Eating Disorders and DBT
The following is a brief description of our DBT program with special focus on eating disorders.
There are no modules devoted entirely to eating disorders; rather, the discussion of eating disorders and their related issues are woven throughout the teaching of the DBT modules (Mindfulness, Interpersonal Effectiveness, Emotional Regulation, and Distress Tolerance Skills). The shared problems of emotional dysregulation are discussed as they precipitate a number of impulsive, out-of-control, dysfunctional behaviors.
Unlike the discussion of suicidal behaviors, the discussion of eating behaviors does not appear to have a contagion effect upon group members. Clients from all ED populations are treated in the same group which requires that patients refrain from talking about numbers of any kind (ie. Weight, BMI, and calories) and suicidal or self-harm behaviors.
Those patients with anorexia nervosa are monitored for Stage i behaviors (life-threatening behaviors) and CBT is integrated with DBT or DBT-enhanced cognitive-behavioral therapy, with a focus on cognitive restructuring, identifying ineffective thoughts, and understanding how thoughts affect behaviors. As such, patients are taught and encouraged to do a chain analysis of their behaviors.
The DBT Team meets Weekly to discuss individual cases so that all members of the team are informed of the progress and skills that the group members have learned. Telephone consultation and coaching are provided, and although there is a 24 hour rule for self-harm behaviors, patients are encouraged to Call when they have problems with the next scheduled meal or snack, even though they may have engaged in ineffective eating behaviors for the previous meal or snack. Telephone contacts are discussed within the team to ensure effective communication.
Nutrition and meal planning are referred to a nutritionist. in group, balanced eating is encouraged and myths about dieting, advertising, and cultural reinforcers for dieting behaviors, psychoeducation regarding eating disorders, weight regulation, and medical issues are woven into the general discussion. Dialectical strategies, such as finding the synthesis between the extremes of over-controlled/rigid eating and absence of an eating plan is encouraged and discussed Within the framework of effective eating.
The goals of a DBT approach to eating disorder treatment are:
Decrease life-interfering behaviors; decrease behaviors that interfere with treatment; decrease quality of life interfering behaviors; finding the path to mindful eating; stop problematic eating behaviors by learning and practicing adaptive emotional regulation skills to replace maladaptive eating; increasing the variety of emotional inputs available in a patient’s environment; increasing the variety of need fulfillments; validating the Worth of the individual; increasing frustration tolerance; learning strategic behavior skills; and increasing sensory input (mindfulness) to substitute sensual activities for food satiety.
DBT is also easy to understand and implement, allowing eating disorder sufferers to put a label on each skill so they have practical things they can do in the moment to make the situation better. As patients master specific: skills, they are more aware of problem behaviors, are able to think before they aot, and feel confident in their ability to deal with Conflict in healthy ways.
Recent studies show promising results for using DBT in the treatment of eating disorders, particularly binge eating disorder and bulimia. For example, the first few published clinical trials reported 82 to 90 percent rates of abstinence from binge eating at the end of a 20-session DBT therapy program (Dimeff, L.A. & Koerner, 2007; Wisniewski, L., Safer, D., Chen, E. Dialectical Behavior Therapy and Eating Disorders; Dialectical Behavior Therapy in Clinical Practice, Applications Across Disorders and Settings, Guilford Press, NY.).