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Treating Eating Disorders with DBT

dbt for eating disorders

There are a variety of treatment options that can include an array of different therapeutic methods that are available for an individual seeking treatment for an eating disorder. The principals of dialectical behavior therapy (DBT) are based on those of cognitive behavioral therapy (CBT). The CBT method works to help an individual learn how his or her feelings, thoughts, and behaviors influence each other. DBT is more keenly focused on the social and emotional aspects, as it helps individuals learn to cope with extreme, unstable and/ or harmful behaviors. Dialectical behavior therapy has evolved into an evidence based psychotherapy approach that is utilized as treatment for an assortment of mental health conditions. 

Eating Disorders

Eating disorders are serious mental illnesses that are characterized by persistent, damaging eating behaviors. They can have grave affects on one’s emotions, health, and capacity to adequately function in important areas of one’s life. There are a number of different manifestations of eating disorders. The various types are listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) under the Disorder Class: Feeding and Eating Disorders. The three most common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder. If left untreated, eating disorders can result in severe short and long-term consequences. While eating disorders are life-long conditions, with treatment, ample support, and steadfast commitment, an individual can learn the tools and skills needed to go on to live a successful, meaningful, and healthy life. 

Dialectical Behavior Therapy

Psychologist Marsha Linehan developed dialectical behavior therapy in the late 1980s. It was initially developed as a means to help treat individuals with borderline personality disorder (BPD) and/ or with chronic suicidal ideations. As time has progressed it has become evident that DBT can be helpful in treating individuals with other mental health conditions and/ or mood disorders. Research has shown that DBT can be advantageous when integrated into one’s treatment plan for mental disorders such as depression, substance use disorder, post-traumatic stress disorder (PTSD), and eating disorders. 

DBT can benefit an individual diagnosed with an eating disorder by helping to foster self-management skills, lower stress, reduce anxiety, and learn to control destructive eating behaviors. The goals of DBT are to help a client learn to establish healthy coping mechanisms that can be applied to environments that would have otherwise provoked engaging in destructive eating behaviors and/ or patterns. It helps clients learn how to reduce emotional reactivity and improve their interactions with others. DBT promotes acceptance and teaches skills to enable an individual to live in the moment and cope with emotional triggers that may otherwise perpetuate eating disorder symptoms and behaviors. 

How Does It Work?

DBT includes a combination of individual therapy sessions, group therapy sessions as well as coaching support. Every individual is different and will require some form of customized treatment plan when it comes to eating disorders. Therefore, the individual therapy sessions are essential in creating a forum for the client to work on his or her own nuanced issues with one-on-one guidance from his or her clinician. Creating personalized behavioral plans and goals surrounding mindful eating are established in individual therapy sessions. These sessions are beneficial in empowering a client as they help to establish and nurture self-compassion, increase one’s sense of self-worth, and develop a positive self-image. 

Group therapy sessions enable a client to practice the skills learned in individual therapy sessions. They can offer a safe environment to connect with other individuals experiencing similar life challenges. Furthermore, they allow individuals in recovery to engage in healthy interpersonal connections, while simultaneously cultivating a support network. Individuals have an opportunity to share their experience as it relates to their personal recovery process as well as offer support and insights to others in the group. Group therapy sessions also teach individuals important self-management life skills while creating an opportunity for the individuals to implement these skills in a group setting (i.e. mindful eating in a group environment). 

While group therapy sessions and individual therapy sessions can provide enormous support, it is not uncommon for a client to experience moments of distress between sessions. During those moments between individual therapy sessions and group therapy sessions, DBT offers coaching guidance. Clients can request clarification for and discuss how to implement certain management skills and/ or self-soothing techniques. If a client is struggling and/ or is in crisis he or she can reach out to and speak with his or her clinician for support over the phone, at any time. The coaching component of DBT is extremely helpful for an individual, as he or she knows that support is available during times of need.

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Eating Disorder Group Therapy in Los Angeles

Eating disorders are complex psychological conditions that are characterized by extremely unhealthy eating habits. If left untreated, eating disorders can have devastating effects and lead to severe short and long-term consequences. There are a variety of different types of eating disorders, and The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) categorizes the various types under Feeding and Eating Disorders. The three most common types of eating disorders include: anorexia nervosa, bulimia nervosa, and binge eating disorder. 

