{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T05:33:54Z","timestamp":1762320834655,"version":"build-2065373602"},"reference-count":51,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T00:00:00Z","timestamp":1762128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100018693","name":"Horizon Europe Framework Programme","doi-asserted-by":"publisher","award":["GA 101080219"],"award-info":[{"award-number":["GA 101080219"]}],"id":[{"id":"10.13039\/100018693","id-type":"DOI","asserted-by":"publisher"}]},{"name":"AGAUR-Generalitat de Catalunya","award":["2021-SGR-00824"],"award-info":[{"award-number":["2021-SGR-00824"]}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["FIS PI20\/00132"],"award-info":[{"award-number":["FIS PI20\/00132"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Portuguese Foundation for Science and Technology","award":["SFRH\/BD\/143601\/2019"],"award-info":[{"award-number":["SFRH\/BD\/143601\/2019"]}]},{"DOI":"10.13039\/501100003741","name":"Catalan Institution for Research and Advanced Studies","doi-asserted-by":"publisher","award":["ICREA-Academia, 2021- Programme"],"award-info":[{"award-number":["ICREA-Academia, 2021- Programme"]}],"id":[{"id":"10.13039\/501100003741","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Difficulties in emotion regulation (ER) are commonly described in eating disorders (ED), but few studies report its impact on ED treatment outcome. The main goal of this study was to investigate the patterns of change in difficulties in ER among ED-diagnosed female patients who received a Cognitive Behavioral Therapy (CBT) treatment. Methods: Participants (N = 74; Mage = 29.2; SD = 11.5) completed pre- and post-treatment questionnaires to assess difficulties in ER, disordered eating symptoms, general psychopathology, and personality traits. Results: Considering ED treatment outcome status, 24.3% of patients displayed a poor outcome, while 28.4% achieved partial remission, and 47.3% achieved full remission. Most of the patients who achieved full remission (80%) reported decreases in difficulties in ER, while only 55.6% of the participants displaying poor outcomes reported improvements in ER. The results from the structural equation modeling (SEM) suggest that the risk of poor outcome was directly related to increased post-treatment difficulties in ER, while improvements in the severity index of global psychopathology was related to increased pre-treatment difficulties in ER. Conclusions: Better ED treatment outcomes are associated with higher levels of ER improvements. Future prospective studies are warranted to establish which ER components may positively influence the recovery of ED-diagnosed patients.<\/jats:p>","DOI":"10.3390\/nu17213470","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T17:32:01Z","timestamp":1762191121000},"page":"3470","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Changes in Difficulties in Emotion Regulation Following Eating Disorders Treatment: Relevant Prospective Implications for Treatment Outcome"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2054-3489","authenticated-orcid":false,"given":"T\u00e2nia F.","family":"Rodrigues","sequence":"first","affiliation":[{"name":"Psychotherapy and Psychopathology Research Labortary, Psychology Research Centre (CIPsi), School of Psychology, University of Minho, 4704-553 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9751-810X","authenticated-orcid":false,"given":"Lucero","family":"Mungu\u00eda","sequence":"additional","affiliation":[{"name":"Clinical Psychology Department, University Hospital of Bellvitge, 08907 Barcelona, Spain"},{"name":"CIBER Fisiopatolog\u00eda Obesidad y Nutrici\u00f3n (CIBERObn), Instituto de Salud Carlos III (ISCIII), 08907 Barcelona, Spain"},{"name":"Psychoneurobiology of Eating and Addictive Behaviours Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6308-3198","authenticated-orcid":false,"given":"Roser","family":"Granero","sequence":"additional","affiliation":[{"name":"CIBER Fisiopatolog\u00eda Obesidad y Nutrici\u00f3n (CIBERObn), Instituto de Salud Carlos III (ISCIII), 08907 Barcelona, Spain"},{"name":"Psychoneurobiology of Eating and Addictive Behaviours Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain"},{"name":"Department of Psychobiology and Methodology, Autonomous University of Barcelona, 08193 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5874-8204","authenticated-orcid":false,"given":"Isabel","family":"S\u00e1nchez","sequence":"additional","affiliation":[{"name":"Clinical Psychology Department, University Hospital of Bellvitge, 08907 Barcelona, Spain"},{"name":"CIBER Fisiopatolog\u00eda Obesidad y Nutrici\u00f3n (CIBERObn), Instituto de Salud Carlos III (ISCIII), 08907 Barcelona, Spain"},{"name":"Psychoneurobiology of Eating and Addictive Behaviours Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain"},{"name":"Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9327-0100","authenticated-orcid":false,"given":"Jessica","family":"S\u00e1nchez-Gonz\u00e1lez","sequence":"additional","affiliation":[{"name":"Clinical Psychology Department, University Hospital of Bellvitge, 08907 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3875-0133","authenticated-orcid":false,"given":"Jessica","family":"Jimenez-de