Written by Emily Keehn, M. Ed., LPC , Dialectical Behavior Therapy Specialist at Timberline Knolls
Dialectical Behavior Therapy (DBT) supports the philosophy that two opposing truths can exist at the same time; in DBT it is acceptance and change. A woman struggling with an eating disorder (ED) can find herself experiencing tension between acceptance and change as she navigates the many complexities of the disorder and recovery. For example, she may acknowledge and accept the function of restricting food intake as a means to validate a traumatic event in her life, and yet, begin to commit to changing her relationship with food in recovery.
This can be supported more intentionally by considering what a meaningful life looks like for each individual. Initially, examining a meaningful life can be challenging if someone has lived with an ED for an extended amount of time. Often, the concept of who she is is dictated by the disorder so much so that she believes “I am my disorder” and any concept of a values-informed meaningful life has long been compromised or has become non-existent. Exploring unclear values or even a new set of values can begin building the foundation for changing one’s commitments to recovery.
Additionally, DBT focuses on changing relationships with thoughts, emotions and urges. Therefore, within the treatment of anorexia, bulimia, and binge eating disorder, the recovery goal becomes changing the relationship with food and the mind/body connection. By utilizing the four main components of DBT, mindfulness, distress tolerance, interpersonal effectiveness and emotion regulation, a person can begin to explore this complex relationship as it exists in the present moment. She can begin to observe prompting events that provoke thoughts or feelings that motivate restricting, bingeing or purging behaviors. In turn, she can practice grounding through her senses: sight, smell, taste and texture. It may be helpful to journal thoughts and feelings for future review with a therapist.
Another key element of DBT and eating disorder recovery pertains to one-on-one or group meal support. This allows an individual to participate in an intentional eating experience with the support of others to practice normalized eating habits and experience with food. Practicing to eat mindfully, engaging in conversation with others to discuss thoughts and feelings allows her to begin reframing a relationship with food that once may have felt challenging and isolative. As a person begins to participate in the meal, emotional distress may increase and practices such as deep breathing can be helpful to reduce or minimize anxiety.
While practicing DBT skills, an individual is ultimately building mastery towards tolerance of what was once an intolerable experience. In addition, validating success in small steps towards overall meal completion or balanced eating is essential in helping to build mastery. This approach can be successful to address both restricting and bingeing eating behaviors as well as managing compulsive purging behaviors following a meal.
Overall, the application of DBT is highly effective for ED recovery as it begins to address the current relationship with food and provides an opportunity to make changes toward a new relationship with food and the mind/body connection.
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