Anorexia nervosa is characterized by behaviors including unreasonable and unhealthy habitual food restrictions, over-exercising, abusing diet pills, abusing laxatives, and/ or fasting. An individual struggling with bulimia nervosa experiences frequent episodes of binge eating (eating excessive amounts of food in short periods of time) followed by purging (attempting to rid the body of the food by vomiting, fasting, and/ or excessively exercising). Binge eating disorder is partially similar to bulimia nervosa, except an individual with binge eating disorder does not follow-up his or her binge eating behaviors by purging. Instead, the individual internalizes the binge eating behaviors by experiencing a slew of damaging emotions (i.e. feeling disgusted, ashamed, guilty and/ or distressed) as a result of his or her excessive over-eating. The treatment for an eating disorder will depend on the particular type of eating disorder developed as well as an individual’s symptoms. Most frequently treatment plans for eating disorders is comprised of therapy, education, and/ or medication.

Types of Therapy

Every individual is different and an individual with an eating disorder will experience a unique set of physiological symptoms. When treating an individual with an eating disorder there is a wide range of therapeutic strategies that are frequently relied upon. Different people will respond to different therapeutic techniques. Often, treatment plans integrate a variety of different therapy methods and configurations (i.e. one-on-one therapy sessions, group therapy sessions, family therapy sessions…etc.). Attending group therapy sessions does not preclude an individual from participating in other forms of eating disorder treatment. For some individuals, participating in group therapy sessions will resonate and for others it will not.  Some individuals will respond best to group therapy that is also supplemented with individual therapy sessions. Others may find group therapy less valuable to their eating disorder recovery progress. 

Participating in group therapy can provide an individual with an eating disorder exposure to different recovery tools than those available in an individual therapy session. The group therapy setting can offer a safe emotional environment for people struggling with eating disorders to verbally describe their experiences regarding how they are working towards recovery with others that are also in recovery for eating disorders. 

Group Therapy in LA

Eating disorder group therapy can be integrated into an individual’s acute eating disorder treatment as well as subsequent recovery process. Individuals that have completed formal treatment for eating disorders will have some type of aftercare plan established. Many will have resources that offer subsequent recovery support in the form of group therapy. Those that do not surely have information that can assist in pointing people in right direction to enable them to join a reputable eating disorder therapy group. The National Association of Anorexia Nervosa and Associated Disorders is an excellent resource for those in need of additional information. Furthermore, any person that needs help locating an eating disorder therapy group could inquire by reaching out to a treatment center, mental health clinician, and/ or hospital. Conducting an Internet search to view eating disorder therapy groups held in Los Angels can yield a number of viable options. There is also the Eating Disorder Resource Catalogue that has compiled a list of eating disorder support group meetings held in California, including many in Los Angeles. 

What Else?

In addition to regularly attending and participating in eating disorder group therapy, maintaining an overall healthy lifestyle can be beneficial to one’s continued recovery. Engaging in self-care practices, such as carving out ample relaxation time into one’s daily schedule, attending eating disorder support group meetings, integrating healthy and regular exercise habits, assuring sufficient sleep is obtained are all helpful to one’s overall recovery. There are general eating disorder support groups in Los Angeles as well as specialized eating disorder support groups. The specific type of support group selected will depend on the individual’s preference. Eating disorders are not temporary conditions and the recovery process will require a life-long commitment. However, with the proper treatment and support an individual recovering from an eating disorder can go on to live a satisfying, healthy, and meaningful life.  

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Dialectical Behavior Therapy for Borderline Personality Disorder

Dialectical behavior therapy, DBT, is a type of therapeutic treatment that falls under the larger umbrella of CBT (cognitive behavioral therapy). DBT was developed in the late 1980s by Marsha Linehan, Ph.D., as a means to specifically treat individuals with borderline personality disorder (BPD). As time has progressed, it has proven to be an effective method in the treatment of individuals that suffer from other types of mental health disorders. While DBT utilizes a cognitive behavioral approach, it predominantly emphasizes the psychosocial aspects of treatment. The theory behind the DBT approach takes into consideration the notion that some individuals are prone to react in a more intense manner when it comes to certain emotional situations. The biological response manifests as an exponential increase in one’s arousal level (different from an average person’s), elevating one’s emotional stimulation, which in turn takes an individual a longer duration of time for the individual to return to his or her baseline arousal level. In order to adequately regulate one’s emotions an individual with borderline personality disorder must integrate specialized coping techniques. 

