Dialectical Behavior Therapy at The Center for Eating Disorders
The primary goal of Dialectical Behavior Therapy (DBT) is to help individuals build a life that has meaning and worth, with a freedom from suffering.
DBT was originally developed by Marsha Linehan, Ph.D., to treat individuals who engage in self-harm behavior, many of whom meet the diagnostic criteria for borderline personality disorder. DBT represents a merging of eastern approaches and western therapies, including cognitive behavioral therapy (CBT). CBT which emphasizes one’s ability to change thoughts and behaviors, has been criticized for not addressing emotional dysregulation (a difficulty with responding to emotions in the culturally accepted manner), often a significant problem for people with Eating Disorders (EDs). Thus, in developing DBT, Linehan also integrated Eastern psychological and spiritual philosophies, including the practice of mindfulness, which provide for a heightened focus on acceptance (rather than change) and on the healthy regulation of difficult emotions.
DBT is composed of four modules, each with its own goals and skill sets.
Mindfulness is 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 focus one’s attention on the present moment, in a non-judgmental way. Commonly, individuals with eating disorders may have automatic or intrusive thoughts that direct their behavior. Mindfulness can help to diffuse those thoughts and raise awareness of one’s judgments about them. The goal behind this module is not to change, but rather to notice and accept whatever one is feeling in any given moment. Through mindfulness, an individual can gain more flexibility and freedom in their thoughts. 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 helpful
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 eating disorder 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.
As noted above, eating disorder 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:
- validation 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 emotional experiences
- mindfully letting go of painful emotions and/or modulating a negative emotion when possible
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:
- getting your objectives met in an assertive manner
- seeking or maintaining an effective relationship
- maintaining your self respect
The Center for Eating Disorders utilizes DBT at all levels of care. The first three modules are introduced in group therapy in our inpatient and partial hospitalization programs, while full coverage of all four modules is applied in our intensive outpatient program, as well as in individual therapy at all levels of care.
We are currently offering a DBT group on an outpatient basis that meets once a week in the evening. If you’re interested in the next phase of this group or would like more information about any of our outpatient treatment groups, please call (410) 938-5252.