Facets of mindfulness, emotion regulation, distress tolerance, and eating disorder symptoms: A network analysis

Dialectical behaviour therapy (DBT) is an effective treatment for eating disorders (EDs), teaching three skills to overcome maladaptive eating behaviours - mindfulness, emotion regulation, and distress tolerance. Although research has demonstrated that each of these skills are independently protective against ED symptoms, no research has explored their interconnectedness. This limits our understanding of which facets are most strongly and uniquely related to various ED symptoms. Thus, the present study (n = 1136) employed a cross-sectional network approach to identify which DBT skills were most central (i.e. the most strongly connected to other variables in the network), and which skills acted as bridges between DBT skills and ED symptoms. Under emotion regulation, negative urgency was negatively associated with binge eating, self-compassion was negatively associated with body dissatisfaction, and psychological inflexibility was positively associated with restriction. Under mindfulness, acting with awareness was negatively associated with binge eating. Moreover, binge-eating, negative urgency, and self-compassion emerged as key bridging symptoms between DBT skills and ED symptoms. Findings suggest that emotion regulation difficulties, particularly negative urgency, psychological inflexibility, low self-compassion, and low acting with awareness, may be especially relevant to ED symptoms, whereas other mindfulness and distress tolerance skills demonstrated comparatively weaker direct associations. Self-compassion in particular emerged as an important construct in the overall network, demonstrating high centrality across strength and betweenness indices, and was identified as a bridge node between DBT skills and ED symptoms. Explicitly targeting self-compassion within DBT protocols may be useful for more reducing prominent ED symptoms.