Dialectical Behavior Therapy for Eating Disorders

Is DBT effective in treating these conditions?

Caucasian women talking in group therapy
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Dialectical behavior therapy (DBT) is a type of psychotherapy. Originally, it was used to treat borderline personality disorder (BPD), and it's now the gold standard treatment for that condition. However, it has since been used to treat other mental illnesses, including eating disorders.

The word "dialectical" means that you're able to hold onto two completely different ideas at the same time. For example, when undergoing dialectical behavior therapy, your therapist will work with you so that you both accept yourself as you are, and are motivated to change.

Does Dialectical Behavior Therapy Work for Eating Disorders?

Dialectical behavior therapy was developed in the late 1970s by Marsha Linehan, Ph.D., and since then, there have been various studies done looking at how well it works in people with eating disorders. The results have been promising — the treatment does appear effective in slowing or stopping problematic behaviors.

However, most of the research that has been done hasn't compared dialectical behavior therapy to other treatments (or to no treatment at all). The one study that compared DBT to active comparison group therapy for binge eating found no real differences — both treatments worked equally well.

Most of the studies conducted on dialectical behavior therapy looked at treating people with binge-eating disorder and bulimia nervosa, not anorexia nervosa.

DBT Includes Therapy, Skills Training

The ideal dialectical behavior therapy set-up for eating disorders includes individual therapy sessions, skills training sessions (which usually are in a group therapy setting), and telephone consultations with a therapist as needed, 24 hours a day.

Unfortunately, many therapy settings are not able to provide for all three of these components at once. For instance, one therapist may offer a skills-training group but not be available for telephone consultations.

An individual therapist may teach specific DBT skills to clients based on their clinical judgment.

This type of treatment may still be helpful but may not be as helpful as receiving all three components of the treatment. Dialectical behavior therapy has also been adapted for use in residential and inpatient treatment settings.

The skills-training component of DBT consists of four modules:

  • Core mindfulness skills: Based on Eastern meditative practices, mindfulness skills encourage the client to fully experience the world around them, in the moment. Many therapists use this principle to treat eating disorders by teaching clients "mindful eating." This allows a person to fully experience the tastes and textures of their food and to cultivate awareness of hunger and fullness signals.
  • Interpersonal effectiveness skills: The goal of this module is to teach people how to express their needs and set boundaries to build healthy relationships.
  • Emotion regulation skills: These skills teach how to identify and name emotions, reduce vulnerability and decrease suffering.
  • Distress tolerance skills: These are skills to help clients survive painful emotions when the situation cannot be changed in the moment.

    Each skill is taught in a session, and then throughout the following days or weeks clients keep track of situations in which they were able to practice each skill. Using diary cards, clients keep a record of urges, such as urges to use alcohol or drugs; urges to harm themselves; urges to restrict, exercise, binge and/or purge.

    In telephone consultations, a therapist prompts the client to use a specific skill in the situation as needed.

    Who Should Try Dialectical Behavior Therapy?

    Given the current research on dialectical behavior therapy and eating disorders, it is likely to be most helpful for people suffering from bulimia nervosa or binge-eating disorder. It is also likely to be helpful for clients who are suffering from borderline personality disorder in addition to an eating disorder.

    Sources:

    Bankoff SM et al. A systematic review of dialectical behavior therapy for the treatment of eating disorders. Eating Disorders. 2012;20(3):196-215.

    Feigenbaum, J. (2008). Dialectical behavior therapy. Psychiatry, 7(3), 112-116.

    Harriet Salbach-Andrae, H., et al. (2008). Dialectical behavior therapy of anorexia and bulimia nervosa among adolescents: A case series. Cognitive and Behavioral Practice, doi:10.1016/j.cbpra.2008.04.001.

    Linehan, M.M. (1993). Skills training manual for treating borderline personality disorder. New York, NY: Guilford Press.

    Safer, D.L., Robinson, A.H., & Jo, B. (2010). Outcome from a randomized controlled trial of group therapy for binge eating disorder: Comparing dialectical behavior therapy adapted for binge eating to an active comparison group therapy. Behavior Therapy, 41, 106-120.

    Safer, D.L., Telch, C.F., & Agras, W.S. (2001). Dialectical behavior therapy for bulimia nervosa. American Journal of Psychiatry, 158(4), 632-634.

    Telch, C.F., Agras, W.S., & Linehan, M.M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69(6), 1061-1065.

    Wisniewski, L. & Kelly, E. (2003). The application of dialectical behavior therapy to the treatment of eating disorders. Cognitive and Behavioral Practice, 10, 131-138.

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