaid

Nancy Mcquaid, PhD, is affiliated with the Department of Psychology, The Ottawa Hospital.

Genevieve Hayden

Renee Grenon, MA, and Genevieve Hayden, BA, are affiliated with the School of Psychology, University of Ottawa.

Mary Gick

Robert Hill, MA, and Mary Gick, PhD, are affiliated with the Department of Psychology, Carleton University, Ottawa.

Hany Bissada

Melissa Palardy, MD, and Hany Bissada, MD, are affiliated with the Department of Psychiatry, University of Ottawa.