ED Therapy - DBT?

This month's blog article was written by Gary Snapper, LPC, LLP, a member of the SMEDA Board and a founder of Cognitive Behavioral Solutions in Kalamazoo.  http://www.southwestmichiganeatingdisorders.org/directory/

DBT History

Marsha Linehan, creator of DBT therapy, described DBT as “a multimodal cognitive-behavioral treatment originally developed to treat chronically suicidal individuals meeting BPD criteria.”  Since DBT’s inception in the 1990s, researchers and clinicians have experimented with broadening the application of DBT to multiple mental-health disorders including OCD, Bipolar Disorder, Substance Abuse Disorders, Depression, and Eating Disorders.

 DBT Components

DBT is a high-intensity treatment program that combines aspects of Cognitive Behavioral Therapy with the concepts of Dialectics and Mindfulness.

 Dialectics is the concept that two apparently polar opposites can be true concurrently.  Dialectics help clients to avoid all-or-nothing thoughts and actions. For example, a person can be doing the best they can AND need to try harder.

 Mindfulness is associated with Eastern Religions, and portions of it have been described in most major religions.  Mindfulness is the nonjudgmental awareness of one’s internal and external experiences and states. This also can be explained as follows:  Attempting to be aware of one’s focus and gentle re-directing of the mind to the present when one notices one’s mind drifting towards judgmental thoughts or over-focusing on past or future worries.   Research has shown Mindfulness helps to reduce anxiety and to increase a sense of balance.

 DBT implements these concepts through a comprehensive regimen that requires all of the following:  1) Individual therapy, 2) Skills training,  3) After hours skills-based phone support, and 4) Weekly DBT team consultation meetings.

 DBT Theory and Eating Disorders (ED)

A cornerstone of DBT theory is that emotion dysregulation contributes to many disorders, including EDs.  Difficulty regulating intense emotions can lead to avoiding  “emotion experiencing”.  Emotions that are avoided may lead to ED symptoms, including food restriction, binging, purging, and over-exercise. DBT provides specific skills to cope with intense emotions in tandem, with a forum to learn, practice, and apply the skills.  This helps the client to replace ED behaviors with effective coping strategies. In essence, DBT teaches the ED client a new language that allows for skills-based emotion regulation in place of ED behaviors.

 Along with new coping strategies, DBT’s use of Mindfulness techniques, Dialectics, and after-hours Coaching, all apply to the treatment of ED’s, and has become a comprehensive approach for treating Eating Disorders.

 Although none of the researched eating disorder treatments are as effective as we would like them to be, research suggests that DBT rivals and/or surpasses the effectiveness of traditional CBT, which has been considered the Gold Standard for treatment of eating disorders in adults.

 A simple 8-minute video describing DBT for Adolescents can be found at: https://youtu.be/Stz--d17ID4?list=PLV9RJQek2bix34tBuHaOp12gt-sHf32yV  .

 Sources:

 Linehan, Marsha, M., (1993).  Cognitive-Behavioral Treatment of Borderline Personality Disorder.  New York: Guilford Publications.

 Linehan, M. and Chen, E. (2005). Dialectical-Behavior Therapy for Eating Disorders. In Freeman, A. Encyclopedia of Cognitive Behavior Therapy. (pp168-171). New York: Springer.