Effective DBT for Eating Disorders

Are you wondering how DBT for eating disorders can help you or your loved one?

Here in ‘Ai Pono Hawaii, we offer DBT for eating disorders that is evidence-based and individually designed to support each patient’s unique needs. Dialectical Behavior Therapy (or simply DBT) for eating disorders is a relatively new yet powerful treatment that’s available for people who suffer from disordered eating patterns. It has shown to be particularly helpful to patients who are struggling with binge eating, bulimia nervosa, and anorexia nervosa, as well as those with Borderline Personality Disorder, a history or pattern of self-harm, and more.

As part of our holistic treatment for people who are suffering from various eating disorders, our DBT program for binge eating, bulimia, and anorexia is a potent complement to the other proven treatment modalities that we offer. It enables us to offer truly comprehensive and person-centered treatment for each and every patient who wants to recover from an eating disorder.

Dialectical Behavior Therapy For Eating Disorders

Eating disorders are the second deadliest mental illness, next only to opioid overdose, which makes it extremely important for patients and their families to seek effective treatment as soon as possible.

While it is one of the newer methods for treating eating disorders, dialectical behavior therapy is of tremendous help when it comes to helping people recover from disordered eating behaviors. We’ve learned this from research, and we also witnessed firsthand how DBT for eating disorders produces incredible and lasting results in our own patients.

DBT is a skills-based type of cognitive behavioral therapy that was originally developed by Marsha M. Linehan, Ph.D. in the late 1970s for chronically suicidal people who were diagnosed with borderline personality disorder (or BPD). It is still considered the treatment modality of choice for this specific population at present.

Over the past few decades, studies have shown that DBT is also quite effective in treating other mental health disorders. These include depression, anxiety, post-traumatic stress disorder (PTSD), substance dependence, and eating disorders. In fact, a growing amount of research has shown DBT’s effectiveness as a treatment for binge eating, bulimia, and anorexia. DBT for eating disorders usually consists of weekly sessions that last from around six to twelve months, depending on each patient’s needs. DBT skills however, are designed to be practiced and integrated in everyday life well beyond the initial intensive treatment period.

The Difference Between CBT and DBT For Eating Disorders

Cognitive-behavioral therapy (or CBT) is well-known as also an effective treatment for many patients with eating disorders. In fact, it is often recommended as their first line of treatment. However, just like any therapeutic modality, it does not work for all ED patients, so experts sought to find a solution that will help those patients who don’t respond well to CBT.

CBT aims to help patients avoid negative feelings and behaviors by changing their thinking patterns. This is very useful for ED patients since they usually have a lot of irrational thoughts that feed into their cycle of disordered eating behaviors. What some believe that CBT lacks is the teaching of practical coping skills for moments when patients have these irrational thoughts and feelings come up.

Specialists in the field identified a parallel between the disordered eating behavior of ED patients and the function of self-injury observed among BDP patients. They noted that the behaviors of both of these populations are directed toward gaining temporary relief from negative emotions. Therefore, it made sense that teaching patients how to regulate and manage their emotions and their subsequent effects would be useful in treating ED as well as BPD.

Thus, DBT is considered a wonderful complement (and in specific groups of people, alternative) to CBT. Through ‘Ai Pono’s DBT for eating disorders, we equip patients with the appropriate skills to manage their unpleasant emotions and lessen conflicts in their relationships. 

What is DBT Therapy For Eating Disorders All About?

The term ‘dialectical’ in DBT represents two opposite ideas that are correct at the same time. Here in ‘Ai Pono, our therapists work with patients to balance these two seemingly contradictory strategies: we encourage patients to experience both acceptance and change. In our dialectical behavior therapy for eating disorders, our therapists help patients to accept themselves as they are, while also encouraging them to change their disordered ideas and behaviors in relation to food and nourishment. At ‘Ai Pono, we focus intensely on the DBT skills of emotional awareness and regulation and interpersonal effectiveness through assertive communication. 

This is particularly important for ED patients since many of them have a “black-or-white” or “all-or-nothing view”. Through DBT, we help our patients recognize the importance of this dialectical view in their journey to recovery: they need to accept the challenges that come with their eating disorder, but also strive to overcome those by changing themselves for the better through therapy.
We empower our patients to avoid destructive that either-or thinking by encouraging them to avoid making statements such as

“I’m either fully recovered or I’m gonna have this disorder all my life!”

Instead, if our patients binged and purged yesterday, we teach them to invite curiosity and change their inner (or outer) monologue from statements like…

“I can’t believe I binged and purged today. I am such a wreck!”

to statements such as…

“Yes, I was not able to stop myself from bingeing and purging yesterday, but I am continuing my recovery today and in the coming days.”

One of our core beliefs in offering DBT at ‘Ai Pono is that our patients are doing the best that they can. We believe that while it’s true that there are times in which they fail, it’s also true that they are working hard on doing better—and we’re here to support them in their mission to recover, every step of the way.

We believe that an individual's disordered behaviors related to food and eating are usually attempts to care for themselves or meet an internal or external need. Thus, even if such behaviors are overall negative, we believe that they actually provide patients with distraction, relaxation, pleasure, and sometimes, even empowerment. With our DBT program for binge eating, bulimia, and anorexia, we enable our patients to learn and apply more positive and constructive ways to distract, relax, feel pleasure, and empower themselves—so that they can ultimately break free from their negative and destructive eating patterns.

