DBT, Adolescents & Eating Disorder Treatment

For the past several decades, Dialectical Behavior Therapy (DBT) has been used to help treat a wide range of mental health disorders, including eating disorders (ED). And while research suggests DBT is often a beneficial form of therapy for both adolescents and adults with EDs, it was not originally designed to treat eating disorders. However, a new form of DBT, developed specifically to treat restrictive eating disorders (and similar mental health illnesses), has recently emerged with promising results for treating adolescents with anorexia nervosa.

What is DBT?

Dialectical behavior therapy (DBT) was originally developed to treat borderline personality disorder in the late 1980s by psychologist Martha Lineham. Combining elements of cognitive-behavioral therapy and Zen Buddhism/mindfulness strategies, DBT helps people regulate their emotions and handle external stressors by teaching them healthy coping skills [1]. Since then, DBT has been adapted and used to treat a wide range of mental health disorders, including eating disorders like anorexia nervosa, binge eating disorder, and bulimia.

RO-DBT, Adolescents & Eating Disorder Treatment

While traditional DBT has proven to be a beneficial form of therapy for individuals with eating disorders, a new type of DBT treatment has emerged that may prove even more effective at treating adolescents with ED. Developed by Dr. Thomas Lynch, Radically Open Dialectical Behaviour Therapy (RO-DBT) is specifically designed to target overcontrol (OC) disorders like anorexia nervosa, obsessive-compulsive disorder (OCD), and chronic depression.

According to Dr. Lynch and other experts, severe and hard-to-treat mental health disorders like anorexia nervosa are characterized by excessive amounts of self-control or overcontrol (OC) [2]. Individuals with overcontrol tend to be perfectionistic, disciplined, conscientious, cautious, inflexible, restrained, and detail-focused [3].

While these characteristics of self-control are not inherently bad or harmful, experts say they may be masking emotional pain and stressors. And when self-control is used as a coping style, it can become excessive and harmful, leading to social isolation, poor relationship skills, and even severe mental health difficulties like anorexia, OCD, and depression [4].

So to summarize, Dr. Lynch and other psychologists believe maladaptive over control (OC) is a fundamental difficulty among individuals with certain mental health issues like restrictive eating disorders. Lynch and others contend that over control (rather than the eating disorder symptoms themselves) is the main problem and that if the overcontrol coping style is targeted and addressed, the eating disorder symptoms will begin to improve [5].

Since traditional DBT was not specifically designed to address overcontrol, Dr. Lynch set out to develop a new form of DBT that would target the overcontrol coping style. Supported by 20 years of research and clinical experience, RO-DBT is now being used to treat adolescents with eating disorders.

Study Finds RO-DBT Effective Treatment for Adolescents with Eating Disorders

A recent study published in the Journal of Eating Disorders illustrates the effectiveness of using RO-DBT when treating adolescents with restrictive eating disorders. The study’s focus was on the Intensive day Treatment Programme (ITP) at Maudsley Hospital in London, UK.

During the study, the ITP treatment program incorporated 2.5 hours of RO-DBT skill classes into their program each week. RO-DBT content was slightly modified to be more appropriate for adolescents.

Since no prior study has ever explored whether overcontrol is a contributing factor in the development and maintenance of restrictive eating disorders in adolescents, this study aimed to 1) find out if ED symptoms are connected to overcontrol in adolescents with ED, and 2) determine if RO-DBT is effective in treating adolescents with eating disorders [6]. The study involved 131 adolescents aged 11-18 years, all of whom were diagnosed with a restrictive eating disorder and received treatment at ITP between February 2015 and January 2019.

Throughout the study, the researchers found evidence to support the RO-DBT concept that overcontrol is directly associated with restrictive eating disorders in adolescence. For example, adolescents in the study reported not only a high prevalence of ED symptoms but also high levels of other problems linked to maladaptive overcontrol [7].

Further, eating disorder symptom severity was significantly linked to the severity of overcontrol factors (e.g., sense of isolation, social withdrawal, emotional suppression, etc.) among adolescents in the study. This finding highlights the importance of not only targeting ED symptoms but also treating the broad range of difficulties that commonly affect adolescents with restrictive EDs.

Most notably, by the end of the ITP, adolescents in the study showed a significant reduction in symptoms of depression and ED symptomatology. The results also indicated that RO-DBT skills classes significantly helped improve participants’ mood, physical health, emotional expression, relationship quality, and social connectedness [8]. The study also indicated RO-DBT gives adolescents the tools they need to better manage overcontrol traits, which in turn helps improve the psychological and physical symptoms associated with eating disorders.

Though more research is needed on RO-DBT treatment for adolescents with eating disorders, the existing research suggests this new form of DBT may be a successful form of therapy for young people with restrictive eating disorders like anorexia. The study authors conclude by stating, “RO-DBT is a promising treatment that offers a new way of conceptualizing treatment targets and recovery for adolescent restrictive eating disorders” [9].

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References:

[1] The Linehan Institute Behavioral Tech. What Is Dialectical Behavior Therapy (DBT)? 2017.
[2] Lynch, T. R., & Cheavens, J. S. (2008, January 9). Dialectical behavior therapy for comorbid personality disorders. Wiley Online Library. https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.20449.
[3] Hall, K. (2018, January 10). Working Toward Psychological Health. Psychology Today. https://www.psychologytoday.com/us/blog/pieces-mind/201801/working-toward-psychological-health#:~:text=Lynch%20notes%20that%20an%20overcontrolled,may%20mask%20their%20emotional%20pain.
[4] Lynch, T. R., & Cheavens, J. S. (2008, January 9). Dialectical behavior therapy for comorbid personality disorders. Wiley Online Library. https://onlinelibrary.wiley.com/doi/abs/10.1002/jclp.20449.
[5] Baudinet, J., Simic, M., Griffiths, H. et al. Targeting maladaptive overcontrol with radically open dialectical behaviour therapy in a day programme for adolescents with restrictive eating disorders: an uncontrolled case series. J Eat Disord 8, 68 (2020). https://doi.org/10.1186/s40337-020-00338-9.
[6] ibid.
[7] ibid.
[8] ibid.
[9] ibid.

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About the Author:

Sarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.

Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.

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The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a 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 February 10, 2021, on EatingDisorderHope.com
Reviewed & Approved on February 10, 2021, by Jacquelyn Ekern MS, LPC