Toro","sequence":"additional","affiliation":[{"name":"Clinical Psychology Department, University Hospital of Bellvitge, 08907 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8316-1285","authenticated-orcid":false,"given":"Laura","family":"Galvez","sequence":"additional","affiliation":[{"name":"Clinical Psychology Department, University Hospital of Bellvitge, 08907 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2147-8790","authenticated-orcid":false,"given":"Cristina","family":"Artero","sequence":"additional","affiliation":[{"name":"Psychoneurobiology of Eating and Addictive Behaviours Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3596-8033","authenticated-orcid":false,"given":"Susana","family":"Jim\u00e9nez-Murcia","sequence":"additional","affiliation":[{"name":"Clinical Psychology Department, University Hospital of Bellvitge, 08907 Barcelona, Spain"},{"name":"CIBER Fisiopatolog\u00eda Obesidad y Nutrici\u00f3n (CIBERObn), Instituto de Salud Carlos III (ISCIII), 08907 Barcelona, Spain"},{"name":"Psychoneurobiology of Eating and Addictive Behaviours Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain"},{"name":"Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4277-9203","authenticated-orcid":false,"given":"Paulo P. P.","family":"Machado","sequence":"additional","affiliation":[{"name":"Psychotherapy and Psychopathology Research Labortary, Psychology Research Centre (CIPsi), School of Psychology, University of Minho, 4704-553 Braga, Portugal"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2968-9898","authenticated-orcid":false,"given":"Fernando","family":"Fern\u00e1ndez-Aranda","sequence":"additional","affiliation":[{"name":"Clinical Psychology Department, University Hospital of Bellvitge, 08907 Barcelona, Spain"},{"name":"CIBER Fisiopatolog\u00eda Obesidad y Nutrici\u00f3n (CIBERObn), Instituto de Salud Carlos III (ISCIII), 08907 Barcelona, Spain"},{"name":"Psychoneurobiology of Eating and Addictive Behaviours Group, Neurosciences Programme, Bellvitge Biomedical Research Institute (IDIBELL), 08908 Barcelona, Spain"},{"name":"Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 Barcelona, Spain"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1007\/s11920-012-0282-y","article-title":"Epidemiology of Eating Disorders: Incidence, Prevalence and mortality rates","volume":"14","author":"Smink","year":"2012","journal-title":"Curr. Psychiatry Rep."},{"key":"ref_2","unstructured":"Association, N.A.P. (2022). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Publishing."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Wolz, I., Ag\u00fcera, Z., Granero, R., Jim\u00e9nez-Murcia, S., Gratz, K.L., Mench\u00f3n, J.M., and Fern\u00e1ndez-Aranda, F. (2015). Emotion regulation in disordered eating: Psychometric properties of the Difficulties in Emotion Regulation Scale among Spanish adults and its interrelations with personality and clinical severity. Front. Psychol., 6.","DOI":"10.3389\/fpsyg.2015.00907"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Leppanen, J., Brown, D., McLinden, H., Williams, S., and Tchanturia, K. (2022). The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach. Front. Psychiatry, 13.","DOI":"10.3389\/fpsyt.2022.793094"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1080\/10640260902848576","article-title":"Differential treatment response for eating disordered patients with and without a comorbid borderline Personality diagnosis using a Dialectical Behavior Therapy (DBT)-Informed approach","volume":"17","author":"Wisniewski","year":"2009","journal-title":"Eat. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1007\/s10879-014-9271-2","article-title":"Dialectical Behavior Therapy: Does It Bring About Improvements in Affect Regulation in Individuals with Eating Disorders?","volume":"44","author":"Federici","year":"2014","journal-title":"J. Contemp. Psychother."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"401","DOI":"10.1016\/j.beth.2019.07.002","article-title":"Emotion regulation difficulties during and after partial hospitalization treatment across eating disorders","volume":"51","author":"Brown","year":"2019","journal-title":"Behav. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1037\/1089-2680.2.3.271","article-title":"The Emerging Field of Emotion Regulation: An Integrative Review","volume":"2","author":"Gross","year":"1998","journal-title":"Rev. Gen. Psychol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1023\/B:JOBA.0000007455.08539.94","article-title":"Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale","volume":"26","author":"Gratz","year":"2003","journal-title":"J. Psychopathol. Behav. Assess."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Beauchaine, T.P., and Crowell, S.E. (2020). Emotion Dysregulation and Eating Disorders. The Oxford Handbook of Emotion Dysregulation, Oxford Library of Psychology.","DOI":"10.1093\/oxfordhb\/9780190689285.013.24"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/j.cpr.2015.05.010","article-title":"Dimensions of emotion dysregulation in anorexia nervosa and bulimia nervosa: A conceptual review of the empirical literature","volume":"40","author":"Lavender","year":"2015","journal-title":"Clin. Psychol. Rev."