Borderline Personality Disorder

Borderline personality disorder is a mental health disorder that impacts the way an individual thinks about him or herself and others. As is described by the National Institute of Mental Health, it is characterized by an ongoing pattern of varying moods, behaviors, and self-image. The precise cause for developing borderline personality disorder remains unknown. There are, however, certain risk factors that research has suggested that may increase one’s susceptibility. Contributing risk factors include: genetics, one’s brain structure, family history, as well as environmental, social, and cultural factors. The symptoms of borderline personality disorder typically result in impulsive actions and relationship problems. The Mayo Clinic provides examples of signs and symptoms that are commonly exhibited in individuals with borderline personality disorder. They include the following:

  • Engaging in risky and/ or impulsive behaviors (i.e. reckless driving, excessive gambling, binge eating, substance abuse, unsafe sex…etc.)
  • Intense fear of abandonment
  • Suicidal ideations
  • Self-injury
  • Severe mood swings (i.e. elation, irritability, shame, anxiety…etc.)
  • Pattern of unstable relationships
  • Irrational displays of anger
  • Distorted self image
  • Feelings of emptiness
  • Stress related paranoia

Every person is different and an individual with borderline personality disorder has the propensity to experience any combination of the above symptoms. Borderline personality disorder is notorious for being an incredibly challenging mental health disorder to both diagnose and treat. The article, Why Psychiatrists are Reluctant to Diagnose Borderline Personality Disorder, pinpoint several challenges psychiatrist’s face when diagnosing borderline personality disorder. Borderline personality disorder is a mental health disorder that is treated by teaching an individual how to manage his or her symptoms. Hence, there is no known treatment for borderline personality disorder that fully eliminates or cures an individual from its diagnosis. 

Dialectical Behavior Therapy

Individuals who are diagnosed with borderline personality disorder tend to view things in extremes (i.e. all good or all bad). This can greatly impact the way one subsequently behaves which can make it challenging to function in one’s everyday life. The American Psychological Association assert that individuals who have undergone DBT as a component of treatment for borderline personality disorder have displayed notable improvements in the following areas:

  • Shorter hospitalizations
  • Reduced anger
  • Less frequent and/ or less severe suicidal ideations
  • Improved social functioning
  • More likely to remain in treatment

It is highly common for individuals with borderline personality disorder to be unable to adequately cope with the sudden experience of surging of emotions, which is a typical symptom of the disorder. DBT helps teach clients learn and integrate coping mechanisms to help with changing unhealthy behaviors. DBT is made up of four modules. The modules are intended to shed light on situations where the objective is to change something (i.e. asking someone to do something) or to resist changes someone else is attempting to make (i.e. saying no). The four modules of dialectical behavior therapy treatment are:

  1. Mindfulness: active practice of being fully aware and present in the moment
  2. Interpersonal effectiveness: learning to advocate for one’s wants as well as say “no” while maintaining self-respect and outside relationships
  3. Distress tolerance: learning to tolerate (not change) pain in challenging situations
  4. Emotional regulation: learning to decrease vulnerability to painful emotions and change unwanted emotions

It is important to note that many individuals with borderline personality disorder have substantial interpersonal skill, but they are unable to properly apply their skills within the appropriate context. Obtaining treatment is essential in providing an individual with borderline personality disorder the needed tools to manage his or her disorder.

