Emotion regulation techniques for patients with eating disorders and co-occurring mood disorders

Watch out for vulnerabilities

Many factors impact how we respond in any given situation—DBT refers to these factors as vulnerabilities. If you have had a poor night of sleep, for example, you might not be at your best the next day. TheFor example, ifrimary vulnerabilities DBT identifih the PLEASE skill:

1. Treat PhysicaL Illness
2. Balance Eating 
3. Avoid mood-altering substances
4. Balance Sleep
5. Balance Exercise

In eating disorder treatment, we work to stabilize eating and exercise patterns, among other things. For those with co-occurring mood disorders, we include taking all medications as prescribed, and highlight the importance of avoiding illicit substances and recommend limiting or entirely avoiding alcohol, nicotine, and caffeine. 

By utilizing emotion regulation skills, patients can build a more solid foundation from which to participate in eating disorder treatment. 

Sometimes, the eating disorder becomes shorthand to manage or communicate distressing emotions. Over time, in therapy, we work on labeling the emotion. This is the first step in being able to respond to or manage distressing emotions. 

Check the facts

Once we identify the emotion (a feelings wheel can be really helpful here, especially if you are someone who has difficulty differentiating emotions), we can “check the facts”  or gently question whether the emotion is based on objective facts, or if we are adding our own information or interpretation to events. If the facts of the situation align with the emotion, then we can move forward with problem solving. If the facts don’t align, we can move into opposite action, which is just what it sounds like—acting opposite to the emotional urge. 

Building a life worth living through the ABCs

In addition to the PLEASE skill, we can include the ABCs:

1. Accumulating positive experiences
2. Building Mastery
3. Cope ahead 

One of the goals of DBT is to build a life worth living. By accumulating smaller, daily positive experiences, we can positively impact our mood. In building mastery, we gain a sense of strength and competence. 

Think about learning to ride a bike. At first, you are likely pretty wobbly and need to stop frequently, but over time, you balance more easily and can ride longer. Eventually, you are very comfortable and maybe no longer think about what you are doing—you just hop on and ride. It is the same way with learning new skills; at first, they take a lot of attention and intention, but over time, they become more natural. 

Cope ahead is a vital skill in ED recovery. I often plan with my patients how to navigate upcoming situations, particularly when they include a challenge, such as eating at a restaurant, going to someone’s house for lunch, or trying a new food. When we cope ahead, we plan in advance for support and determine what skills we will use to achieve an identified goal.

- Cait Scafati, MA, MSW, LCSW

While this is a very brief introduction to some of the emotion regulation skills, many treatment programs will include DBT skills as part of their group offerings. At Within Health, we offer DBT skills groups several times a week, and clinicians also integrate skills into individual sessions.