What is DBT?
Dialectical Behavior Therapy (DBT) is a relatively new treatment approach that is increasingly being used in eating disorder treatment programs. It helps individuals who have difficulty regulating their emotions, as well as those who engage in self-defeating or self-destructive behaviors in response to intense or painful emotions. Originally formulated for individuals with impulsivity, self-injury, unstable interpersonal relationships, poor self-image, and emotions that characterize borderline personality disorder, DBT has been expanded to include treatment for a range of other disorders, including eating disorders. In the application of DBT to eating disorders, food restriction and binge and purge episodes are conceptualized as attempts to regulate painful emotions. Therapy typically consists of weekly sessions (in group and individual settings) that focus on helping individuals develop new emotion-regulation skills to provide an alternative to eating disorder behaviors.
What is the origin of DBT?
DBT for eating disorders is based on the original treatment as developed by Dr. Marsha Linehan, and is built upon a theory of emotional dysregulation. The theory posits that difficulties with emotion regulation develop from an individual’s biological vulnerability to experiencing intense emotions. This vulnerability is then thought to interact with an invalidating environment; over time this interaction shapes difficulties with emotion regulation and interpersonal relationships. Within this model, treatment is comprised of a balance between acceptance and change-based strategies. As such, treatment is focused on validation of the individual’s current emotional experience while also developing new ways to tolerate, modulate and respond effectively to these emotions.
In standard DBT, treatment is delivered in two weekly formats: (1) group training in mindfulness, distress tolerance, emotion regulation and interpersonal effectiveness skills, and (2) individual sessions where the therapist helps apply these skills to the challenges that the patient faces in their life. The skills training in DBT draws on principles of Zen practice as well as core principles of cognitive-behavior therapy. For example, coping responses for the urge to binge eat may include training in mindfulness – observing the urge and allowing it to decrease over time, as well as training in alternative behavioral responses such as self-soothe or distraction techniques.
How is DBT applied to recovery?
Standard DBT treatment consists of stages and targets that determine the content and structure of each session. The goal of stage one of DBT is to decrease or eliminate:
- life-threatening behaviors (e.g., suicidal behavior, severe drug addiction, non-suicidal self-injury)
- therapy interfering behavior – clinician or patient behavior that can divert, slow down, or derail the therapeutic process (e.g., the clinician being inadequately prepared for session or the patient not completing their homework outside of session)
- hospitalization use as a way of handling crisis, and behaviors that interfere with quality of life (e.g., eating disorders, unemployment)
At the same time, the goal is to increase behaviors that will enable a person to have a life worth living and provide training in behavioral skills to increase skill effectiveness.
The second stage of DBT focuses on decreasing post-traumatic stress. Stage three goals include increasing self-respect, setting individual goals and solving ordinary life problems. Finally, developing the capacity for freedom and joy is the goal of stage four. For self-injurious patterns and borderline personality disorder, this form of treatment has garnered consistent research support for its benefits.
DBT programs offer an excellent option for focused short-term treatment of eating disorder behavior in general, and particularly for those who want an additional focus on emotion regulation, self-image, interpersonal challenges, feelings of emptiness or isolation, or other impulsive or self-defeating behaviors.
For further information, please refer to the website: Behavioral Tech, LLC.
Angela Davis, Ph.D.
Michael W. Otto, Ph.D.