Patients and providers sometimes ask if I recommend Dialectical Behavior Therapy (DBT) for treating eating disorders.
In fact, I don’t recommend DBT for the treatment of all eating disorders. There are other more cost- and time-efficient interventions such as Enhanced Cognitive Behavioral Therapy (CBT-E) and Family Based Treatment (FBT) that have more research supporting their use with eating disorders.
That being said, not all people respond to CBT or FBT. Research tells us that these evidence-based interventions are effective for 60-75% of people who receive them. That leaves many people needing another option.
So what about DBT? An adapted version developed at Stanford University, known as DBT for Binge Eating Disorder and Bulimia Nervosa (DBT for BED & BN), is an excellent option for individuals with those problems who don’t also suffer from significant co-occurring conditions. For people with Binge Eating Disorder or Bulimia Nervosa whose eating issues evolve from emotion management problems, I do recommend this treatment.
There is another group of patients for whom I recommend MED-DBT, which is a comprehensive DBT treatment for multi-diagnostic eating disorders. This model could be recommended to a patient who simultaneously suffers from multiple, significant issues, including those that could interfere with the person’s ability to engage in treatment.
For example, maybe there is a notable depression/anxiety disorder that interferes with attending sessions. Or there is a patient who has trouble managing their emotions (including those related to eating) and engages in self-harm regularly. Therapists trained in MED-DBT are trained to address these issues simultaneously.
So for people who have not been helped by standard evidence-based treatments, I do recommend Dialectical Behavior Therapy as a next step. And for those with multi-diagnostic presentations or for people who have emotion regulation issues at the core of their eating disorders, I recommend that form of DBT as the first line of treatment.
SEP
About the Author:
Dr. Lucene Wisniewski is an internationally recognized leader in eating disorder treatment and Dialectical Behavior Therapy, with more than 25 years of clinical and training experience. She may be reached for consultation through the "contact" page on this website.