Treating Eating Disorders Using Dialectical Behavioral Therapy

Dialectical behavioral therapy (DBT) combines cognitive and behavioral therapies to teach people healthy ways to handle painful emotions through acceptance and change. Originally developed in the 1970s by Marsha Linehan, Ph.D., to treat borderline personality disorders, DBT uses four skill sets – interpersonal effectiveness, emotional regulation, distress tolerance, and mindfulness – to improve people’s coping skills. Through DBT, patients learn how to increase self-awareness, control self-defeating thoughts, modify black-or-white thinking, and handle conflict and stress.

How DBT Can Help

Because of the emphasis on regulating emotions and finding healthier coping mechanisms, DBT is increasingly being incorporated into contemporary eating disorder treatment. Eating disorders are often characterized by deeply negative emotions, impulsive behavior, and desperate attempts to relieve emotional or psychological pain. According to eating disorder specialists, DBT is a natural fit in treating these life-threatening conditions.

Specifically, DBT teaches eating disorder sufferers to identify triggers for disordered eating and find better ways to respond to stress, such as breathing or relaxation exercises, taking an emotional timeout, or finding a healthy distraction. It also guides eating disorder sufferers through the practice of mindful eating, increasing awareness of emotional responses to food while preparing and eating meals. To combat guilt, shame, and other self-defeating emotions, DBT encourages people to recognize and accept their feelings without judging them as “good” or “bad” or acting out behaviorally.

According to Thomas Marra, Ph.D., author of Dialectical Behavior Therapy in Private Practice: A practical and comprehensive guide, the goals of a DBT approach to eating disorder treatment are:

Increasing the variety of emotional inputs available in a patient’s environment;

Increasing the variety of need fulfillments;

Validating the worth of the individual;

Increasing frustration tolerance, learning strategic behavior skills;

Increasing sensory input (mindfulness) to substitute sensual activities for food satiety.

DBT is also easy to understand and implement, allowing eating disorder sufferers to put a label on each skill so they have practical things they can do in the moment to make the situation better. As patients master specific skills, they are more aware of problem behaviors, are able to think before they act, and feel confident in their ability to deal with conflict in healthy ways.

Recent studies show promising results for using DBT in the treatment of eating disorders, particularly binge eating disorder and bulimia. For example, the first few published clinical trials reported 82 to 90 percent rates of abstinence from binge eating at the end of a 20-session DBT therapy program. With ongoing research, DBT may become a widespread approach for treating eating disorders.

Finding DBT-Centered Treatment

Some of the most cutting-edge treatment programs have already begun incorporating DBT into their approach for combating eating disorders. Carolina House, a residential treatment center for women suffering with anorexia nervosa, bulimia nervosa, binge eating disorders, and related issues, has made the DBT skill sets a central part of its core program.

“Many of our residents are using their eating disorder as an ineffective coping skill,” says Stacie McEntyre, MSW, LCSW, CEDS, the executive director of Carolina House. “By offering instruction on more effective coping strategies using DBT, patients get their needs met in a way that satisfies their long-term goals of a higher quality of life and improved physical health.”

Carolina House’s clinical director Chase Bannister, MSW, MDiv, LCSW, adds, “Not only do eating disorder sufferers confront phobic issues around food, but they also experience a great deal of emotional dysregulation. Using DBT skills, we help them learn to navigate complex emotions, be mindful enough to name what they are, free the mind from the maelstrom, accept and grieve the experience, and begin to move on – for oneself and also for the sake of one’s personal relationships.”

Endearingly called “DEARMAN” skills at Carolina House, residents are frequently asked how they are going to utilize their new DBT skills in difficult situations. Staff members take every opportunity to encourage residents to practice their skills in order to make their experiences most effective and get their needs met.

“When patients leave our care, they feel confident knowing they have learned a series of skill sets that enhance their lives,” says Bannister. “These women had no idea they were so capable of managing conflict and coming out okay on the other side.”

Long after formal treatment ends, patients are still using the skills they learned at Carolina House to create healthy relationships, resolve conflicts, and abstain from disordered eating.

DBT skills can be applied not only in treatment, but also in daily life. Parents who simultaneously learn DBT skills with their daughter are better equipped to handle their own stresses as well support their daughter throughout her recovery. Carolina House also encourages staff to “practice what they preach,” using DBT skills in their own lives and in their demanding work with eating disorder sufferers.

Beyond DBT

At Carolina House, treatment doesn’t stop at DBT. Therapists are trained in a wide variety of therapeutic modalities, including cognitive behavioral therapy, psychodynamics, family therapy, and others, enabling them to provide well-rounded care based on a myriad of disciplines.

A multidisciplinary team, consisting of psychologists, social workers, psychiatrists, nutritionists, nurses, residential staff, art therapists, and yoga instructors, makes treatment decisions right alongside the patient. Residents have both a weekly treatment plan and a master treatment plan, which requires them to meet with a dietician at least once per week, attend at least one individual and one family therapy session per week, and report in for regular medical checks. Residents also participate in nutritional, culinary, body movement, art, and spiritual therapy, in addition to a full schedule of other activities, outings, and therapeutic services.

Situated in a beautiful craftsman style farmhouse and surrounded by 10 acres of North Carolina forest, Carolina House provides a beautiful, safe, and nurturing environment for women to heal.

For more information about Carolina House and the effectiveness of DBT in treating eating disorders, visit or call (866) 690-7240.