Melissa M. Gonzalez, Psy.D.
Dialectical Behavior Therapy (DBT) is a specialized and empirically-validated form of cognitive behavioral therapy that was developed by Marsha Linehan for the treatment of women with Borderline Personality Disorder (BPD). In it’s original form, DBT involved an intensive outpatient treatment including weekly individual therapy, weekly group skills training, weekly therapist consultation team meetings, and 24-hour access to telephone coaching as needed.
The theory underlying this treatment poses that emotionally vulnerable women, when exposed to an environment they perceive as invalidating, will experience chronic emotional dysregulation or difficulty modulating their emotional reactions. So what is meant by emotionally vulnerable? Essentially, this means an individual who has a heightened sensitivity to emotional stimuli, intense emotional responses, and difficulty returning to an emotional baseline. Consequently, when these women become emotionally dysregulated, they may have difficulty inhibiting mood-dependent behaviors (such as self-injury), organizing themselves to achieve goals independent of mood, regulating physiological arousal, diverting attention away from emotionally volatile stimuli, or simply experiencing any emotion without either avoidance or extreme secondary emotional interference. Since it’s inception, DBT strategies have been applied to the treatment of many mental disorders with similar characteristics. Since eating disorders (EDs) are often characterized by problem behaviors (e.g. restricting, bingeing, purging) that are associated with emotional dysregulation, DBT has been proposed as a treatment option for Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge Eating Disorder (BED).
A recent journal article published in Eating Disorders: The Journal of Treatment and Prevention (April 2012) described a systematic literature review of studies citing the use of DBT or DBT-based approaches in the treatment of EDs. The findings of this review indicated that the use of treatments based on the DBT model – often modified for the specific treatment of EDs – generally resulted in positive impact on the reduction of ED behaviors, improvement in markers of mood and affect, and greater retention of individuals in treatment. These are important and promising findings as this means that clients are safer, less emotionally volatile, and more likely to continue working toward recovery. Eating Disorders are notoriously difficult to treat as clients are often highly resistant to change and treatment is often initiated by others when the individual is already in serious danger. Furthermore, since mood disorders, substance abuse, self-harming behaviors, and BPD often co-occur with EDs, DBT treatment targets are often well suited to these clients.
At the Tarnow Center for Self-Management, this type of specialized treatment can be incorporated in several ways into a comprehensive treatment approach which can include psychiatry, individual therapy, family therapy, and group therapy provided by an experienced team of clinicians. Ongoing DBT groups provide specific skills for teenage girls and their parents for the development of emotional regulation; and DBT skills can be incorporated into other areas of treatment as well. Please call us if you or someone you know is struggling with disordered eating.
If you suspect that your chld may suffer from an eating disorder or may be developing patterns of disordered eating, express your concerns difectly and privately in a kind, empathic, calm and supportive manner. Be able to ask educated questions. Do not try to force your child to eat. Engaging in a power struggle will not help. Providing advice about dieting or nutrition commenting positively about appearance, or attempting to solve your child's problems is not recommended. Do not agree to keep disordered eating habits a secret. Finally, do not let fear prevent you from confronting your child. EDs have the highest mortality rate of any psychiatric illness. Intervening and seeking help may save your child's life. We here at the Tarnow Center for Self-Management believe in a comprehensive approach to the treatment of eating disorders. This "attack n all fronts" often includes family therapy; and parents become an important part of the treatment process. Additionally, parents are encouraged to seek support, for themselves during this challenging process and that may take the form of support groups including other parents of children with EDs, use of online resources, or even individual therapy.