Development of a Dialectical Behavior Therapy Intervention Package for Patients with Obesity
Keywords:
Dialectical Behavior Therapy, Obesity, Synthesis ResearchAbstract
The present study aimed to develop a dialectical behavior therapy (DBT) intervention package for patients with obesity. This study was qualitative in nature and employed a meta-synthesis strategy with a synthesis research approach to extract the components of the therapeutic package from valid sources. To determine the sample, two sampling frameworks were considered: (1) studies accessible through computerized databases, including the Noor Specialized Journals Database, the Iranian Journals Database, the Academic Center for Education, Culture and Research (ACECR) Scientific Database, and Google Scholar; and (2) student theses available in the Iranian Research Institute for Information Science and Technology (IRANDOC). Subsequently, findings related to the selected documents within the relevant research domain were analyzed, coded, and categorized with the aim of developing a DBT intervention package for patients with obesity as a novel product, and the main themes of the therapeutic package were extracted. After validation using the Content Validity Index (CVI) and the Content Validity Ratio (CVR) by a panel of 15 experts, the intervention package was finalized. Based on the obtained data and prior studies, DBT was coded and categorized into eight therapeutic themes: conceptualization, distress tolerance and flexibility, states of mind, emotion regulation, nutrition and body-related considerations, chain analysis of events influencing overeating, management of maladaptive behaviors and cognitive patterns, and mindfulness. These findings can be utilized in psychological intervention programs for patients with obesity.
Downloads
References
Abolghasemi, A., & Jafari, I. (2012). The effectiveness of dialectical behavior therapy on body image and self-efficacy in girls with bulimia nervosa. Clinical Psychology, 4(2), 29-38.
Agüera, Z., Lozano-Madrid, M., Mallorquí-Bagué, N., Jiménez-Murcia, S., Menchón, J. M., & Fernández-Aranda, F. (2021). A review of binge eating disorder and obesity. Neuropsychiatrie, 35(2), 57-67. https://doi.org/10.1007/s40211-020-00346-w
Alizadeh Fard, S., & Naqavi, F. (2013). The effectiveness of mental state training on improving theory of mind levels and social skills in elementary school children
Boswell, R. G., Sun, W., Suzuki, S., & Kober, H. (2018). Training in cognitive strategies reduces eating and improves food choice. Proceedings of the National Academy of Sciences of the United States of America, 115(48), E11238-E11247. https://doi.org/10.1073/pnas.1717092115
Cerolini, S., D'Amico, M., Zagaria, A., Mocini, E., Monda, G., Donini, L. M., & Lombardo, C. (2024). A Brief Online Intervention Based on Dialectical Behavior Therapy for a Reduction in Binge-Eating Symptoms and Eating Pathology. Nutrients, 16(16), 2696. https://doi.org/10.3390/nu16162696
Dennis, J. P., & Vander Wal, J. S. (2010). The Cognitive Flexibility Inventory: Instrument development and estimates of reliability and validity. Cognitive therapy and research, 34(3), 241-253. https://doi.org/10.1007/s10608-009-9276-4
Doroodian, F. (2025). Comparison of the Effects of Rapid, Moderate, and Slow Weight Loss Combined with a Low-Calorie Diet and Physical Activity on Inflammatory Factors in Obese Women. International Journal of Sport Studies for Health, 1-12. https://journals.kmanpub.com/index.php/Intjssh/article/view/4236
Ebrahimi, S., Shiraseb, F., Ladaninezhad, M., Navaei, N., Izadi, A., & Mirzaei, K. (2025). The Association Between Lifestyle Risk Score and Mental Health in Iranian Overweight and Obese Women: A Cross-Sectional Study. Frontiers in Nutrition, 12. https://doi.org/10.3389/fnut.2025.1533453
Faqih, A., & Anoosheh, M. (2008). Investigation of some eating behaviors in obese individuals مراجعه کننده to the health center of Janah district. Hormozgan Medical Journal, 12(1), 53-60.
Ghasemi, F., & Atashpour, H. (2023). The effectiveness of dialectical behavior therapy on attachment style, interpersonal adjustment, and communication pattern in individuals with bulimia nervosa in Isfahan. Behavioral Sciences Research, 21(4), 741-752.
Golabi, F., Alizadeh Aghdam, M., Aghayari Hir, T., & Habibi, A. (2019). The relationship between nutrition literacy, diet, and obesity. Payesh, 18(4), 393-404.