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1016\/j.comppsych.2013.12.001","article-title":"Difficulties in emotion regulation across the spectrum of eating disorders","volume":"55","author":"Brockmeyer","year":"2013","journal-title":"Compr. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1080\/10640266.2015.1044345","article-title":"Integrating Family-Based Treatment and Dialectical Behavior therapy for adolescent Bulimia Nervosa: Preliminary outcomes of an open pilot trial","volume":"23","author":"Murray","year":"2015","journal-title":"Eat. Disord."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/j.beth.2009.01.006","article-title":"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","volume":"41","author":"Safer","year":"2010","journal-title":"Behav. Ther."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1016\/S0005-7894(00)80031-3","article-title":"Group dialectical behavior therapy for binge-eating disorder: A preliminary, uncontrolled trial","volume":"31","author":"Telch","year":"2000","journal-title":"Behav. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1002\/eat.20730","article-title":"Emotion avoidance in patients with anorexia nervosa: Initial test of a functional model","volume":"43","author":"Wildes","year":"2009","journal-title":"Int. J. Eat. Disord."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"543","DOI":"10.1017\/S0033291713001098","article-title":"A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa","volume":"44","author":"Wonderlich","year":"2013","journal-title":"Psychol. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.cpr.2017.09.002","article-title":"Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review","volume":"57","author":"Sloan","year":"2017","journal-title":"Clin. Psychol. Rev."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1556\/2006.2022.00004","article-title":"Emotion regulation as a transdiagnostic factor in eating disorders and gambling disorder: Treatment outcome implications","volume":"11","author":"Granero","year":"2022","journal-title":"J. Behav. Addict."},{"key":"ref_20","first-page":"53","article-title":"Emotion regulation as a transdiagnostic feature among eating disorders: Cross-sectional and longitudinal approach","volume":"26","author":"Riesco","year":"2017","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"785","DOI":"10.1037\/ccp0000011","article-title":"Dynamic longitudinal relations between emotion regulation difficulties and anorexia nervosa symptoms over the year following intensive treatment","volume":"83","author":"Racine","year":"2014","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_22","unstructured":"Academy for Eating Disorders Psychological Care Guidelines Task Force (2025, July 01). A Guide to Selecting Evidence-Based Psychological Therapies for Eating Disorders. Available online: https:\/\/higherlogicdownload.s3.amazonaws.com\/AEDWEB\/27a3b69a-8aae-45b2-a04c-2a078d02145d\/UploadedImages\/Publications_Slider\/FINAL_AED_Psycholohgical_book.pdf."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1002\/wps.21182","article-title":"Outcomes in people with eating disorders: A transdiagnostic and disorder-specific systematic review, meta-analysis and multivariable meta-regression analysis","volume":"23","author":"Solmi","year":"2024","journal-title":"World Psychiatry"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1097\/YCO.0000000000000453","article-title":"Relapse in anorexia nervosa","volume":"31","author":"Berends","year":"2018","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.jpsychires.2023.01.002","article-title":"Predictors of relapse in eating disorders: A meta-analysis","volume":"158","author":"Sala","year":"2023","journal-title":"J. Psychiatr. Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s40337-023-00801-3","article-title":"Eating disorder outcomes: Findings from a rapid review of over a decade of research","volume":"11","author":"Bryant","year":"2023","journal-title":"J. Eat. Disord."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1278","DOI":"10.1002\/eat.23508","article-title":"Outcomes for adults with anorexia nervosa who do not respond early to outpatient treatment","volume":"54","author":"Wade","year":"2021","journal-title":"Int. J. Eat. Disord."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_29","unstructured":"Garner, D.M. (1991). Eating Disorder Inventory-2: Professional Manual, Psychological Assessment Resources."},{"key":"ref_30","unstructured":"Garner, D.M. (1998). Inventario de Trastornos de la Conducta Alimentaria (EDI-2) Manual, TEA."},{"key":"ref_31","unstructured":"Derogatis, L.R. (1994). SCL-90-R: Symptom Checklist-90-R. Administration, Scoring and Procedures Manual\u2013II for the Revised Version, Clinical Psychometric Research."},{"key":"ref_32","unstructured":"Derogatis, L.R. (2002). SCL-90-R. Cuestionario de 90 S\u00edntomas\u2013Manual, TEA."},{"key":"ref_33","unstructured":"Cloninger, C.R. (1999). The Temperament and Character Inventory\u2013Revised, Center for Psychobiology of Personality, Washington University."