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Drugs vs. Therapy When Treating OCD

Obsessive-compulsive disorder (OCD) is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an anxiety disorder. It is characterized by habitual, recurrent and disturbing thoughts (also known as obsessions) and/ or repetitive behaviors (also known as compulsions). Research has indicated that OCD is rooted in a biochemical imbalance within one’s brain. It is most common for an individual with OCD to experience both obsessions and compulsions. In order for an individual with OCD to manage his or her obsessions, he or she will actively attempt to avoid any triggers, by way of avoiding situations, and/ or neutralizing obsessions by engaging in a related compulsion. Even in situations where an individual with OCD recognizes his or her thoughts and/ or behaviors to be excessive and/ or senseless, he or she will be unable to refrain from carrying them out. OCD can be a debilitating condition as it drastically affects one’s thoughts, actions, and behaviors. There are several common obsessions associated with OCD. They can include, but are not limited to the following examples:

  • Contamination (i.e. fear of germs, dirt, and/ or illness)
  • Safety 
  • Intrusive sexual thoughts 
  • Religiously preoccupied 
  • Unwanted acts of aggression 
  • A need for exactness and/ or symmetry
  • Superstitions 
  • Fear of losing or not having items one needs

The National Institute of Mental Health (NIH) provide examples of commonly reported compulsions in association with OCD, which include the following:

  • Habitually double checking things (i.e. door closed, appliance turned off, water faucet shut…etc.)
  • Constantly engaging in senseless behaviors in attempts to reduce stress (i.e. tapping, counting, repeating words…etc.)
  • Spending excessive amounts of time washing or cleaning (i.e. ritualized hand washing)
  • Consistently and continuously checking in on the safety of loved ones
  • Ordering and/ or arranging things symmetrically and/ or no flexibility regarding the placement of items
  • Unable to discard superfluous items (i.e. hoarding) 

It is not uncommon for an individual with OCD to struggle with several different types of obsession and compulsions simultaneously. Alternatively, some individuals may experience only one component of OCD (either compulsions or obsessions). The symptoms associated with OCD can be incredibly time consuming, and will undoubtedly impede an individual’s relationships as well as interfere with many aspects of his or her daily life. 

Treatment Options

Prior to seeking any type of professional treatment for OCD, an individual must be clinically diagnosed with the disorder. Much like any mental health disorder, it is best to obtain a diagnosis from a qualified mental health professional (i.e. psychiatrist, psychologist, clinical social worker…etc.). This typically includes a comprehensive psychological evaluation as well as a physical exam. Every individual is different and has nuanced needs when it comes to establishing a treatment plan for OCD. Each individual will respond distinctly to the various types of treatment methods available to those with OCD. The typical treatment options for OCD usually consist of medication and/ or psychotherapy. There are a variety of contributing factors when attempting to distinguish which is more effective. It is also not uncommon for both options to be integrated into an individual’s treatment plan.

  • Medication: while medications have not been identified as a sole treatment method for OCD, depending on the situation, there are several psychiatric medications that may be helpful to one’s treatment. For example, antidepressant medications such as SSRIs (selective serotonin reuptake inhibitors) are FDA-approved as an effective treatment option for adults with OCD.
  • Therapy: there are a variety of psychotherapeutic methods relied upon by mental health clinicians to help treat an individual with OCD. Many individuals with OCD will require tailored treatment plans, which often involve utilizing a combination of different therapy strategies. Specific types of therapy frequently used to treat OCD include various types of cognitive behavioral therapy (CBT) and behavior techniques, more specifically the behavioral treatment known as ERP therapy (exposure and response prevention). 

In addition to formalized psychotherapy, there are a myriad of relaxation techniques that can be helpful in managing one’s OCD symptoms. Furthermore, maintaining a healthy lifestyle (i.e. regular exercise, adequate sleep, and healthy eating habits) can contribute to reducing one’s anxieties and keeping OCD symptoms at bay. In situations where medication is deemed beneficial in assisting to regulate the manifestation of one’s OCD symptoms, it is usually done so as a supplementary component of one’s treatment plan that consists of one or more therapeutic modalities. According to the Mayo Clinic, a combination of psychotherapy and medication provide an individual with optimum chances for a successful outcome. Although each individual is different, with the proper treatment, an individual with OCD can generally begin to experience some relief from his or her symptoms within six months. 

