DBT & Eating Disorder Treatment: What You Need to Know

Dialectical Behavioral Therapy (DBT) is a type of therapy that is used to treat mental health conditions to include eating disorders.

It works to help individuals learn healthy, adaptive ways to regulate emotions, analyze and restructure behaviors that are a result of emotional dysregulation and focuses on increasing mindfulness, and tolerate distress [1].

It’s Origins

Marsha Linehan, Phd., created DBT to help those individuals who are chronic suicidal and have urges for self-harm. Many of the individuals treated with DBT were diagnosed with Bipolar Personality Disorder.

DBT is also used to help other mental health issues such as eating disorders.

What it Is

Dialectic means that two opposite ideas can be correct at the same time [1]. Often in those with eating disorders, one struggle can be with all-or-nothing thinking and be able to use DBT means that they can feel and think two different thoughts about self or recovery at the same time.

Its development is based on the assumption that impulsive and self-destructive behavior is caused by an inability to self-regulate emotion.

Components

This therapy focuses on several elements for the participant:

• Individual therapy
• Skills training groups
• Telephone coaching by the person’s therapist when the person is in crisis.

Four skills training are also involved which are:

• Mindfulness
• Emotional regulation
• Interpersonal effectiveness
• Distress tolerance.

Both of the person’s sessions and group modules are completed weekly. Therapy focuses on gaining healthy skills and strategies to cope with day-to-day functioning.

Mindfulness is when a person focuses their attention on the present without judgment. It can be challenging for those with an eating disorder to focus on the here-and-now.

With the numbing effect of eating disorder behaviors, it can be scary for a person to work on mindfulness. This skill can aid in the individual learning to be aware of triggers and symptoms, providing insights into their thinking and behavior.

Interpersonal effectiveness is learning how to communicate and act in relationships with others. It is common for people to pull away from loved ones or withdraw from social situations for fear of being rejected by others.

Learning how to identify healthy relationships and keep healthy relationships is essential in this process.

Distress tolerance is about coping with a crisis or stressful situations without engaging in unhealthy behaviors. It is about learning how to deal with the pain of the situation and how to radically accept the reality of what is occurring, without judgment and then to move forward.

Emotional regulation is teaching the person to observe and describe what emotions they are feeling and how to understand them without judgment. Individuals are learning how to hold onto and process the feelings rather than suppress or reject the feelings.

Emotional Dysregulation

Experiencing frustration, anger, and disappointment are all emotions. Most people can identify and manage these negative feelings through self-care or healthy expression [2].

For those with eating disorders, it can be challenging to know what they are feeling and how to express them outside the eating disorder.

Shame and anxiety often come with these emotions, and emotional dysregulation is when an individual has a chronic issue coping with unpleasant feelings or overwhelming emotions.

For these people, overwhelming emotions lead to self-destructive behaviors, like binging and purging, or restriction of food.

For others, these feelings may trigger chaotic and situationally inappropriate behaviors.

Emotional dysregulation is believed to have origins in the relationship between the environment and biology.

Some researchers think that some people are more sensitive to their emotions from birth and as this intensifies it can lead to eating disorder symptoms [2].

This is considered an ‘invalidating environment’ within DBT. These environments teach people that their feelings and experiences are incorrect, unwanted, and inappropriate.

They may be punished or ignored when they do express emotion, causing the person to doubt their gut reaction to a situation.

Parts to DBT

DBT includes individual therapy on a once-a-week basis for the sufferer. The therapist and client work together to focus on life goals and self-destructive behaviors and behaviors that interfere with treatment.

Next, the person attends skills training group therapy once-a-week to learn skills of distress tolerance, interpersonal effectiveness, and mindfulness. Included in treatment are skills coaching by telephone with their therapist.

This allows the individual to practice skills in real-life and contact their therapist if they need too.

DBT and ED

Because DBT focuses on emotional dysregulation, it makes a fantastic approach for treating eating disorders. Individuals with an eating disorder tend to report that they have significant difficulty describing, expressing, and tolerating their emotions [2].

Eating disorder symptoms can become worse if emotional dysregulation skills are not acquired. Binge eating, purging, and restricting foods are all ways the person is trying to self-soothe from painful emotions.

It can be a way to escape or provides temporary relief from the discomfort they are feeling.

DBT can help with commitment and motivation for treatment [2]. Typically for eating disorder clients, they often feel ambivalent about therapy at first.

With the balance of acceptance and change-based strategies in DBT, it can aid in continual commitment to learning how to accept self non-judgmentally.

DBT has been shown to increase self-confidence and self-esteem in eating disorder clients [2]. Through the teaching of life building skills, and the supportive nature of the therapy it can boost the feelings of self-worth.

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About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.

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References:

[1] Company, I. G. (2013, Nov. & dec.). Dialectical Behavioral Therapy for Eating Disorders — Therapeutic Tool of Acceptance and Change . Retrieved December 28, 2017, from http://www.socialworktoday.com/archive/111113p22.shtml
[2] Federici, PhD, A. (n.d.). Dialectical Behaviour Therapy for the Treatment of Eating Disorders. Retrieved December 28, 2017, from http://nedic.ca/dialectical-behaviour-therapy-treatment-eating-disorders

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on February 15, 2018.

Published on EatingDisorderHope.com