Dialectical Behaviroal Therapy for Eating Disorders

Dialectal Behavioral

Therapy for Eating Disorders...

DBT skills have been shown to be an effective adjunctive treatment for eating disorders, particularly bulimia and binge-eating. [1][2][3]

Clients learn to effectively regulate their emotions and better tolerate distress.
They learn to assert themselves in effective, functional ways.
They become more mindful of their physical, emotional and cognitive process.

Often, deficiencies in one or more of these areas exacerbate the impulse to engage in pathological eating.

Emotional Regulation

A correlation between unpleasant affect and bulimic symptoms has long been recognized. With DBT skills training, clients are better able to acknowledge and cope with unpleasant feelings. Safer, Telch and Agras (2001) found that clients’ rates of bulimic symptoms saw a significant decrease after learning emotion regulation skills in the DBT model.[4]
Polivy and Herman (1993) (among others) have argued convincingly that binging is primarily a dysfunctional attempt at regulating negative affect.[5]
Telch, Agras and Linehan (2001) found a significant decrease in binge-eating behavior after group DBT skills training.
Of participants in the DBT group, 89% (16 of 18) had stopped binge eating for at least 4 weeks prior to the end of treatment, compared with just 12.5% (2 of 16) of controls. Confidence in our findings and in the efficacy of DBT skills training for BED is enhanced by the fact that a similar abstinence rate of 82% occurred in our uncontrolled trial.[6]

Distress Tolerance

Persons with bulimia and binge-eating disorder operate under the expectation that eating is the primary means of alleviating distress.[7][8]
By providing a wider range of coping mechanisms, in particular the ability to self-nurture and self-soothe without the use of food, DBT skills can greatly increase a patient’s capacity to tolerate distress in a functional manner.

Interpersonal Effectiveness

Anecdotal evidence strongly suggests that a commonly occurring challenge in people with eating disorders is difficulty asking for things or saying “no” to others. The resulting feelings of powerlessness and frustration are often triggers to pathological eating.
The DBT skills module on interpersonal effectiveness allows clients the opportunity to examine feelings of unworthiness, overcome inhibitions to self-assertion and experience a greater sense of choice and agency in their interactions with others.

Mindfulness

Wiser and Telch (1999) assert that binging functions to lower awareness of unpleasant or unacceptable emotional states.[9] Baer, Fischer and Huss (2005) found DBT mindfulness skills to be effective in making such emotional states more accessible and more acceptable.
The [DBT] mindfulness skills are taught to counteract the tendency to use binge eating to avoid awareness of negative emotional states. These skills encourage nonjudgmental and sustained awareness of emotional states as they are occurring, without reacting to them behaviorally.
That is, participants learn to observe their emotions without efforts to escape them and without self-criticism for having these experiences. This state of mindful awareness facilitates adaptive choices about emotion regulation and distress tolerance skills that could be used in place of binge eating.[10]
Because of its effectiveness in decreasing bulimic and binge-eating symptoms, DBT skills training is now a common treatment protocol in recovery programs for eating disorders.
DBT skills can help individuals with bulimia or binge-eating across a spectrum of behavioral challenges, resulting in lowered symptomatology and greater satisfaction in living.

Citations:

[1] Wisniewski, L., Safer, D., & Chen, E. (2007). Dialectical behavior therapy and eating disorders. In Dimeff, L. A. & Koerner, K. (Eds.), Dialectical behavior therapy in clinical practice: Applications across disorders and settings (pp. 174-221). New York: Guilford Press.

[2] Kristeller, J. L., Baer, R. A., & Quillian-Wolever, R . (2006). Mindfulness-based approaches to eating disorders. In Baer, R. A. (Ed.), Mindfulness-based treatment approaches: Clinician’s guide to evidence base and applications (pp. 75-91). San Diego, CA: Elsevier Academic Press.

[3] Telch, C.F., Agras, W. S., & Linehan, M. M . (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 1061-1065.

[4] Safer, D. L., Telch, C.F., & Agras, W. S. (2001). Dialectical behavior therapy for bulimia nervosa.American Journal of Psychiatry, 158, 632-634.

[5] Polivy, J., & Herman, C. P. (1993). Etiology of binge eating: Psychological mechanisms. In C. G. Fairburn& G. T.Wilson (Eds.), Binge eating: Nature, assessment and treatment (pp. 173–205). New York: Guilford Press.

[6] Telch, C. F., Agras, W. S., &Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 1061-1065.

[7] Jackson, B., Cooper, M. L., Mintz L., & Albino, A. (2003). Motivations to eat: Scale development and validation. Journal of Research in Personality, 37, 297–318.

[8] Hohlstein, L. A., Smith, G. T., & Atlas J. G. (1998). An application of expectancy theory to eating disorder: Development and validation of measures of eating and dieting expectancies. Psychological Assessment,10, 49–58.

[9] Wiser, S., & Telch, C. F. (1999). Dialectical behavior therapy for binge eating disorder. Journal of Clinical Psychology, 55, 755–768.

[10] Baer, R. A., Fischer, S., & Huss, D. B. (2005). Mindfulness and acceptance in the treatment of disordered eating. Journal of Rational-Emotive & Cognitive-Behavioral Therapy, 23, 281-300.