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OCD Signs in Children and Therapy Options

Obsessive-compulsive disorder (OCD) is a neurobiological illness, and is listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) as an anxiety disorder. It is characterized by excessive, intrusive thoughts (obsessions) that lead to repetitive behaviors (compulsions). While the exact cause of OCD remains unknown, certain research findings have indicated that a child diagnosed with OCD does not produce sufficient amounts of serotonin, alluding that the development of OCD may originate within one’s brain. The Obsessive Compulsive Foundation of Metropolitan Chicago asserts that OCD appears to be “at least partially genetic and, in some cases, may be activated by a strep infection.” For children that are genetically predisposed, the onset of OCD can occur as young as three years old. It is more common, however, for OCD symptoms to begin in children around age ten. While there are several overlaps, the signs and symptoms of OCD manifest and are exhibited differently in children than in adults. OCD affects the way a child is able to adequately filter and process information. This, in turn, leads the child to perseverate on thoughts that would be otherwise ignored or dismissed by a child without OCD. 

Signs and Symptoms

Adolescence is a challenging time in one’s life. It is a time of significant physical, emotional, educational and developmental growth. It is not uncommon for a child to exhibit a plethora of varying behaviors prior to and throughout his or her adolescence. The signs and symptoms that a child with OCD may present might appear similar to the neurotypical child, but for a child with OCD they will be debilitating. The International OCD Foundation provide the following examples of commonly reported obsessions and compulsions displayed by children with OCD:

  • Obsessions:
    • Religious fixations
    • Aggressive thoughts
    • Fear of contamination
    • A need for order, symmetry and/ or precision 
    • Sexual thoughts
    • Fear of germs and/ or dirt
    • Preoccupation with bodily waste
    • Intrusive sounds and/ or words
    • Preoccupation with household items
    • Fear of illness and/ or harm coming to oneself and/ or others
  • Compulsions:
    • Repeating rituals (i.e. entering and exiting doorways multiple times) 
    • Ordering and/ or arranging objects
    • Grooming rituals (i.e. showering, brushing teeth, hand washing, hair combing…etc.)
    • Counting rituals
    • Checking rituals (i.e. pushing repeatedly on doors to assure they are closed)
    • Touching rituals
    • Cleaning rituals (i.e. household items)
    • Hoarding 
    • Rituals to prevent self-harm and/ or harming others 

It is important to note that stress does not cause OCD, however it can exacerbate one’s symptoms. It is common for a child to attempt to hide his or her symptoms due to confusion and/ or embarrassment, depending on his or her age. 

PANDAS

Children are highly susceptible to contracting typical illnesses (i.e. strep, the flu, the common cold, conjunctivitis…etc.). Some studies have found that a strep infection may trigger the onset of OCD symptoms in children. When this occurs, it is known as Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal infections (PANDAS). The studies indicate that strep antibodies attack certain parts of a child’s brain, which can manifest as OCD symptoms. Although this is possible, it is imperative to bear in mind that the majority of strep infections in children do not lead to the development of any obsessions nor compulsions. Furthermore, most reported childhood OCD is unrelated to infection.

Treatment Options

The most effective method of treatment for children with OCD is formalized psychotherapy. There are a variety of different types of therapy that can be combined to create the ideal treatment plan for a child. Cognitive behavioral therapy (CBT) is most commonly used when treating children with OCD, according to the Child Mind Institute. CBT is multifaceted and a form of psychological treatment that is used by many mental health professionals. One of the specific types of CBT that is used in a child’s treatment plan is known as Exposure and Response Prevention (ERP) therapy. Through ERP therapy a child learns techniques to not only confront his or her obsessions but also actively commit to not engage in the compulsive behavior. 

Depending on several contributing factors, supplementary treatment methods, such as medication, may be incorporated into a child’s treatment plan. Additionally, maintaining a healthy lifestyle by engaging in regular exercise, establishing healthy eating habits, and obtaining ample sleep can help reduce the severity and/ or frequency of a child’s OCD symptoms. With the proper treatment and support a child can learn to control his or her symptoms and implement healthy coping strategies for navigating and managing any subsequent recurrences. 

 

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In DBT

Dialectical Behavioral Therapy versus Cognitive Behavioral Therapy: What’s Best for Me?

Nowadays there are a variety of different types of therapy available for individuals in need. While many therapeutic methods can be utilized concurrently, certain therapeutic techniques can be especially beneficial for certain ailments. Any qualified mental health professional will be able to assist in deciding the best course of action regarding one’s therapy plan. Having a broad understanding of the similarities and differences of some of the therapeutic modalities that are frequently utilized in mental health treatment can be helpful for a client. Certain therapeutic methods have tangential methods that are widely used. For example, Psych Central indicates that dialectical behavioral therapy (DBT) is actually a form of cognitive behavioral therapy (CBT). 

