All About DBT for Eating Disorders: A Guide for Patients and Loved Ones
Eating disorders are severe and potentially life-threatening conditions that deeply affect physical, emotional, and social well-being. For a subset of individuals seeking treatment for eating disorders, conventional treatments will not be sufficient. Dialectical Behavioral Therapy (DBT) has emerged as a highly effective option, offering substantial improvements in both physical health and overall quality of life for individuals with eating disorders.
Recent research has deepened our understanding of eating disorders, leading to various treatment models with positive outcomes for many patients. However, a subset of eating disorder patients may not achieve lasting relief from more standard treatments like Enhanced CBT and symptoms can sometimes recur.
This is particularly true for individuals with complex conditions such as co-occurring borderline personality disorder, substance abuse, chronic suicidality, self-harm, or significant difficulties in regulating emotions.
Studies suggest that traditional treatments, including Cognitive Behavioral Therapy (CBT) and Family-Based Therapy (FBT), may be less effective for individuals with these additional mental health challenges. This is where DBT for eating disorders can be effective.
What is DBT-ED
DBT-ED is based on the idea that disordered eating behaviors—such as restricting food intake, binge eating, purging, and compulsive exercise—serve as ways to manage emotions. These behaviors may temporarily help individuals escape or numb negative feelings.
While more adaptive coping strategies exist, disordered behaviors often prevail when healthier options are not available. The cycle of perfectionism, guilt, and self-criticism exacerbates the issue, reinforcing the use of disordered behaviors and leading to severe long-term consequences. DBT treatment aims to break this cycle by teaching people more adaptive and ultimately effective ways to manage their emotions and reducing reliance on problematic coping techniques.
The Role of DBT in Treating Eating Disorders
Given the limitations of standard treatments for some patients in eating disorder recovery, exploring alternative options is essential. Dialectical Behavioral Therapy (DBT) is a well-established method with proven success in treating self-injurious behaviors, suicidality, and a range of other conditions, such as substance abuse, PTSD, treatment-resistant major depression, bipolar disorder, and ADHD.
A specialized version of DBT, designed specifically for eating disorders and known as DBT-ED, has emerged as a transformative treatment for many who have not benefited from conventional therapies.
Key Features of DBT-ED
DBT-ED enhances behavioral control by teaching adaptive emotional regulation strategies. Clients learn to identify triggers for disordered behaviors, develop alternative coping methods, and create "cope-ahead" plans for challenging situations. They also work on recognizing and addressing harmful thought patterns, such as all-or-nothing thinking, which can lead to symptoms. By increasing self-awareness, reducing vulnerability to negative emotions, and fostering self-compassion, DBT-ED supports clients in achieving lasting recovery.
Benefits of DBT-ED
DBT-ED offers several advantages, especially for individuals who have not found success with multiple previous treatments. Its focus on building motivation and commitment to change makes it particularly effective for those who may be reluctant to abandon certain aspects of their eating disorder. DBT-ED also addresses therapy-interfering behaviors (“TIBs”), such as concealing symptoms or dropping out of treatment. By validating these behaviors and working collaboratively to overcome them, therapy participation is enhanced and treatment outcomes are improved.
Another significant advantage of DBT-ED is its ability to address multiple issues concurrently. Many individuals with eating disorders also face additional challenges, such as suicidal thoughts, self-harm, anger dysregulation, and mood symptoms.
DBT systematically targets these issues, starting with life-threatening behaviors, then addressing barriers to effective therapy, and finally focusing on "life worth living" goals. This comprehensive approach ensures that all aspects of the client's well-being are addressed.
Frequently Asked Questions About DBT-E
Is DBT-ED effective?
Recent studies have shown promising results for DBT in treating eating disorders, although effectiveness can vary by diagnosis. For instance:
One study found that DBT was highly successful in treating binge eating disorders among women, with an impressive 89% success rate.
Another study reported that 90% of adults with anorexia nervosa responded positively to DBT.
Research indicated that individuals with bulimia experienced fewer bingeing and purging symptoms after 20 weeks of DBT therapy.
How long does it take for DBT-ED to work?
Some research suggests that DBT can reduce eating disorder symptoms in as little as 20 weeks for adults. Typically DBT-ED is a six-month course during which participants move through four distinct modules; we would expect to see improvement within this time period. It is recommended that participants repeat the four modules over the course of a second six-month period. Further studies are needed to confirm these findings across a broader range of demographics, including different genders, races, and ages. Additionally, DBT may need to be adapted for different types of eating disorders.
