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Dialectical Behavior Therapy for Eating Disorders

Posted Oct 07 2008 5:31pm

Question from an interested reader: Is DBT useful for eating disorders patients?

Answer from "Treatment Notes": One recent development in the contemporary treatment of eating disorders is the use of Dialectical Behavior Therapy (DBT) as a treatment approach. You may be familiar with DBT, as developed by psychologist Marsha Linehan, for use with patients who are diagnosed with borderline personality disorder or demonstrate suicidal behaviors. Recent DBT studies show some very promising results for the treatment of eating disorders, including the first few published clinical trials which report 82-90% rates of abstinence from binge eating at the end of a 20-session DBT therapy program.

DBT consists of four main components:

  1. mindfulness training
  2. emotional regulation
  3. distress tolerance
  4. interpersonal skills training

The "dialectical" aspect of DBT refers to the dual emphasis upon learning to experience and accept emotions and behavioral problems while also learning to cope with and regulate negative feeling states and bring about behavior change. One reason for the promising results may be that DBT has been shown to be useful for a broader range of patients than traditional cognitive-behavioral therapy (CBT). According to Thomas Marra, Ph.D., author of Dialectical Behavior Therapy in Private Practice: A practical and comprehensive guide, the goal of a DBT approach to eating disorders treatment involves:

  • 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, most importantly, increasing sensory input (mindfulness) to substitute sensual activities for food satiety.

At a workshop of the Academy for Eating Disorders (AED) InternationalConference on Eating Disorders, 2007, presenters Lucy Miznuski and Deborah Safer detail the sue of standard DBT techniques for treating eating disorders, including behavior chains,hierarchical therapeutic goals, the use of a therapeutic contract, and the use of a DBT diary card. Marsha Linehan and others presented further information at this year's 2008 AED Conference.

For additional information, see McCabe, E.B., LaVia, M.C. & Marcus, M.D. (2004). Dialectical Behavior Therapy for Eating Disorders. In Thompson, J.K. (Ed.) Handbook of Eating Disorders and Obesity. New Jersey: John Wiley & Sons, Inc.

Linehan, M.M. (1993). Skills Training Manual for Treating Borderline Personality Disorder. New York: The Guilford Press.

If you have a question or a topic that you would like to see addressed in Treatment Notes, send an e-mail tomail@drshepp.comand include "treatment notes" or "blog" in the subject line.

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