Gottlieb, A. L., Klinger, C., & Sampaio, D. (2022). Introduction to Dialectical Behavior Therapy for Psychiatrists and Psychiatry Residents. Advances in Psychiatry and Behavioral Health, 2, 241-251. https://doi.org/10.1016/j.ypsc.2022.03.008
Herwig, U., Opialla, S., Cattapan, K., Wetter, T. C., Jäncke, L., & Brühl, A. B. (2018). Emotion introspection and regulation in depression. Psychiatry Research: Neuroimaging, 277, 7-13. https://doi.org/10.1016/j.pscychresns.2018.04.008
Homayounpour, P., Seyrafi, M., & Gharreh, S. (2022). The effectiveness of dialectical behavior therapy in reducing negative emotions and weight loss in obese women. Iranian Journal of Health Psychology, 5(1), 57-64.
Honardar, A., Ansari Shahidi, M., Rahnejat, A. M., & Rezaei Jamalouei, H. (2022). Comparing the effectiveness of dialectical behavior therapy and cognitive-behavioral therapy on emotional eating in obese individuals. Community Health, 16(4), 1-11.
Honardar, A., Ansari Shahidi, M., Rahnejat, A. M., & Rezaei Jamalouei, H. (2023). Comparing the effectiveness of dialectical behavior therapy and cognitive-behavioral therapy on self-management in obese individuals. New Psychological Research Quarterly, 18(70), 271-281.
Husodo, C., & Sukamto, M. E. (2024). Dialectical Behavior Therapy for Reducing Emotional Eating in Emerging Adult Women. Bulletin of Counseling and Psychotherapy, 6(2). https://doi.org/10.51214/0020240610540
Jandaghiian, M., Omidi, A., Zanjani, Z., & Gilasi, H. (2023). The effect of dialectical behavior therapy on emotion regulation, impulsivity, and body mass index in obese or overweight adolescent girls. Feyz Journal of Kashan University of Medical Sciences, 27(3), 269-279.
Jasemi Zargani, M., Seyrafi, M., Taghdisi, M. H., Malihi al-Zakerini, S., & Taghavi Kajidi, H. (2021). The effectiveness of mindfulness-based mindful eating training on weight loss, self-efficacy, emotion regulation, and healthy eating in women with obesity. Clinical Psychology, 13(1), 101-113.
Kahal, H., Kilpatrick, E., Rigby, A., Coady, A., & Atkin, S. (2019). The effects of treatment with liraglutide on quality of life and depression in young obese women with PCOS and controls. Gynecological Endocrinology, 35(2), 142-145. https://doi.org/10.1080/09513590.2018.1505848
Karapatsia, M., Tzavara, C., Michopoulos, I., & Gonidakis, F. (2024). Online dialectical behavior therapy for binge eating disorder: an open trial. Eating Disorders, 1-18. https://doi.org/10.1080/10640266.2024.2421047
Khatibi, F., Khanmohammadi Otaghsara, A., & Heydari, S. (2025). The Effectiveness of Group-Based Acceptance and Commitment Therapy on Self-Worth and Resilience in Obese Women. Psychology of Woman Journal, 6(3), 1-9. https://doi.org/10.61838/
Linardon, J., Anderson, C., & McClure, Z. (2024). A dialectical behavior therapy skills training smartphone app for recurrent binge eating: a randomized clinical trial. Psychological medicine, 1-12. https://doi.org/10.1017/S0033291724002800
Linehan, M. M. (2015). DBT Skills Training Manual (2 ed.). Guilford Press.
Linehan, M. M., & Alavi, K. (2014). Skills Training Manual for Treating Borderline Personality Disorder. Arjmand Publications.
Masrour, S., & Toozandehjani, H. (2019). The effectiveness of dialectical behavior therapy on anxiety sensitivity and body image in girls with bulimia nervosa. Clinical Psychology, 11(1), 37-48.
Matinfar, E. (2014). A comparison of the effectiveness of acceptance and commitment group therapy and dialectical behavior therapy group treatment on reducing anxiety, depression, and weight in women on a diet Ferdowsi University of Mashhad, Faculty of Educational Sciences and Psychology].
