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Eating Disorders and DBT

Mar 12, 2020

The Core Components of DBT

Dialectical Behavior Therapy (DBT) is one type of cognitive-behavioral therapy. It has demonstrated effectiveness with a variety of mental health issues such as post-traumatic stress disorder (PTSD), depression, and anxiety. Though it was developed in the 1980s by Marsha Linehan, Ph.D., as a therapy for suicidal thinking and self-harm, DBT has found applications for many more substance abuse disorders as well as mental health diagnoses.

How Can Dialectical Behavioral Therapy Help With Eating Disorders?

DBT focuses on the fluid nature of acceptance and change, two concepts that may seem mutually exclusive. Practitioners believe that people need to learn new behaviors to find satisfaction in their lives. Supporting and validating clients helps them to gain the motivation to learn and practice new things. DBT demonstrates effectiveness in addressing eating disorders using the five components of the treatment.

• DBT skills training: Usually offered in a weekly group format, these sessions are like a class where participants learn behavioral skills and complete assigned homework. The tasks provide clients with opportunities to try out their new skills in the real world. Skills training takes 24 weeks to complete the four modules of the curriculum.
• • Mindfulness is the practice of staying in the moment and fully aware with a focus on making decisions with one’s “wise mind.” The wise mind uses both emotional and rational inputs to contribute to decision making to avoid emotional eating.
  • Distress tolerance is one’s ability to cope with feelings that cause distress. This skill is critical for dealing with crises, identification of emotions, and reducing vulnerability to emotional extremes.
  • Interpersonal effectiveness is the way that a person expresses needs and sets boundaries to establish and grow healthy relationships. This concept includes acquiring assertiveness skills, learning to ask for help, and saying “no” to others.
  • Emotional regulation is the process of changing emotions that you want to change.
• Individual therapy: DBT focuses on growing the client’s motivation to make changes and then assisting through the application of those skills to real life. Therapy sessions are usually once a week for as long as necessary, running concurrently with the DBT skills training sessions.
• Coaching to ensure the generalization of skills: DBT uses coaching sessions over the phone to provide support at the moment when clients are struggling. The goal is to teach clients how to use DBT skills when challenging situations arise in day to day life.
• Structure the environment with case management: With the assistance of case management, clients learn how to manage their own lives in their usual physical and social circles.
• DBT consultation team to support the therapist: The DBT treatment team offers support to the professionals providing the various services, including therapists, case managers, group leaders, and others.

Common Desired Outcomes of DBT

Cognitive-behavioral therapies such as CBT are the preferred method of treatment for eating disorders as it appears to slow or stop the unhealthy behaviors present in the condition. DBT is often offered alongside other types of service in residential treatment programs for eating disorders. Other clients receive DBT services in an outpatient setting. Sessions may be in a group format or one-on-one with a trained therapist. Individual sessions allow the client to practice what they are learning in a group so that the best approach may be a combination of the two.
Clients report multiple positive outcomes with DBT services.

• • • Leaving sessions with concrete skills to apply to real-world experiences
    • Gaining knowledge of how to make decisions in stressful situations
    • Successful avoidance of behaviors such as binging and purging through improved coping skills

Case Studies and Research About the Effectiveness of DBT and Eating Disorders

The body of research on DBT and eating disorders is still evolving. However, the current prominent perspective is that DBT is most helpful for clients with bulimia nervosa or binge eating disorder. It is most likely to be successful with clients who have Borderline Personality Disorder and intense emotions along with the eating disorder. For clients who have not found success with traditional CBT or other forms of individual psychotherapy, DBT may produce better results. Mindful eating, trigger identification, and healthy responses to stressors are a few of the skills that DBT teaches these clients to use.

Here are a few of the relevant studies into the use of DBT with eating disordered clients.

• 2001: Participants with a binge eating disorder receiving DBT experienced a decrease in symptoms. A surprising 89% were symptom-free at the end of the study, and 56% maintained that status six months later. Similar studies with participants diagnosed with bulimia found symptom reduction after DBT as well.
• 2014: A study of clients with anorexia nervosa receiving DBT found improved body mass indexes (BMIs) at six and 12 months after services. Another study involving women with anorexia nervosa or bulimia nervosa found improved emotion regulation and a reduction in symptoms with DBT.
• 2015: A study found that a combination of DBT and Family-Based Treatment (FBT) led to a reduction in binging and purging episodes in teens with bulimia nervosa.

Along with the research studies, case studies exist demonstrating the effective use of DBT for clients with eating disorders. A 23-year-old female diagnosed with anorexia nervosa, binge-eating/purging subtype, received six months of residential treatment. She found DBT helped her learn the skill of “Opposite to Emotion” or “Opposite Action,” which means acting in a way that is opposite or different from what your emotions would typically demand. Rather than reacting with food restriction when offered meals, she chose to practice gratitude for the meal and for the chance to practice her new skills.

This client also used the concept of “Radical Acceptance” as her weight began to restore to a healthy level. Instead of attacking herself, she instead committed to love and accept everything about herself throughout the growth process. Over time, her inner dialogue changed for the better.

Dialectical Behavioral Therapy at MHS

The Minnesota Department of Human Services certifies Mental Health Systems as an accredited provider of DBT for adults and adolescents, including those with developmental disabilities. Contact us today to set up an appointment for evaluation if you or someone you love is struggling with an eating disorder.

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Image Credit: Getty/ KatarzynaBialasiewicz