climbED: DBT For Eating Disorders

DBT (dialectical behaviour therapy) is often used to help treat personality disorders, however my eating disorder service run a DBT group to treat eating disorders and I thought I’d share my experiences of it so far.

The set up of the DBT group is that we attend the group to learn the DBT skills and then we have individual sessions to talk about our specific eating disorders and applying the skills to our behaviours. We also fill out a daily diary card scoring on a scale of 0-5 our emotions and urges and if we engaged in any behaviours such as self-harm, restriction or exercise.

The aim of DBT is to decrease relationship difficulties, intense and unstable emotions, impulsive behaviours and confusion about one’s self and troubling thoughts. DBT then aims to increase interpersonal effectiveness, emotion regulation, distress tolerance and mindfulness.

Interpersonal effectiveness skills teach a person how to get what they want, how to say ‘no’ and how to deal with conflict. Emotion regulation skills teach people how to change their emotions or situations, if this is not appropriate then distress tolerance skills should be used in order to tolerate and get through the situation without changing it or making it worst. Mindfulness teaches people to be in the present.

So how can these skills help to treat eating disorders?

Mindfulness includes ‘what’ skills (observe, describe and participate) and ‘how’ skills (one mindfully, effectively, non-judgementally) and it can be applied to nearly everything we do, including eating. Mindful eating may help people with an eating disorder by treating food in a non-judgmental way. Rather than describing the food as ‘good’ or ‘bad’ or looking at it and seeing the number of calories in it, describe it by it’s colour, shape, texture, taste and/or smell. Mindfulness can also help people to relax, I find that using bath bombs works really well when practicing mindfulness as it involves touch, smell and visionary senses.

We often talk about the states of mind in DBT. Firstly there is emotional mind which involves:

  • Emotion controlling thoughts and behaviours.
  • Thoughts that are unhelpful and distressing.
  • Difficulty thinking logically and rationally.
  • Facts that are distorted to fit with current distress.
  • Emotions tend to drive opinion and strong behaviour.

Then there is reasonable mind which involves:

  • Intellectual, scientific facts which are evidence based.
  • Logical and rational thinking.
  • Focuses attention.
  • People in reasonable mind can come across as cool when approaching problems.

Wise mind integrates both emotional and reasonable mind, reasonable mind must be listened to but emotional mind needs to be soothed. By being in wise mind we can see the bigger picture and do what is both appropriate and effective in a given situation. Mindfulness can help people to get to wise mind.

Recovery from an eating disorder can be incredibly stressful. It can be distressing to increase dietary intake and to gain weight. I have to do the opposite of what my head was telling me which is very difficult. Distress tolerance skills can help people to cope. For example, distraction skills such as ACCEPTS can help people to manage around meal times.

Activities: Baking, writing, journalling, nail painting, making amazon wishlists etc

Contributing: Blogging, making something for someone, looking after a pet etc

Comparisons: Think about where you have come from and where you want to go.

Emotions (opposite): Watch something funny, find positive quotes etc

Pushing away: Leave the situation behind for a while. Decide not to think about it.

Thoughts (changing): Word games, puzzle books, make plans, learn lyrics etc

Sensations (smell, taste, sound, sight, touch): Bath bombs, stress ball, hand cream, loud music, bright pictures etc.

It can be helpful to list out the pros and cons of behaviours that you engage in and to put them somewhere you can easily access when you are struggling. For example write out the pros and cons of binging, why do you do it? What are the consequences? When you feel the urge to binge go and read your pros and cons card.

Urge management can be particularly helpful for binge eating. When an urge strikes rate the intensity from 0-10. Set a timer for 15 minutes and in the meantime choose a pleasant activity to distract you and/or write out the pros and cons of engaging in the urge. At the end of 15 minutes rate your urge intensity again, if the urge has gone down then carry on with your day, if it’s the same or higher reset the timer and repeat.

I think DBT can help an individual to cope with the stress and distress of both their eating disorder and recovery from their eating disorder by learning how to tolerate the distress rather than using harmful behaviours to get rid of the distress.

Here’s today’s sock it to eating disorders silly socks photo:


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