Navigating the eating disorders treatment landscape can often feel like swimming in alphabet soup. Acronyms abound – CBT, DBT, FBT, ACT – the list goes on and on. And, to someone who isn’t familiar with the treatment of eating disorders, understanding each of these treatment modalities may feel overwhelming.
As a therapist who has been utilizing Dialectical Behavior Therapy (DBT) as a primary treatment modality for the entirety of my career, I hope to provide a brief, yet informative summary of this approach, particularly as it applies to eating disorders.
DBT is a treatment that was initially developed for adult females struggling with Borderline Personality Disorder (BPD), a disorder characterized by emotional, behavioral, cognitive, and interpersonal dysregulation, as well as struggles with sense of self. The first studies on the use of DBT with this population had positive outcomes, and as data supporting the use of DBT continued to mount, researchers began to wonder what other groups of individuals DBT might be able to help. Overtime, DBT has been found to be effective in the treatment of many types of disorders, including eating disorders, substance use disorders, and mood disorders. Moreover, DBT has been found to be effective across the lifespan, and in many types of settings, including various treatment programs and even schools!
So what is DBT? DBT is a treatment that is focused on helping individuals to regulate their emotions and “build a life worth living.”
Achieving this lofty goal requires robust treatment, and DBT is just that. It is comprised of five different modes of treatment, each with unique functions.
The mode of DBT that people are often most familiar with is DBT Skills Training, which typically occurs in a group therapy format, sometimes with patients alone and sometimes with patients and their families. The goal of this mode of treatment is to help patients learn strategies to assist with regulating their emotions, tolerating distressing situations effectively, improving their interpersonal relationships, enhancing nonjudgmental awareness of the present moment, and approaching their world in a balanced fashion. If we think of our patients as being tasked with building a house that represents their “life worth living,” DBT Skills Training is the equivalent of our patients filling up their shopping cart with tools from Home Depot and taking home-building courses. It is critical that they have the resources and knowledge needed to embark upon this journey.
The second mode of DBT is Individual Therapy, which involves patients meeting regularly with a therapist. The primary goal of this mode of treatment is to assist patients in cultivating and sustaining their motivation to make difficult changes in their lives, and this mode also helps patients to apply the information they are learning through DBT Skills Training to their own unique circumstances. Continuing with the analogy of our patients as home builders, Individual Therapy is the equivalent of our patients meeting with a consultant once or twice a week to help them develop a strategy for each step of building their home, and to help them maintain their motivation if it starts to wane – building a house is a long process, and anyone tasked with such an endeavor needs support!
The third mode of DBT is Skills Coaching (called Telephone Consultation, when applied in outpatient settings), which entails patients having access to staff who can support them in applying their skills in-the-moment to challenging situations that arise. The main goal of this mode of treatment is to help patients apply the skills they are learning to real-world situations. Building upon our analogy, Skills Coaching is like construction workers on the worksite of our patients’ homes stepping in to assist when a crisis is mounting or is in the process of occurring, rather than waiting to address the problem with their consultant later in the week. This can be especially helpful when the risk of a negative outcome is high, like flooding from a plumbing issue, or if the patient is trying to do something new and challenging.
The fourth mode of DBT is Case Consultation Meetings for treatment team members, and the fifth mode of DBT involves Ancillary Treatments, such as psychiatry, dietetics, primary care, and so forth. In the treatment of eating disorders through the use of DBT, Ancillary Treatments is a bit of a misnomer, in that the medical and psychiatric complexity of eating disorders truly requires an integrated approach – all disciplines are central to effective treatment. In wrapping up our analogy, when building a house, it is critical that all individuals involved are knowledgeable about the most up-to-date building codes, and the use of specialized expertise for things like electrical work, aesthetic elements, and so forth is often necessary. Similarly, it is vital that each member of the multidisciplinary team treating a patient’s eating disorder sustains their motivation, thinks creatively when encountering challenges, and is aware of current best practices in their area of expertise.
So how can you help a loved one struggling with an eating disorder, particularly if your loved one is receiving treatment from a program that utilizes DBT as a treatment modality? Perhaps the most useful thing you can do is start to learn more about DBT, and particularly about DBT skills.
DBT skills apply to everyone and as you start to use them, you will likely find that your own quality of life improves.
While learning about DBT may feel like a long and perhaps daunting process, know that thousands of families have experienced similar challenges, and that you too have the capacity to follow in their footsteps by supporting your loved one on the path toward recovery.
Stay tuned for Part 2 in our “Building a Life Worth Living” series for more information on how DBT skills are particularly helpful for patients with eating disorders.
Written by Alyssa Kalata, Ph.D.
Associate Clinical Director, Veritas Collaborative