Mattingley, S., Youssef, G. J., Manning, V., Graeme, L., & Hall, K. (2022). Distress tolerance across substance use, eating, and borderline personality disorders: A meta-analysis. Journal of affective disorders, 300(1), 492-504. https://doi.org/10.1016/j.jad.2021.12.126
Mohajan, D., & Mohajan, H. K. (2023). Body Mass Index (BMI) is a Popular Anthropometric Tool to Measure Obesity among Adults. Journal of Innovations in Medical Research, 2(4), 25-33. https://doi.org/10.56397/JIMR/2023.04.06
Mohammadi, F. (2021). The effectiveness of dialectical behavior therapy on emotion regulation and food craving in overweight individuals Sepahan Institute of Higher Education of Science and Technology, Faculty of Humanities].
Mousavi, S. A., Pourhossein, R., Zare Moghaddam, A., Rezaei, R., Hasani Astalakhi, F., & Mirbolook Bozorgi, A. (2020). Mindfulness-based cognitive therapy. Royesh-e Ravanshenasi, 9(4), 133-144.
Mousavinejad, M., Sanagouye Moharrer, G., & Zarban, A. (2018). Determining the effectiveness of mindfulness-based cognitive therapy on cognitive flexibility and perceived stress in patients with type 2 diabetes. Journal of Disability Studies, 8(1), 1-9.
Nasri, M., Anvari, M., & Razmkhah, N. (2019). The effectiveness of dialectical behavior therapy on binge eating symptoms and body image in girls with bulimia nervosa
Nazemi, M., Shahini, H., Hosseini Arian, N., Tatari, A., Karbasi, T., & Toozandehjani, H. (2022). Investigating the effectiveness of dialectical behavior therapy on binge eating habits and severity of binge eating in young girls with bulimia
Padmala, S., Sambuco, N., & Pessoa, L. (2019). Interactions between reward motivation and emotional processing. Progress in brain research, 247, 1-21. https://doi.org/10.1016/bs.pbr.2019.03.023
Pourmohammad, P. (2014). The effectiveness of techniques based on dialectical behavior therapy including mindfulness, emotion regulation, and distress tolerance in improving symptoms of bulimia nervosa University of Tabriz, Faculty of Psychology and Educational Sciences].
Pourmohammad, P. (2022). The effectiveness of techniques based on dialectical behavior therapy in improving symptoms of bulimia nervosa. New Psychological Research Quarterly, 16(64), 48-58.
Rahmani, M., & Omidi, A. (2019). The effectiveness of dialectical behavior therapy on quality of life in women with obesity, overweight, and binge eating disorder: A clinical trial. Journal of Rafsanjan University of Medical Sciences, 18(2), 133-146.
Rezaei, A., Khodadadi, Z., & Mirmohammadi, L. (2011). The relationship between dysfunctional thoughts and suicidal ideation in abused spouses. Woman and Society, 2(3), 123-137.
Rommel, D., Nandrino, J. L., Ducro, C., Andrieux, S., Delecourt, F., & Antoine, P. (2012). Impact of emotional awareness and parental bonding on emotional eating in obese women. Appetite, 59(1), 21-26. https://doi.org/10.1016/j.appet.2012.03.006
Salehi Moghaddam, N., Hatami, H., & Ahadi, H. (2020). The effectiveness of dialectical behavior therapy on self-efficacy, eating-related lifestyle, and body mass index in overweight individuals. Thought and Behavior in Clinical Psychology, 15(55), 47-56.
Soleimani, M. (2008). The effectiveness of dialectical behavior therapy in reducing binge eating and depression and increasing self-esteem in female patients with binge eating disorder Allameh Tabataba'i University, Faculty of Educational Sciences and Psychology].
Tanofsky-Kraff, M., Schvey, N. A., & Grilo, C. M. (2020). A developmental framework of binge-eating disorder based on pediatric loss of control eating. American psychologist, 75(2), 189-203. https://doi.org/10.1037/amp0000592
Vakili, M., Bagherzadeh Golmakani, Z., & Bolghan Abadi, M. (2024). The effectiveness of dialectical behavior therapy on self-blame and rumination in patients with binge eating. Journal of Psychological Science, 23(140), 199-217.
Vujanovic, A. A., Dutcher, C. D., & Berenz, E. C. (2017). Multimodal examination of distress tolerance and posttraumatic stress disorder symptoms in acute-care psychiatric inpatients. Journal of anxiety disorders, 48, 45-53. https://doi.org/10.1016/j.janxdis.2016.08.005