Cognitive Behavioral Therapy

The American Psychological Association asserts that cognitive behavioral therapy (CBT) is a common form of psychological treatment. CBT can be an effective form of treatment for many health disorders, such as anxiety disorders, depression, Posttraumatic Stress Disorder (PTSD), phobias, eating disorders, obsessive-compulsive disorder (OCD), sleep disorders, bipolar disorders, substance use disorder, sexual disorders, and schizophrenia. It can also be helpful with managing situational emotional challenges. The Mayo Clinic provides various examples of these, which can include, but are not limited to, the following:

  • Overcoming emotional trauma related to abuse and/ or violence
  • Resolving relationship conflicts
  • Coping with grief and/ or loss
  • Coping with a medical illness
  • Managing chronic physical symptoms

Cognitive behavioral therapy uses tools to help teach healthy coping mechanisms for regulating emotional challenges. It focuses on helping people learn how thoughts affect feelings and behaviors. In shifting one’s thought patterns, an individual is more capable of releasing negative feelings and breaking unhealthy behavioral patterns. One of the goals of CBT is to help a client learn techniques to enable them to be their own therapist. Through various exercises (conducted both in and out of therapy sessions) a client develops coping skills to learn to change his or her own problematic emotions, damaging thinking patterns, and unhelpful thoughts. Mental health clinicians that integrate CBT into their treatment plans generally practice talk therapy that is reliant upon several guiding features. 

Dialectical Behavioral Therapy

The term “dialectical” derives from the idea that combining two opposites in therapy (acceptance and change) yields better results than either would on its own, as is described by WebMD. DBT was created out of a need to help diagnose individuals with borderline personality disorder (BPD). While DBT is housed under the larger umbrella of CBT as a form of mental health treatment, this type of specialized treatment has been known to be highly effective in helping clients that struggle with self-harming behaviors. It is also commonly used to help treat individuals struggling with the following ailments:

  • Sexual trauma survivors
  • Borderline personality disorder
  • Chronic suicidal ideations
  • High risk and/ or difficult to treat patients

Dialectical behavioral therapy (DBT) is a type of CBT that is tailored towards helping a client acknowledge the pain and discomfort he or she feels, while being empowered to choose healthy behaviors instead of engaging in harmful actions to simultaneously allow him or herself to feel and move through the uncomfortable emotions. The following four components make up DBT:

  • Individual therapy: focused on improving client motivation and helping clients apply and integrate skills learned to navigate specific life challenges.
  • Group skills training: focused on improving and teaching healthy client behavioral skills, as well as provide a forum to practicing integrating the skills.
  • If needed, distance/ phone coaching: in-the-moment coaching to assist in and provide crisis management support between sessions
  • Consultation team: this component is solely for the mental health provider treating the client. A consultation team serves as support for the clinician in treating clients with severe, complex, and/ or challenging to treat disorders. 

In DBT there is some emphasis placed on dealing with and navigating thoughts, however the primary focus is placed on helping clients learn to identify triggers outside of themselves and pair those triggers with healthy responses and coping mechanisms. 

What’s Best for Me?

Every individual is complex with nuanced needs and will respond to different forms of treatment for mental illness uniquely. With the wide variety of therapeutic modalities available, certain types have been proven more effective for certain mental health ailments. For example, a therapy technique that works well for individuals struggling with depression and/ or anxiety may exacerbate an individual struggling with an eating disorder. CBT focuses on rationale and reasoning, DBT heavily relies upon mindfulness skills to assist in effectively regulating emotions. Both types of therapy techniques can yield successful results. The best way to figure out which type of therapy treatment is best is to consult a mental health professional. Any qualified mental health professional will consider all symptoms, health history, and goals of a client when recommending the best course of action regarding his or her treatment plan. 

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Please do not hesitate to contact Dr. Wallach with any questions you may have.

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9615 Brighton Way, Suites 410 & 412, Beverly Hills CA 90210
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Email: suzannewallachmft@gmail.com


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