By Gregory Holich, MS, LPC, DBT Specialist, Timberline Knolls Residential Treatment Center
Eating disorders are multi-faceted and highly complex diseases; as such, multiple treatment strategies are recommended to help an individual fully recover.
Dialectical behavioral therapy (DBT) is a recovery tool designed to help people recognize the ability to create a meaningful life for themselves, regardless of past challenges. The goal of creating a meaningful life complements other strategies by creating a framework in which a person can be set free from an eating disorder and go on to live a balanced, healthy and productive life.
The dialectic in DBT is that acceptance and change can exist simultaneously. DBT is particularly effective in treating those who have experienced repeated relapses of self-harm, eating disorders and co-occurring emotional illnesses.
The four primary aspects of DBT skills training include:
- Mindfulness. Learning to control your mind so it does not control you.
- Distress Tolerance. Learning how to make it through crisis situations without making matters worse (without engaging in negative or unhealthy behaviors).
- Emotion Regulation. Learning ways to reduce emotional vulnerability and increase emotional awareness/identification.
- Interpersonal Effectiveness. Learning how to be more effective in communicating with others, and being aware of your own limits in relationships while also observing the limits of others.
When people engage in DBT they are asked to consider how they would define living a meaningful life. A response could be as simple as “living a life where I don’t have to binge and purge,” or “living a life free from calorie counting.” The fascinating aspect of this initial response is that this definition often expands and changes as these individuals progress through treatment. As they heal from their disorder, they often broaden their definition of a meaningful life to include the possibility of a more expansive career, future love relationships or the advent of children in their lives.
They are encouraged to develop an understanding of the tenants of DBT and start practicing the skills right away. Mindfulness is perhaps the most important, in that the other components naturally stem from this state. People practice slowing down, being present and living in the moment. For many this is extremely challenging, since they have utilized their eating disorder to numb their minds and escape from their personal, painful lives.
It is important for people to return to a life that includes emotion while in therapy. Many have existed in a feeling-free world for so long, it is genuinely difficult for them to recognize an emotion when it presents itself. Since these feelings are often unpleasant, and they can no longer rely on unhealthy behaviors to vanquish them, they must learn and practice the skills of emotion regulation and distress tolerance. They soon discover that emotions, though difficult, are not lethal, and that they, through their own power, can choose how to react and cope.
The fourth component of DBT, interpersonal effectiveness, is crucial to learn and practice. This tool is designed to help people in recovery get their needs met in a way that is respectful to both themselves and others.
Once learned, the skills associated with DBT can be taken from the therapy setting and back into the real-world environment where they can be used to sustain recovery.