What is dialectical behavior therapy?
DBT was originally developed to help patients with borderline personality disorder, a condition where people experience very intense emotions and have trouble managing their emotional reactions. The technique has since been adapted to help with other conditions, including eating disorders.
The framework of DBT is based on another type of psychotherapy called cognitive behavioral therapy (CBT). CBT uses a structured format to help patients learn to identify unhelpful thought and behavioral patterns and eventually replace them with healthier coping mechanisms.
Dialectical behavioral therapy also helps patients identify and change unhelpful patterns in this way, but it addresses some additional emotional components that may interfere with positive change. The “dia-” in “dialectical" comes from a Latin prefix that often stands for “two.” In dialectical behavioral therapy, this describes the idea that two opposing things can be true at once.
DBT programs helps you learn the importance of both change and acceptance.
Patients in DBT programs learn the importance of not just change, but acceptance—that they can be at peace in the present moment, even as they need to change certain thoughts or behaviors. While the two are seemingly opposing therapeutic strategies, in DBT, they’re presented in a balanced way, to help patients make a positive, lasting change.
DBT and eating disorders
When used to treat eating disorders, dialectical behavior therapy operates off the idea that disordered behaviors such as binging, purging, or extreme food restriction are used to help patients relieve intense and unpleasant emotions.2
The goal of DBT is to help patients recognize, understand, and change these patterns and associations. The treatment focuses on helping patients gain more awareness and control over their emotional reactions, which can help them choose healthier behaviors when dealing with intense or overwhelming feelings.3
During DBT sessions, the therapist uses a combination of acceptance and change techniques to help a patient embrace this new behavior.6
Acceptance techniques
Acceptance techniques are dialectical behavior therapy skills that place a focus on understanding and embracing oneself. The hope is allowing patients to let go of destructive or disordered behaviors as attempts to control their emotions or circumstances, and rather to embrace or make the most of the moment as it’s presented.
Coping statements are a common acceptance technique, meant to help people feel more at peace with where and who they are in the present moment. Examples of coping statements include:
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- I can’t change what happened in the past.
- The present moment is the only one I have control over.
- Even though my emotions are uncomfortable, I will get through it.
- I accept this moment for what it is.
Change techniques
Change techniques are the new skills and strategies patients learn to replace the unhealthy and unhelpful behaviors they’ve adopted to help relieve unpleasant emotions. They often revolve around challenging unhelpful thoughts and finding new methods for dealing with stress.
One technique often taught in DBT is
distress tolerance, which offers alternative skills and ideas for dealing with difficult or overwhelming emotions or situations. Rather than reverting to harmful or disordered behavior, distress tolerance can help someone deal with these situations by:
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- Using mindfulness techniques to feel more at peace
- Distracting themselves until they feel calm enough to deal with the situation
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What to expect in dialectical behavior therapy
Dialectical behavior therapy is a structured type of therapy. That means sessions follow a pre-set course, including certain modules meant to help patients focus on learning specific skills or addressing other aspects of therapy.
Generally, patients are asked at intake to describe what they’re struggling with and choose certain goals they hope to accomplish over the course of treatment. Treatment is then directed toward helping patients achieve those goals, while instilling the lessons of change and acceptance central to DBT.
There are three basic phases of dialectical behavior therapy that most patients go through:3
- Individual therapy
- Group therapy sessions or skills training
- Telephone crisis coaching
Individual therapy
Individual therapy typically involves weekly one-on-one sessions with a therapist. These sessions are used to help a patient work toward the specific goals identified at intake and work on any particular issues or complications they may be facing.
Throughout treatment, patients are often given “homework” in individual sessions, and asked to fill out “diary cards,” which track their progress between sessions. Diary cards can also be used to help track emotions, identify thought or behavioral patterns, or identify triggers for disordered eating. Diary cards can also be used to help determine what will be addressed in each session.
Group skills training
Group therapy sessions are where patients learn and practice the skills that help them find acceptance and the strategies that help them implement change.
Generally speaking, DBT sessions focus on four main skills modules:
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- Mindfulness: Mindfulness skills help a patient tune into the present moment by encouraging them to focus on breathing or other immediate sensations. In DBT, it’s meant to help people stop their thoughts and/or emotions from spiraling or skewing destructively negative. Mindfulness can also help someone better recognize and identify their feelings and eventually have more control over how they react to triggering situations.
