Dialectical behavior therapy (DBT) is a form of psychotherapy originally designed for work with persons with borderline personality disorder (BPD), a difficult disorder to treat. DBT has been shown to be very effective with BPD; researchers are now learning whether DBT is effective with binge-eating disorder (BED) as well.
Why DBT May Be Appropriate for Treating Binge-Eating Disorder
Those with BPD often lead very chaotic lives, in part due to living on a constant emotional roller coaster. Emotions are unrealistically positive at times: Every new opportunity (in work, relationships, or even treatment) seems to be the ideal and final answer to every desire. But emotions also run so deeply negative at other times that suicide attempts are common. Whether positive or negative, emotions in those with BPD lead to impulsive behavior.The emotional ups and downs in a person living with BPD are similar to the emotional hazards for those with eating disorders. Many believe that binge eating is a way to regulate emotions. In binge-eating disorder, binging is a repetitive, impulsive behavior. The impulsivity is similar to that in behaviors associated with BPD.
The hope is that dialectical behavior therapy can address the emotions underlying binge eating, just as it helps those with BPD address emotions that lead to their erratic behavior.
How DBT Can Help to Change Binge-Eating Behaviors
DBT therapy includes a group therapy component in addition to individual sessions. In DBT, the group provides immediate practice in regulating emotions that arise in the context of the group. With more people present (and more relationships), emotions are more likely to surface.
The core goal of DBT is to help clients to build skills for regulating emotions:
- It teaches the ability to recognize what triggers the emotions and how to keep them from leading to unhealthy behaviors. One basic skill is learning to breathe with focus on the diaphragm, which encourages relaxation.
- It also includes education and practice in mindful eating, with a focus on awareness of emotional responses to food while eating. This provides a way out of the emotional and mental numbness that binge eating often creates.
- Encourages the person to recognize that the emotions present aren't bad. For example, a common thought process might be, "I'm angry! What's wrong with me?" DBT helps to change this to, "I'm angry. I wonder why?" This ensures that anger and other "negative" emotions don't lead to shame and guilt.
- DBT teaches self-distraction and self-soothing for moments in which the person cannot change a stressful situation right away. Note that being "distracted" can seem like the opposite of mindfulness, but in this case the person actively chooses the distraction, rather than defaulting to binging and purging for a distraction.
Initial Testing of DBT for Binge-Eating Disorder
The first research investigation of DBT's effectiveness with binge-eating disorder was very promising, though small. Several participants dropped out of the study before completing it, but of the 18 that remained, 16 (89%) had stopped binge eating by the end of treatment. Of those in a control group who did not received DBT, only 12% stopped binging. Note that these were well-established binge eaters; the average duration of participants' binge eating problems was over 29 years. To reverse a trend of nearly three decades in the span of 20 weeks is encouraging.
At the end of six months after treatment, 56% of the participants were still abstinent from binge eating. Basic follow-up therapy and maintenance could limit this drop-off; those who received DBT in the study did not receive any further help after the 20-week treatment period.
The authors note that a significant limitation of the study is that there were no other treatment programs involved for comparison. It's clear that DBT is better than doing nothing, but is it better than other treatments? More research will shed light on this question.
Should You Try DBT for Binge-Eating Disorder?
There's a great deal of potential for DBT as a treatment for BED. Here are two factors that can help you decide if it's a good option for you:
- Are you willing to work in the context of a group? DBT's group component may seem daunting at first.
- Are you willing to do homework outside of the scheduled meeting times? Application of the concrete skills you learn in therapy is key.
I believe that DBT is a good option to explore. It encourages awareness of underlying causes of binge eating in addition to dealing directly with the behaviors themselves. Given its success in working with a population as difficult as those with borderline personality disorder, for which it was designed, it seems reasonable that it is powerful enough to address the emotional components of binge eating. As you seek out therapists in your area, ask whether they offer DBT as a treatment option. If one clinician does not, he likely can point you to others who do.
Sources:
Safer DL, Telch CF, and Agras WS. Dialectical behavior therapy adapted for bulimia: A case report. International Journal of Eating Disorders 30 (2001): 101-106.
Telch CF, Agras WS, and Linehan MM. Dialectical behavior therapy for binge eating disorder. Journal of Consulting & Clinical Psychology 69 (2001): 1061-1065.
Wiser S and Telch CF. Dialectical behavior therapy for binge-eating disorder. Journal of Clinical Psychology 55 (1999): 755-768.
