RO-DBT in Recovery

As an eating disorder specialist in Texas I use a method called Radically-Open Dialectical Behavioral Therapy (RO-DBT) to help people work toward recovery from eating disorders.

It has been shown to be very effective at helping people who struggle with hiding, avoiding, and suppressing their emotions.

We all want to avoid emotions, but for some, emotions are so scary and overwhelming, you want to lock them away and pretend - and try with all your might - to avoid facing, acknowledging, and accepting these uncomfortable emotions.

I get it....emotions can get REALLY BIG and scary. It is sometimes in your best interest to lock emotions away and pretend they are not there. Doing this has helped you in so many ways and has been really good for you at times.

But it also means there are times when doing this has contributed to greater anxiety, upset, and emotional pain. Eating disorder behaviors are used to help you avoid emotions, and this is an incidence when avoiding emotions is not in your best interest.

The goal of recovery is to learn how to deal with emotions, even the big and scary ones, without using eating disorder behaviors.

Eating disorder thoughts lead to anxiety, distress, and other emotional upset. Emotions - whether you like it or not - have a way of letting you know they are around and forcing you to pay attention to them.

This is when things get complicated because it feels like you literally can NOT deal with the emotion and you feel overwhelmed and distressed.

When you would rather lock the emotions away for no one to see, RO-DBT has some tools to help you learn to cope in a more healthful way.

If you are like my clients with an eating disorder, you have a lot of unhelpful beliefs about your body and about food.

For example, let’s say you believe you are not “good enough”. I tell my clients “you cannot think something and not believe it to be true”. This is why it  feels hard to challenge eating disorder thoughts because once the brain has a belief about something it continues to find evidence to support the belief.

So if you think “I am not good enough” you go throughout your day and all the mistakes, all the comparisons, all the challenges, or all the things that do not go as you want them to become continued evidence of “I am not enough”.

This is called confirmation bias. In other words, you pay attention to things that fit your beliefs and ignore or dismiss things that don’t. This is NOT your fault - it is just how the human brain works!

 Therefore this makes challenging eating disorder beliefs and beliefs about your body super hard because your brain literally is not able to process the more helpful challenging view.


So one of the first things you  want to do - in order to help you recover - is to teach the brain to be more flexible in receiving opposing information.

You want to learn to become radically open.

 Being radically open is about becoming mentally flexible, but flexibility may feel scary because things seem unknown and it requires accepting opposing food and body rules.

Rather than thinking “I am not good enough”, mental flexibility is about considering “I am enough”.

The following acronym will help you become more mentally flexible and open to accepting opposing eating disorder thoughts and help you feel less emotionally distressed.

Flexible Mind DEFinitely

D - acknowledge DISTRESS or unwanted emotion

E - Use self-Enquiry to learn

F - Flexibly respond with humility

So let’s take a deeper look at how you can start to apply this to your own recovery.

D - Acknowledge DISTRESS or unwanted emotions

Anxiety, frustration, tension, and the like are emotions that arise when faced with a new and uncertain situation - for example eating a challenge food. You may also feel distressed when you are invalidated. For example a support telling you to “get over it”. 

The first step in practicing openness is learning to identify situations that will cause emotional upset and then reminding yourself these uncomfortable emotions are part of the process.

Start by describing what happened. Notice how you feel in your body and observe any tension. This emotional reaction is your cue to use self-Enquiry.

 E - Next you want to use self-Enquiry to learn from the distress rather than automatically attempting to manage, avoid or fix the emotion. Rather than trying to change your emotional experience try learning from your emotions instead. Practice being curious with your emotional reactions by asking yourself questions like: 

●      Is it possible that these thoughts about my body and food may be wrong and that I don’t know what I don’t know?

●      What am I afraid of?

●      What am I avoiding?

●      What can I learn from this that will allow me to enjoy life more?

 There is no right or wrong answer to these questions, but when you become curious about your emotions you are able to then practice Flexibility.

F - Flexibility. Here is where you respond by doing what is best and needed in the moment, in a way that is compassionate and honors your healthy self. Practice flexibility by asking yourself the following questions:

 ●      What is the downside of holding on to eating disorder thoughts and behaviors?

●      What goals and values are negatively impacted by my eating disorder thoughts and behaviors?

You will need to practice this each time you want to work to challenge eating disorder thoughts and behaviors.


The idea is to learn from emotional distress rather than using eating disorder behaviors to improve your emotional reaction.

Rather than quickly wanting to change your emotional distress, start by recognizing and acknowledging you are upset. Your emotions are not bad, even the uncomfortable ones.

Next practice using curiosity to learn from your emotions and seek to understand what the upsetting emotion is trying to tell you.

Emotions are a signal that something is wrong so ask yourself questions to understand what this distress is all about. As you become more curious about your emotions, you can practice being flexible.

You may believe the thoughts you have about your body and food, but being flexible allows you to consider there is another way to understand your body and food. Once you are open to considering different thoughts about your body and food, you will notice your beliefs about your body and food start to shift to be more aligned with your “healthy” self.


About the Author: Dr. Stephanie Waitt

Dr. Stephanie Waitt resides in Sherman, TX.

Stephanie is a therapist that specializes in treating eating disorders and is a body image, self-esteem, and eating disorder recovery coach. She works with young adults and teens to recover from disordered eating and find confidence and happiness. Stephanie is dedicated to helping individuals receive access to eating disorder treatment. She believes that everyone deserves quality and specialized treatment. She is passionate about eating disorder awareness, dogs, and Wonder Woman.

You can find her spending time with her husband visiting comic book stores or a craft brewery, and hanging out with her beloved Golden Retriever Prince Fenway and Corgi Lord Odin.

You can learn more about Stephanie at

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