The Importance of Dialectical Behavior Therapy (DBT) in Eating Disorder Treatment

By Megan Samuels, LMSW

Dialectical Behavior Therapy, or DBT for short, is a treatment modality that has research to support its effectiveness for the treatment of suicidality, borderline personality disorders, eating disorders, and self harm behaviors.  It has four sections, also known as modules, which are mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.  All of these components are helpful to the process of recovering from an eating disorder. 

Below, I have listed the four modules of DBT, including a brief description about its relevance to eating disorder treatment.  I have also listed some practice exercises if you are interested in engaging with any of these modules. 

Mindfulness

• People with eating disorders are often stuck in the past (“How many calories was that snack that I ate?”) or stuck in the future, (“How many miles will I need to run to burn off what I ate for dinner?”).  Mindfulness helps people focus on the present moment (including the 5 senses) in a nonjudgemental way.  

 
Let’s Practice:

• Find somewhere comfortable to sit.  Name 5 things that you can see, 4 things that you can feel, 3 things that you can hear, 2 things that you can smell, and 1 thing that you can taste (or would like to taste).  Remember to name these things non-judgementally.

Distress Tolerance

• I like to think of distress tolerance as how someone can handle an intense or overwhelming emotion.  It’s important to note that what’s intense and overwhelming to one person, may not be intense and overwhelming to another.  DBT provides skills to use for when someone is struggling with an overwhelming emotion.  If we think about this in terms of eating disorder treatment, a common emotion that someone may feel after eating is guilt.  If the guilt becomes too overwhelming, one could engage in maladaptive behaviors and restrict or cut OR one could use a DBT distress tolerance skill to survive crisis situations without making anything worse.

 
Let’s Practice:

• What is an emotion that feels really overwhelming to you?  When do you typically feel this emotion?  If it feels safe for you, where do you typically feel that emotion throughout your body?

Interpersonal Effectiveness

• The skills in this module can help you develop, maintain, or strengthen relationships.  The skills focus on boundary setting, compromising, and maintaining your self respect.  In recovery from an eating disorder, one may have a hard time setting boundaries to friends or family members who discussing dieting or weight loss.  These skills can help the person in recovery find the tools and the words to effectively and skillfully set boundaries to protect their recovery and also maintain their relationship with the other person.

 
Let’s Practice:

• Journal about a relationship that you are struggling with right now.  Think about how you could maintain or strengthen that relationship.  What skills would you need to achieve that?  What might their reaction be?

Emotion Regulation

• This module focuses on understanding emotions, changing responses to certain emotions, and managing painful emotions.  One skill in this module, focuses on coping ahead for potentially triggering or overwhelming situations.  For someone struggling with an eating disorder, it may feel triggering to walk into the dining hall at college.  One can create a cope ahead plan to reduce the anticipated distress by enlisting a friend to go to the dining hall with them to distract them from feeling overwhelmed.

 
Let’s Practice:

• When may you feel overwhelmed over the next week?  What emotion are you anticipating feeling?  What skills do you have to handle that emotion?  What can you do NOW to plan ahead for that situation so it is less overwhelming?  

Hopefully, these descriptions and exercises gave you a sneak peak at what DBT can help with.  If it was difficult to do any of these exercises, please be gentle with yourself.  These are skills that work best when they are reinforced and practiced regularly.  

Want more?  The majority of the therapists at Eating Disorder TheDialectical Behavior Therapy, or DBT for short, is a treatment modality that has research to support its effectiveness for the treatment of suicidality, borderline personality disorders, eating disorders, and self harm behaviors.  It has four sections, also known as modules, which are mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.  All of these components are helpful to the process of recovering from an eating disorder. 

Below, I have listed the four modules of DBT, including a brief description about its relevance to eating disorder treatment.  I have also listed some practice exercises if you are interested in engaging with any of these modules. 

Mindfulness

• People with eating disorders are often stuck in the past (“How many calories was that snack that I ate?”) or stuck in the future, (“How many miles will I need to run to burn off what I ate for dinner?”).  Mindfulness helps people focus on the present moment (including the 5 senses) in a nonjudgemental way.  

 
Let’s Practice:

• Find somewhere comfortable to sit.  Name 5 things that you can see, 4 things that you can feel, 3 things that you can hear, 2 things that you can smell, and 1 thing that you can taste (or would like to taste).  Remember to name these things non-judgementally.

Distress Tolerance

• I like to think of distress tolerance as how someone can handle an intense or overwhelming emotion.  It’s important to note that what’s intense and overwhelming to one person, may not be intense and overwhelming to another.  DBT provides skills to use for when someone is struggling with an overwhelming emotion.  If we think about this in terms of eating disorder treatment, a common emotion that someone may feel after eating is guilt.  If the guilt becomes too overwhelming, one could engage in maladaptive behaviors and restrict or cut OR one could use a DBT distress tolerance skill to survive crisis situations without making anything worse.

 
Let’s Practice:

• What is an emotion that feels really overwhelming to you?  When do you typically feel this emotion?  If it feels safe for you, where do you typically feel that emotion throughout your body?

Interpersonal Effectiveness

• The skills in this module can help you develop, maintain, or strengthen relationships.  The skills focus on boundary setting, compromising, and maintaining your self respect.  In recovery from an eating disorder, one may have a hard time setting boundaries to friends or family members who discussing dieting or weight loss.  These skills can help the person in recovery find the tools and the words to effectively and skillfully set boundaries to protect their recovery and also maintain their relationship with the other person.

 
Let’s Practice:

• Journal about a relationship that you are struggling with right now.  Think about how you could maintain or strengthen that relationship.  What skills would you need to achieve that?  What might their reaction be?

Emotion Regulation

• This module focuses on understanding emotions, changing responses to certain emotions, and managing painful emotions.  One skill in this module, focuses on coping ahead for potentially triggering or overwhelming situations.  For someone struggling with an eating disorder, it may feel triggering to walk into the dining hall at college.  One can create a cope ahead plan to reduce the anticipated distress by enlisting a friend to go to the dining hall with them to distract them from feeling overwhelmed.

 
Let’s Practice:

• When may you feel overwhelmed over the next week?  What emotion are you anticipating feeling?  What skills do you have to handle that emotion?  What can you do NOW to plan ahead for that situation so it is less overwhelming?  

Hopefully, these descriptions and exercises gave you a sneak peak at what DBT can help with.  If it was difficult to do any of these exercises, please be gentle with yourself.  These are skills that work best when they are reinforced and practiced regularly.  

Want more?  The majority of the therapists at Eating Disorder Therapy Boca Raton has extensive training and experience in using Dialectical Behavior Therapy (DBT) as an effective treatment modality for eating disorders.  Contact us for a free 15-minute consultation today!

References:

DBT Skills Training Handouts and Worksheets, Second Edition by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.

*Disclaimer: The information is provided for educational and informational purposes only. It is not intended to be a substitute for your independent medical decision-making nor a recommendation or endorsement for any particular treatment plan, organization, provider, professional service, or product. You assume all responsibility and risk for any use of the information.

Eating Disorder Therapy Boca Raton  is a premier outpatient eating disorder therapy center founded by Jennifer Rollin. We specialize in helping teens and adults struggling with anorexia, binge eating disorder, bulimia, OSFED, and body image issues. We provide virtual eating disorder therapy in Boca Raton, Ft. Lauderdale, Palm Beach, Pinecrest, Parkland, Naples, Miami Shores, Palmetto Bay. Virtual eating disorder therapy throughout Florida.