Dialectical behavior therapy (DBT) is a type of “talk” therapy, based on cognitive behavior therapy (CBT), that has been adopted for treating people with eating disorders. The goal is to identify and change self-destructive behaviors--including those seen in people with eating disorders--while also pushing for a positive change.
DBT was originally developed to help patients with borderline personality disorder, which is a disorder that commonly occurs alongside eating disorders. It has since been adapted by the eating disorder treatment community as a great tool in their treatment, especially with patients who are emotionally dysregulated.
The term “dialectical” comes from the idea of how two opposing things could both be true. In DBT for eating disorders, the focus is on balancing change with acceptance, two seemingly opposing therapy strategies. However, DBT teaches patients that achieving both of these goals together is possible.
During DBT, your therapist will work with you to accept yourself as you are and also motivate you to change negative behaviors.
Dialectical behavior therapy uses emotional regulation to treat eating disorders and is considered by some to be a good alternative to CBT.
The goal of DBT is to work toward reducing eating disorder behaviors--like purging and bingeing--that provide temporary relief from negative emotions or feelings of vulnerability. (4) A DBT therapist works with patients to cope with negative emotions more healthily.
During DBT sessions, the therapist uses a balance of acceptance and change techniques:
Acceptance techniques place a focus on understanding the self and making sense of why a person might engage in certain eating behaviors.
An example of an acceptance technique is coping statements, which are meant to remind people there are some things you can’t change. It’s not meant to undermine a personal situation, it’s simply a way to let go of negative thoughts and feelings. Examples of coping statements include:
Change techniques teach how to replace harmful behaviors with helpful ones. This may involve challenging unhelpful thoughts and encouragement to find new methods of dealing with stress.
One such technique is distress tolerance, which teaches how to get through rough patches without turning to potentially harmful coping techniques.
In times of crisis, a person may binge and purge to deal with tough emotions and stress. This may make someone feel better temporarily, but is not a good coping mechanism for the long run. Distress tolerance skills can help a person:
DBT can vary between treatment providers, but, usually, a DBT course includes the following types of sessions: (4)
Prior to beginning treatment, a patient may be offered an assessment to determine how suitable DBT is for them. This assessment may include learning about the DBT model and how it works in treating those with eating disorders.
Individual therapy typically involves weekly one-on-one hour-long sessions with a DBT therapist. Typical goals include:
As an example, you may leave sessions with homework, such as being given diary cards that will be discussed at your following appointment. The diary cards are used to track your emotions, to help identify patterns and triggers for your destructive eating behaviors.
The information on your diary cards is used by you and your therapist to decide what you’ll work on in each session.
Usually, two therapists lead weekly sessions intending to teach you skills in a group setting that you can implement in your everyday life.
Generally speaking, DBT sessions focus on four main skills modules:
You might also be asked to do group exercises and engage in some role-play. Plus, you’ll be given homework each week to help you practice your DBT skills.
A DBT course often offers telephone crisis coaching to provide you with support between sessions, like when you need help to deal with an immediate crisis or want advice on how to properly use your DBT skills.
Regardless of your diagnosis, DBT may not be the right treatment option for you. DBT is more likely to work if:
That being said, in the right patients, researchers have found that DBT is effective regardless of a person’s sex, gender identity, sexual orientation, age, race, and ethnicity. (5)
With group sessions, DBT provides you with a good support network to help you overcome your challenges. DBT helps you form healthy relationships - with respect and trust - which can be beneficial way beyond treatment.
The social skills developed in DBT can be carried through to your current relationships, by helping define boundaries and developing trust.
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.
Acceptance is a key part of moving forward and improving your overall quality of life. DBT encourages you to make positive changes, but to also accept that it’s okay to find things difficult at times.
The disruptive emotions felt by many people with eating disorders can have a significant impact on their quality of life. Distress tolerance and emotional regulation skills can help in managing and gaining control over these feelings.
DBT is not effective on it’s own as an eating disorder treatment. Instead it will form part of a multidisciplinary approach, which includes nutrition education and counselling, psychiatry, and medical interventions if necessary.
Completing DBT is a big time commitment. It requires attendance to multiple sessions a week and you’re expected to complete homework on a regular basis.
The rationale for using DBT to treat people with eating disorders has been described comprehensively through scientific research. The primary hypothesis is that DBT would benefit people with eating disorders by addressing the emotional dysregulation that commonly triggers eating behaviors, such as purging, restricting, and binge-eating. (6)
While a lot of the research has been positive, the majority of the studies conducted on DBT have looked at treating people with bulimia nervosa (BN) and binge-eating disorder (BED). (2) For example studies have shown that DBT has resulted in meaningful changes in the behaviors associated with BN and BED, including a reduction of binge eating episodes. (3,8)
Research into DBT as a treatment for anorexia nervosa (AN) is much more limited. However, Kroger et al. (2010) (7) discovered a 33% remission rate in people with a comorbidity of AN and borderline personality disorder (BPD) after an inpatient DBT program.
Our clinical care team at Within Health believes DBT is an effective way to treat patients with eating disorders, particularly those struggling with interpersonal relationships, or emotion dysregulation. Within Health incorporates 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.
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. Our clinical team will work with you to craft the right program for your specific needs.