Who would be a good candidate for DBT-ED?
DBT has been identified as a promising treatment for adults with binge eating disorder, bulimia, and anorexia. It is also supported for treating anorexia and bulimia in adolescents. Individuals who have not responded well to traditional treatments like Enhanced CBT may find DBT beneficial. Moreover, those with co-occurring eating disorders and borderline personality disorder might also benefit from DBT. It is crucial to consult with a healthcare team, including a primary care physician, psychiatrist, and therapist, to determine if DBT is appropriate for your specific needs.
Who Might Not Be Suitable for DBT for Eating Disorders?
Due to the high risk of physical harm or death associated with eating disorders, it is essential to stabilize a patient’s physical health to a certain extent before beginning any therapy, including DBT. If an eating disorder is severe enough to pose an immediate danger, the individual may need residential treatment or hospitalization rather than DBT.
What is the structure of DBT-ED?
DBT for eating disorders typically includes weekly individual therapy sessions, group skills training, and access to phone coaching or crisis sessions. Some programs also involve a weekly consultation team for additional support. Traditional DBT methods often involve worksheets and between-session homework. Practicing, practicing, practicing newly acquired skills in between sessions is a major focus of the treatment.
What are some core components of the DBT-ED treatment?
1. Self-Monitoring
DBT-E incorporates regular monitoring of eating disorder behaviors and other behavioral targets of treatment like self-harm, suicidal thoughts, and other problematic impulsive behaviors.
2. Skills Training
DBT-ED is structured around four key modules designed to address various aspects of emotional and behavioral challenges. The Mindfulness module helps individuals become more aware of their thoughts, feelings, and bodily sensations, improving their ability to recognize and respond to triggers for disordered eating.
Distress Tolerance equips clients with strategies to manage and endure emotional pain without resorting to harmful behaviors, while Emotion Regulation focuses on understanding, labeling, and managing emotions to reduce vulnerability to disordered eating.
Finally, the Interpersonal Effectiveness module enhances communication skills, supports relationship building, and teaches assertiveness to improve social interactions and support recovery. Together, these modules provide a comprehensive approach to managing eating disorders and fostering long-term recovery.
3. Building Motivation
Sessions often include discussions about the motivations for recovery, helping clients consider the short- and long-term consequences of disordered behaviors.
4. Goal and Value Exploration
A fundamental part of DBT is understanding and living by core values, which often contrast with eating-disordered behaviors. Therapists work with clients to align their daily lives and recovery goals with these values.
5. Challenging Dichotomous Thinking
DBT addresses rigid thinking patterns, encouraging clients to use dialectical strategies to balance their thoughts.
How do I find a DBT-ED therapist?
It’s important to understand that DBT is a sophisticated and complex treatment that takes a high level of training and experience to deliver well. Given the expanding “popularity” of DBT, there are many providers who integrate aspects of DBT into treatment, but this is not how DBT is designed to be delivered.
Adhering closely to the principles and protocols of DBT is essential because it ensures that the treatment is delivered at the appropriate “dose,” maximizing its effectiveness. Deviating from the established DBT framework can compromise the therapeutic process, potentially diminishing the benefits and leading to inferior outcomes.
To find a DBT therapist who specializes in eating disorders, start by searching online directories like Psychology Today, which allows you to filter by specialty, including DBT for eating disorders. It’s important to confirm that the provider completed advanced training in DBT (preferably through Behavioral Tech, the premier training institute for DBT) and delivers either a “comprehensive” or “adherent” model of DBT. You can also:
Search for professional organizations such as the Association for Behavioral and Cognitive Therapies (ABC)
Check the Linehan Institute directories of trained practitioners.
Contact specialized eating disorder treatment practices that have DBT-ED as a core part of their offerings.
Ask for referrals from your primary care physician, psychiatrist, or current therapist.
Moving Forward
At Columbus Park, we recognize how frustrating it can be to feel stuck in eating disorder treatment , particularly when previous efforts have not been successful. Our team is committed to using our expertise in DBT-ED to support clients through their unique challenges and promote meaningful progress.
We believe in the potential for change and the importance of closely monitoring progress to achieve treatment goals. If you’re interested in exploring how DBT-ED can impact your recovery journey, schedule a complimentary phone call with us today.
