The Evidence Base: Eating Disorders and DBT
By: Melissa Gerson, LCSW There is a growing base of evidence supporting the effectiveness of dialectical behavior therapy (DBT) with certain eating disorder patients.
DBT has its roots in treating borderline personality disorder (BPD); in fact, the American Psychological Association lists DBT as one of the best empirically supported treatments for BPD1. At its core, DBT teaches patients skills to help them better manage their emotions. Because many patients with eating disorders experience this kind of emotion dysregulation, DBT has been studied as a treatment for anorexia, bulimia, and binge eating disorder.
A recent paper in the American Journal of Psychotherapy2 reviewed the research on DBT for eating disorders.
Here are my key takeaways:
- There is good evidence to support the use of DBT skills training with bulimia and binge eating patients. The evidence on anorexia is less compelling, but encouraging.
- There is promising evidence to support the use of DBT with any eating disorder patient who also has BPD. According to one study, about 20% of eating disorders patients have comorbid BPD3; given the effectiveness of DBT with BPD, it makes sense that DBT would be effective for this subpopulation.
These findings mirror what I see in practice as the Clinical Director of an eating disorder treatment center. We generally start our co-morbid BPD patients with DBT early on; improved emotion regulation makes treatment more effective for these patients. We also turn to DBT when patients treated with cognitive behavioral therapy (CBT-E) get stuck because of significant mood-intolerance component.
If you are seeking a DBT resource for an eating disorder patient, there are key components to look for:
- Skills Training Group. These group sessions are where the core skills of mindfulness, interpersonal effectiveness, emotion regulation, and distress tolerance are taught.
- Individual Therapy. These one-on-one sessions help patients apply skills to their personal situation.
- Telephone Consultation. These brief phone calls are designed to help patients deploy skills in-the-moment, when they’re experiencing distress and/or facing obstacles. At Columbus Park we find this component particularly helpful; over the phone, the therapist identifies the problem, evaluates the skills the client used already, and then offers additional skill options for managing the struggle. This intervention helps clients replace emotion-driven, impulsive behaviors with active, competent self-directed skill use.
- DBT Consultation Team. In a comprehensive DBT practice, providers meet weekly for DBT consultation. These team meetings are a critical component of effective DBT practice as they are designed to support each therapist in his/her work while encouraging constant growth and learning for the group as a whole. Patients benefit in turn from a strong, committed and motivated team of providers.
1Oldham JM: Guideline Watch: Practice Guideline for the Treatment of Patients with Borderline Personality Disorder. Arlington, VA: American Psychiatric Association, 2005
2Wisniewski, L & Ben-Porath, D. D. (2015). Dialectical Behavior Therapy and Eating Disorders: The Use of Contingency Management Procedures to Manage Dialectical Dilemmas. American Journal of Psychotherapy, Vol 69, No. 2, 129-140
3Milos, G. F., Spindler, A. M., Buddeberg, C., & Crameri, A. (2003). Axes I and II comorbidity and treatment experiences in eating disorder subjects. Psychotherapy and Psychosomatics, 72, 276-285