Dialectical Behavioral Therapy (DBT)
DBT is a broad-based cognitive-behavioral treatment developed by Marsha Linehan, PhD. DBT draws influence from a dialectical world-view, Zen practice, behavioral and psychodynamic theory. Originally designed to treat borderline personality disorder, DBT has subsequently been adapted to treat a wide variety of problems associated with emotional dysregulation including eating disorders. The utility of DBT as a treatment for Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED) and Eating Disorder Not Otherwise Specified (EDNOS), rests on the emotion-regulation model of eating disorder symptoms. In this model, eating disorder behaviors (e.g. restricting, over-exercising, bingeing, purging, laxative, diet pill and diuretic abuse) serve as maladaptive mechanisms for reducing unpleasant emotional states. The aim of DBT is to improve each participant’s ability to be mindful of their thoughts, feelings and behaviors, and then cope more adaptively with emotional and physical distress.
DBT addresses four areas of skills necessary to increase participants’ adaptive coping and reduce the frequency and severity of eating disordered behaviors: Core Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness.
For adults with an eating disorder, regular daily functioning in work, school and relationships are interrupted by feelings of self-loathing, preoccupation with weight and shape, intrusive obsession with calories, and paralyzing self-doubt. The skills taught in DBT can help adults gain control over their eating disorder behaviors which will impact all areas of their life. Skill modules addressing mindfulness, emotion regulation, interpersonal effectiveness and distress tolerance empower individuals to manage their social, emotional and physical worlds with a new and expanded sense of competence and control.
Adolescence is a tumultuous time. Friendships grow more complicated and peer groups realign as issues such as drugs, dating, parties and popularity take precedence over loyalties and connections forged in childhood. Family relationships are strained as teenagers struggle to balance the need to forge their own identities and have greater freedom while longing for the safety of childhood and the safety of connections with parents, siblings and other relatives. The physical and hormonal changes brought on by puberty leave many adolescents feeling like aliens in their own skin. And all this without fighting a love-hate battle with an eating disorder.