- Distress tolerance: Learning to deal with stress or crises without resorting to harmful behaviors like purging, binging, restricting food, or over-exercising is the central focus of distress tolerance in DBT for eating disorders. Rather, patients are taught different, healthier strategies and skills for dealing with stress and getting through stressful situations.
- Interpersonal effectiveness: This involves developing the skills to ask for things and to say no when necessary, while retaining respect for yourself and others. Interpersonal effectiveness may involve skills like properly setting and maintaining boundaries, or focus on helping someone learn how to have healthier relationships with others.
- Emotional regulation: As the name suggests, this skill is about learning to better understand and be aware of emotions, in order to have better control over them. Patients learn to separate thoughts from facts and to see thoughts as independent entities. Emotional regulation can also help people learn to better verbally communicate, rather than reacting through emotion.
In group therapy sessions, patients may be asked to practice these skills through group exercises or role-play. As with individual therapy, patients may also receive “homework” from group sessions.
Telephone crisis coaching
A DBT course often offers telephone crisis coaching to provide support between sessions. This can be particularly helpful for patients having a hard time with emotional regulation and those who need help dealing with immediate crises, but they can also be used for those who want or need additional support from their therapist, or those looking for advice on how to properly use new DBT skills.
How effective is DBT in treating eating disorders?
Dialectical behavioral therapy is an evidence-based treatment, or one that has been thoroughly tested through peer-reviewed studies, and is generally considered effective for patients struggling with eating disorders.
Several studies have shown the treatment is especially helpful for relieving binge eating behavior, and as such, DBT has become a popular choice for both binge eating disorder and bulimia nervosa.1 Fewer studies have been conducted with patients with anorexia nervosa, though what reports have been done show promising results.1,7
Analyses have also shown DBT can be effective regardless of a person’s sex, gender identity, sexual orientation, age, race, and/or ethnicity.5
Regardless, DBT is not for everyone. A patient who is not willing or able to participate in group treatment may not benefit from or feel comfortable with this approach. Other patients may want or benefit from more intensive individual therapy or other techniques. As with all medical issues, each case is entirely individual, and the best possible treatment depends on a patient’s specific needs and background.
Benefits of DBT
The overwhelming emotions felt by many people with eating disorders can have a significant impact not just on their physical health, but on their emotional health and overall quality of life. Skills like distress tolerance and emotional regulation can help them manage and gain control over these potentially destructive feelings.
Acceptance is also a key part of moving forward and improving quality of life. DBT encourages patients not only to make positive changes, but to find acceptance in a given moment or situation. This can help create a healthy balance, where actions and reactions are intentional, and hopefully made with a generally positive outlook.
The skills taught during a DBT course not only improve the symptoms of people living with an eating disorder but can also be applied to many other areas of life too, including at work, home, and play.
With a focus on group sessions, DBT can provide patients with a solid support network, even as they receive individual psychological help. The skills learned in DBT can also help patients form healthy relationships, based on respect, trust, and boundaries, which can be beneficial in treatment and beyond.
Limitations of DBT
As with all forms of therapy, DBT is generally not effective on its own as an eating disorder treatment. These conditions are complex and often require a multidisciplinary treatment approach, which includes nutrition education, meal support and counseling, and medical interventions if necessary.
Completing a course of dialectical behavioral therapy also requires a significant amount of time and energy to be dedicated to this cause. There are usually multiple sessions per week and patients are expected to complete homework on a regular basis.
Dialectical behavior therapy at Within
Our clinical care team at Within believes DBT is an effective way to treat patients with eating disorders, particularly those struggling with interpersonal relationships or emotional dysregulation.
We incorporate DBT into our virtual treatment programs, with specific DBT sessions and groups. We offer a DBT skills group that teaches the four categories of skills aimed to enhance the regulation of emotion and improve relationships. We also use a trauma-informed approach to treatment, as we understand the significant role trauma can play in the development of an eating disorder.
Get treatment from home
If you are looking for a DBT approach to your eating disorder treatment, or are interested in learning more about our virtual treatment modalities, call our clinical care team today. We will work with you to craft the right program for your specific needs.
Call (866) 293-0041
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