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Dialectical behavior therapy (DBT) is a type of psychotherapy, or talk-based therapy, used to treat a range of mental health conditions, including eating disorders.
The technique is designed to help patients learn to better identify and regulate their emotions, deal more effectively with stressful situations, and develop stronger interpersonal relationships. The goal is to help someone move away from unhealthy coping mechanisms and embrace a sense of acceptance as a means to healing.
During a course of DBT, patients work through a series of dialectical behavior therapy modules to help them learn these new skills. Therapists guide patients through these modules, which generally follow a pre-set course, making DBT a good option for many people, whether or not they’ve tried therapy before.
Dialectical behavior therapy was first developed in the 1970s, originally meant to help people with borderline personality disorder (BPD). However, in recent years, it has been expanded to treat a variety of mental health conditions.1
The word “dialectical” refers to combining seemingly opposite ideas. It points to one of the major principles of dialectical behavior therapy: that two opposing things can be true at once. In DBT, this usually refers to a patient:1
This perspective is used to help enforce the idea of acceptance, which guides much of the healing process in DBT.
The other major aspect of the practice is emotion regulation. In DBT, helping people learn to recognize and regulate their intense, negative emotions is seen as the key to curbing harmful behavior. Patients also learn alternative coping mechanisms for when distressing emotions do arise.
What are the dialectical behavior therapy modules?
Dialectical behavioral therapy is a structured form of therapy. That means, regardless of someone's case, a course of treatment generally follows a pre-set path.4
That path involves four major modules, which focus on helping patients develop specific skill sets or perspectives. The modules generally break down as:2
Mindfulness has long been used in many types of therapy. The concept generally involves focusing on the present moment and receiving information from the five senses. Many exercises have been developed to help patients zero in on that focus.
In DBT, mindfulness is used to help patients observe their current experiences from a non-judgemental point of view.2 They may also be encouraged to participate fully in a particular experience or focus entirely on one thing at a time to help develop more attentive behavior.2
In a session of dialectical behavior therapy, DBT therapists help patients learn how to get what they want and what they need out of relationships while remaining respectful both to themselves and to the other person or people involved.2
The idea is to help patients:2
Get their needs met
Learn to say "no" to inappropriate demands
Altogether better handle interpersonal conflict
This can also help the patient maintain, improve, and strengthen their relationships, which is often a helpful aspect of healing.
Distress tolerance skills could also be referred to as reality acceptance skills. That's because this group of coping mechanisms is intended to help patients get through emotional crises without making the situation worse by resorting to unhelpful behaviors.4 Throughout this module, patients learn and actively practice these new coping mechanisms.
One popular distress tolerance skill, which also dovetails with mindfulness, is radical acceptance. Intended to help people accept whatever comes their way in the present moment—whether good, bad, or ugly—radical acceptance helps patients navigate through life without blaming, self-pity, or otherwise trying to change the situation willfully.4
In many ways, emotion regulation is at the heart of dialectical behavioral therapy. The treatment was initially developed to help patients with borderline personality disorder, which is thought to be a disorder of emotional dysregulation, so DBT is a highly emotionally-focused solution.4
Many different skills are taught in this module to help patients better understand, recognize, label, and manage emotions. Patients are also taught how and when to apply emotional regulation strategies, e.g., when they feel overwhelmed.4
Who should try DBT?
Many types of people can benefit from DBT treatment, but it might be particularly well-suited for patients with eating disorders who struggle with regulating their emotions and behaviors.1
Because it was initially used to treat people with borderline personality disorder and suicidality, DBT may be suitable for eating disorder patients who have co-occurring BPD or those who experience or have experienced suicidality, self-injury, and low self-esteem.
DBT may also be a good alternative for patients who have not succeeded with other therapies or treatments. For example, while approaches like cognitive behavioral therapy (CBT) are generally considered very effective, some research shows that as many as 50% of patients with binge eating disorder may not respond to this course of treatment.7
DBT can be administered alone or used to supplement other types of therapy, including CBT, acceptance and commitment therapy (ACT), and exposure therapy, making it a well-rounded choice for many people.
How effective is DBT for eating disorders?
Research indicates that DBT is an effective treatment for patients experiencing eating disorders.
One study found that both therapists and patients rated the treatment highly and that patients experiencing binge eating and/or purging saw significant reductions in this behavior. Symptoms of depression were also reduced throughout treatment, and patients saw continued improvements after treatment, as well.8
Further research indicates that, when used in intensive outpatient and partial hospitalization settings for patients with eating disorders and co-occurring mental health issues, DBT helped improve both eating disorder symptoms and emotional regulation.3
DBT adaptations and eating disorder recovery
Some adapted versions of DBT, such as the Stanford DBT and radically open DBT (RO-DBT), have also shown considerable promise in treating eating disorders.
Stanford DBT involves weekly two-hour groups for binge eating disorder and weekly one-hour DBT individual therapy for bulimia nervosa, as opposed to the combination of individual therapy and group skills training of standard DBT.3
Meanwhile, RO-DBT, which can be helpful for people with anorexia nervosa as well as bulimia nervosa and binge eating disorder, helps patients who struggle with self-controlling behaviors. This DBT adaptation focuses on fostering flexibility and openness.5 Studies on RO-DBT effectiveness found that it improved eating disorder symptoms in patients with anorexia nervosa.3
Where can you receive DBT for eating disorders?
You can receive DBT for an eating disorder in many different treatment facilities and settings, including:
Many eating disorder treatment programs may include several different treatment modalities in a patient’s treatment plan to help provide them with comprehensive and integrated care. This could mean learning DBT skills while simultaneously taking cognitive behavioral therapy or other types of care to help address the many intersecting risk factors and challenges involved for a particular patient.
If you're interested in DBT, you can ask your primary care physician or therapist for a recommendation or call your insurance company to see if your plan covers any programs near you.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Yes. Dialectical behavior therapy has been shown to help decrease eating disorder symptoms in both inpatient and outpatient settings.3
What are the six main points of DBT?
There are many “main points” of dialectical behavior therapy taught throughout the four modules of DBT. Some major skills the treatment works to develop are:
Dialectical thinking
Mindfulness
Emotion regulation
Distress tolerance
Interpersonal effectiveness
Validation
Is DBT group therapy?
DBT is usually administered through individual therapy sessions, but the skills it teaches can be—and frequently are—practiced in group sessions, called skills training sessions.2
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