The growing popularity of Dialectical Behavior Therapy (DBT) in the treatment of eating disorders (ED) is of great interest to professionals, patients and families who have been struggling with the effects of an eating disorder.  Recently, our blog, “Dialectical Behavior Therapy: Part I” introduced the background and basic principles behind DBT in an effort to clarify its importance and relevance in the field of ED treatment.  Today, Part II of the blog goes a step further to help increase understanding of the DBT process and the specific ways in which it can help move patients toward recovery.  As mentioned in Part I, DBT is composed of four modules, each with its own goals and skill sets.  Each of these modules are introduced and described below:

Mindfulness: 

The art of “learning to be in control of your mind, instead of letting your mind be in control of you.”  Accomplishing this is not a task of controlling one’s thoughts, but rather practicing the ability to control one’s attention. The goal behind this module is not change, but rather acceptance of whatever one is experiencing in any given moment.  In this module, individuals learn how to:

• be exposed to information from inside themselves to which they would usually be unaware
• more effectively regulate these thoughts, feelings, and reactions
• shift attention when attention on a certain thing is not productive

Distress Tolerance: 

Distress tolerance is the ability to endure and accept emotional suffering.  This is essential to good mental health since, as Linehan notes, “pain and distress are part of life; they cannot be completely removed or avoided.”  Mastering these skills is vital to recovery since ED symptoms are often used to provide immediate gratification in the relief of pain/distress.  If someone is not able to tolerate distressing feelings without acting on symptoms, then those impulsive actions will continually interfere with efforts at recovery.  The goal of this module is to decrease impulsive behaviors (i.e. self-harm, bingeing, purging, etc.) by providing alternate healthy ways of coping with negative emotions such as self-soothing, distracting, and thinking of pros and cons.

Emotion Regulation: 

As noted above, ED symptoms often serve to numb out painful emotions.  As a result, many individuals in the early stages of recovery have a hard time identifying what they are feeling and why.  Emotion Regulation skills focus on:

• understanding one’s emotions, including learning how to identify a specific emotion and it’s function
• reducing one’s vulnerability to negative emotional states and increasing positive emotions
• mindfully letting go of painful emotions and/or modulating or changing a negative emotion when possible 

Interpersonal Effectiveness: 

Difficulties with self-esteem, perfectionism, tolerating distress, and the drive to please others, can often interfere with attempts to have healthy, fulfilling relationships. This module provides concrete strategies to help improve assertiveness and interpersonal problem-solving in order to facilitate healthy life changes and improve/maintain self-respect.  Skills learned in this module include:

• asking for what one needs
• saying no and setting healthy boundaries
• coping with interpersonal conflict effectively. 

The Center for Eating Disorders is now offering DBT group therapy on an outpatient basis.  Each group will meet once a week for a six month period.  

Beginning June 4th, 2009, our 1st DBT group will be starting from 5:30 – 7:00 pm. A second DBT group will be starting on Tuesdays from 11:00 am – 12:30 pm. Start date TBD.  

For more information about these groups or any of our DBT programming, please call (410) 938-5252.

References

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

Behavioral Tech, LLC. (1996-2009). What is DBT?  Available at:  http://behavioraltech.org/resources/whatisdbt.cfm 

Written by: Kristin Grasso, Psy.D., Center for Eating Disorders at Sheppard Pratt