One of the big dialectics of DBT (Dialectical Behavior Therapy) is the acceptance of clients in their current distress, while at the same time giving them skills to alter their dysfunctional behavioral patterns. Those that struggle with eating disorders, tend to use disordered eating as a means to regulate their own emotions. Bingeing and bulimic behavior has often been explained as a “result of trying to escape or block primary or secondary aversive emotions that may be triggered by thoughts regarding food, body image, perfectionism, the self, or interpersonal situations” (Linehan and Chen). Basically, it functions to provide an escape from physiological responses and feelings, because the client lacks other emotion regulation skills.
DBT focuses on 5 specific core areas, wherein skills are taught that lie within each of these:
- Distress Tolerance
- Walking the Middle Path
- Emotion Regulation
- and Interpersonal Effectiveness
Many of the skills in each of these areas can help in the treatment of eating disorders.
Some of these include:
- Using mindfulness as a means of decreasing mindless eating, and being more aware and present with what is occurring.
- Being aware of one’s emotions and cravings, and using “opposite action”, which is a skill where urges to engage in dysfunctional behavior are overcome by doing the action opposite to the urge.
- Coping ahead by identifying triggers and urges, as well constructing new adaptive responses to those situations and contexts.
- Identifying new ways to handle the underlying emotional dysregulation and distress, by using distress tolerance skills like “self-soothe”, “pros and cons”, and “distracting with wise-mind”.
- Practicing self-validation, as well as learning how to ride the wave of their own emotions, as well as identifying ways to reduce emotional vulnerability.
It should be noted, that weight loss is not the goal of treatment, but that managing one’s own emotional dysregulation and responding to their struggles in healthy ways is. Weight loss, or reaching a healthy weight can absolutely come about as a result of using these skills, yet the focus in DBT treatment is not on gaining or losing weight in and of itself.
DBT therapists at Sunrise provide each student with DBT Diary Cards, where the student then tracks their triggers, as well as their emotions. These are followed up on in weekly therapy, and the therapist then discusses these emotions with the student. The DBT therapists at Sunrise focus on teaching these skills to their students, as well as establishing reasons for skills failure, reinforcing the approximation of skills, and ensuring that the student has a broad set of skills rather than becoming over-reliant on just one skill.
sources: Linehan and Chen (2005). Encyclopedia of Cognitive Behavior Therapy. Dialectical Behavior for Eating.