Dialectical Behaviour Therapy for Eating Disorders

DBT was originally developed by American psychologist Marsha M. Linehan in the late 1980s as a treatment for borderline personality disorder (BPD). Over time, researchers and clinicians began to recognize that DBT could also be adapted to treat other mental illnesses that also featured emotional dysregulation and unhealthy coping behaviours, such as eating disorders. Since the early 2000s, DBT has been increasingly used to treat patients with eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating disorder.

Principles of Dialectical Behaviour Therapy for Eating Disorders

There are several key principles underlying the application of DBT for eating disorders.

Dialectical Thinking

DBT encourages patients to recognize and accept the inherent contradictions and tensions in their: 

• Thoughts
• Feelings
• Behaviours 

Related to their eating disorder. For example, on one hand, the person might desperately want to get better, but on the other hand, they find themselves actively protecting their eating disorder and resisting change. Dialectical thinking seeks to accept and incorporate both of these truths as a necessary step to move forward in the recovery process.

A key skill in DBT for eating disorders is dialectical abstinence. In dialectical abstinence, the patient needs to set the goal in therapy to stop engaging in all eating disorder behaviours. Because the urges to engage in these behaviours are so strong, one must have this 100% strong commitment. Anything short would be an attempt to protect the eating disorder and sabotage any possible recovery. The certainty that disordered eating behaviours are completely out of the question is kept at the forefront of the mind at all times.

However, simultaneously the patient must keep in mind - way, way back in the very farthest part so that it never interferes with their resolve - that if they do slip, it will be dealt with effectively by accepting it nonjudgmentally and recommitting to 100% full abstinence. 

Emotional Regulation

Many individuals with eating disorders struggle with managing their emotions, leading to unhealthy coping strategies such as restrictive eating, bingeing, overexercising, or purging. DBT aims to help patients develop healthier strategies for regulating their emotions by teaching them skills related to mindfulness, distress tolerance, and emotion regulation. 

Validation and Support

DBT emphasizes the importance of validating patients' experiences and emotions, while also providing a supportive environment in which they can take steps towards change. This approach helps reduce feelings of shame and self-blame often associated with eating disorders, which can be barriers to recovery.

Techniques Used in Dialectical Behaviour Therapy for Eating Disorders

Key features of DBT for eating disorders are:

• Chain analysis - This involves taking a detailed account of all the different thoughts, feelings, behaviours, and situations that led up to engaging in an eating disorder behaviour as a way to understand the function (or purpose) of the behaviour and target the triggers
• Daily diary cards - This is a daily record of DBT skills used, emotions, and urges to engage in eating disordered and other unhealthy behaviours

DBT for eating disorders typically involves a combination of individual therapy, group skills training, and phone coaching. Some of the key techniques used in DBT for eating disorders include:

Mindfulness

Patients learn to observe and describe their thoughts, feelings, and sensations without judgment. This practice helps develop greater self-awareness and emotional regulation, which can be particularly beneficial for individuals with eating disorders. 

A key part of DBT for eating disorders is applying mindfulness to eating to acknowledge and accept difficult feelings that come up around eating, eliminate mindless eating, and decrease cravings, urges, and preoccupation with food.

Distress Tolerance

This aspect of DBT teaches patients how to tolerate and manage distressing emotions and situations without resorting to self-destructive behaviours. Skills learned may include distraction, self-soothing, and radical acceptance.

Emotion Regulation

DBT helps patients learn to identify, understand, and manage their emotions more effectively, which can be crucial in addressing the emotional dysregulation often present in eating disorders.

Effectiveness of Dialectical Behaviour Therapy for Eating Disorders

A growing body of research suggests that DBT can be an effective treatment for eating disorders. Several studies have found that DBT can lead to significant reductions in eating disorder symptoms, as well as improvements in emotional regulation and overall psychological functioning. Moreover, DBT has been shown to be effective in reducing the frequency of binge eating and purging episodes, as well as improving weight restoration in patients with anorexia nervosa.

Benefits and Limitations

Benefits of DBT for eating disorders include:

Comprehensive Approach: DBT addresses both the emotional and behavioural aspects of eating disorders, making it a more comprehensive treatment option than some other forms of therapy.

Skills-Based Focus: By teaching patients concrete skills for managing their emotions and behaviours, DBT can help individuals with eating disorders develop a stronger foundation for long-term recovery.

Evidence-Based: DBT is supported by a robust body of research, providing a strong evidence base for its effectiveness in treating eating disorders.

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While DBT has been shown to be effective for many individuals with eating disorders, it may not be the best fit for everyone. Some patients may respond better to other therapeutic approaches or require additional interventions to address co-occurring issues such as trauma.

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