},{"key":"ref_34","first-page":"8","article-title":"Inventario del Temperamento y el Car\u00e1cter\u2013Revisado (TCI-R). Baremaci\u00f3n y Datos Normativos en una Muestra de Poblaci\u00f3n General [Temperament and Character Inventory Revised (TCI-R). Standardization and Normative Data in a General Population Sample]","volume":"32","author":"Montserrat","year":"2004","journal-title":"Actas Espa\u00f1olas De Psiquiatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1002\/erv.2822","article-title":"The impact of duration of illness on treatment nonresponse and drop-out: Exploring the relevance of enduring eating disorder concept","volume":"29","author":"Treasure","year":"2021","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1002\/erv.2855","article-title":"Executive functions in binge spectrum eating disorders with comorbid compulsive buying","volume":"29","author":"Lucas","year":"2021","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_37","unstructured":"StataCorp (2023). Stata Statistical Software: Release 18, Stata Press Publication (StataCorp LLC)."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1002\/1521-4036(200112)43:8<985::AID-BIMJ985>3.0.CO;2-4","article-title":"On the False Discovery Rate and Expected Type I Errors","volume":"43","author":"Finner","year":"2001","journal-title":"Biom. J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"552","DOI":"10.7334\/psicothema2016.383","article-title":"Non-normal data: Is ANOVA still a valid option?","volume":"4","author":"Blanca","year":"2017","journal-title":"Psicothema"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1016\/j.paid.2006.09.018","article-title":"Structural equation modelling: Adjudging model fit","volume":"42","author":"Barrett","year":"2006","journal-title":"Personal. Individ. Differ."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1177\/0013164413495237","article-title":"Sample size requirements for structural equation models","volume":"73","author":"Wolf","year":"2013","journal-title":"Educ. Psychol. Meas."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1002\/erv.2834","article-title":"A systematic review of network analysis studies in eating disorders: Is time to broaden the core psychopathology to non specific symptoms","volume":"29","author":"Monteleone","year":"2021","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1556\/2006.2021.00017","article-title":"Emotional regulation in eating disorders and gambling disorder: A transdiagnostic approach","volume":"10","author":"Granero","year":"2021","journal-title":"J. Behav. Addict."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/BF03325050","article-title":"Temperament and character in eating disorders: Ten years of studies","volume":"9","author":"Fassino","year":"2004","journal-title":"Eat. Weight Disord -Stud. Anorex. Bulim. Obes."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"e7958","DOI":"10.7717\/peerj.7958","article-title":"Cloninger\u2019s TCI associations with adaptive and maladaptive emotion regulation strategies","volume":"7","author":"Chae","year":"2019","journal-title":"PeerJ"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.cpr.2009.11.004","article-title":"Emotion-regulation strategies across psychopathology: A meta-analytic review","volume":"30","author":"Aldao","year":"2009","journal-title":"Clin. Psychol. Rev."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Thompson-Brenner, H., Singh, S., Gardner, T., Brooks, G.E., Smith, M.T., Lowe, M.R., and Boswell, J.F. (2021). The Renfrew Unified Treatment for Eating Disorders and Comorbidity: Long-Term Effects of An Evidence-Based Practice Implementation in Residential Treatment. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.641601"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Mena-Moreno, T., Mungu\u00eda, L., Granero, R., Lucas, I., Fern\u00e1ndez-Aranda, F., G\u00f3mez-Pe\u00f1a, M., Moragas, L., Verdejo-Garc\u00eda, A., Mench\u00f3n, J.M., and Jim\u00e9nez-Murcia, S. (2022). e-Estesia: A Serious Game for Reducing Arousal, Improving Emotional Regulation and Increasing Wellbeing in Individuals with Gambling Disorder. J. Clin. Med., 11.","DOI":"10.3390\/jcm11226798"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1037\/0022-006X.68.4.564","article-title":"Stepped care treatment for eating disorders","volume":"68","author":"Wilson","year":"2000","journal-title":"J. Consult. Clin. Psychol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"933","DOI":"10.1002\/jclp.22297","article-title":"A factor analytic evaluation of the difficulties in emotion regulation scale","volume":"72","author":"Lee","year":"2016","journal-title":"J. Clin. Psychol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1007\/s10862-017-9586-x","article-title":"Factor structure of the difficulties in Emotion Regulation Scale (DERS) in adult outpatients receiving Dialectical Behavior therapy (DBT)","volume":"39","author":"Osborne","year":"2017","journal-title":"J. Psychopathol. Behav. Assess."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/21\/3470\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,5]],"date-time":"2025-11-05T05:16:48Z","timestamp":1762319808000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/21\/3470"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,3]]},"references-count":51,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["nu17213470"],"URL":"https:\/\/doi.org\/10.3390\/nu17213470","relation":{},"ISSN":["2072-6643"],"issn-type":[{"type":"electronic","value":"2072-6643"}],"subject":[],"published":{"date-parts":[[2025,11,3]]}}}