DBT for Eating Disorders Is Part Of Holistic Treatment

Around 50 percent of patients with binge-eating disorder and bulimia do not improve using standard treatment. In such cases, DBT’s focus on regulating emotions can be very helpful, particularly when focusing on a single DBT component: skills training. In cases of binging and purging or binging, we have seen how even simple DBT can work wonders.

We typically employ several therapeutic modalities in order to fully address each patient’s eating disorder from different angles. We saw that this technique produces the best and most lasting results in our patients. Here in ‘Ai Pono, we use DBT together with other research-backed and time-tested therapies to empower our patients to change their behavioral patterns. We often utilize DBT skills together with CBT and ACT.

An example of our multifaceted therapeutic approach includes:

• Nutrition therapy for our ED patients in order to guide them in building a healthier and more rational relationship with food. 

• Interpersonal group therapy to lessen feelings of shame by allowing our patients to interact with people who have similar struggles as them. 

• Experiential therapies (like art therapy, sound therapy, and dance therapy) to enable our patients to deeply connect with their own bodies through movement and arts.

DBT for Eating Disorder: Group Therapy

Often regarded as the pillar of DBT, skills training involves teaching important life skills to patients, usually in a group setting such as a weekly class. In these sessions, our group leaders teach important behavioral skills to patients and assign the latter to do homework tasks.

Our DBT Skills Groups includes therapeutic modules for these categories:

Mindfulness

We help our ED patients learn and hone the practice of being and staying fully aware and present in the moment to appreciate their physical, emotional, and relational experience in real-time. People are not naturally good at using mindfulness effectively, that’s why intensive training is needed to get better at doing this.

In our eating disorder treatment center, we help patients remain fully aware and avoid making judgments of themselves and their surroundings, especially during important times, such as when they are tempted to give in to their impulse to restrict, binge, or purge

We teach them how to concentrate on making decisions using their “wise mind”—which includes both their rational and emotional inputs—as they learn to manage the urge to give in to their disordered eating patterns.

Using their developed mindfulness skills, our patients become aware of their potential triggers, problematic emotional states and thoughts, and unproductive choices that can lead to disordered eating behavior.

Keep in mind that even though mindfulness can inspire action, we don’t encourage responding to emotions nor managing them in this part of the program. Rather, we simply want our patients to first learn how to acknowledge and accept their emotions.

At ‘Ai Pono, we practice mindfulness in DBT groups as well as through guided meditation, somatic therapy (mindfulness of movement), and mindful walks to the nearby beach.

Emotion Regulation

As we’ve discussed earlier, regulating one’s emotions is a key element of DBT. Hence, the first module in any DBT Skills Group is focused on helping our patients learn how to manage their feelings, particularly basic emotions like sadness, fear, and anger.

By helping our patients regulate these emotions, they can avoid such emotions from evolving into more intense feelings or even destructive behaviors such as the ones characteristic of eating disorders.

Part of learning how to regulate emotions is learning to accept emotions as gifts. So often, those who struggle with eating disorders have been taught or believe that being “emotional” is wrong or bad, but we know that is not the case. Those who struggle with eating disorders are typically highly sensitive, intuitive beings who have simply developed an obsession with food, fat, and dieting as a way of coping with social and psychological stress.

Here at ‘Ai Pono Hawaii, we help our patients identify, label, and then process their emotions. We also guide them on how to lessen and cope with their unpleasant emotions, accept highly negative emotions and strengthen their resilience to those, and boost their positive emotional experiences.

All of those promote the use of coping strategies instead of maladaptive responses such as restriction, binge eating, or purging.

Our goal is to help our patients do the following on their own:

• Accurately identify, label, and process their emotions and understand the importance of having those emotions

• Lower sensitivity to negative emotions and increase positive emotions

• Transform their negative emotional states into positive ones using different skills, such as opposite action

• Make decisions that support a healthy lifestyle, promote good and harmonious relationships with others, encourage their personal development

• Promote a positive disposition in life and non-judgmental view of emotions

We would also like to assure you that it is natural for patients to run into setbacks as they’re learning to regulate their emotions. Based on our 35+ years of experience in treating eating disorders, we’ve come to know that many of those who struggle with an eating disorder have been unable to regulate their emotions for pretty much their whole lives before they sought treatment.

Our therapists are aware of this, and patients should be as well. Patience is crucial as this process takes time, but it’s all worth it because developing this skill of emotion regulation can serve everyone well for the rest of their life.

Distress Tolerance

This second skill is important for ED patients to manage the different feelings that cause them distress.

Upsetting emotions often make ED patients feel desperate to make those negative feelings instantly go away. By teaching our patients other ways to cope with distressing feelings, they can avoid the need to perform problematic eating behaviors.

At ‘Ai Pono Hawaii, we build our patients’ distress tolerance by helping them identify the various emotions that they’re bound to feel, particularly the ones that are related to their eating disorder. We want to lessen their susceptibility to emotional extremes using techniques such as distraction, self-soothing, awareness exercises, and radical acceptance. Ultimately, we want to help our patients cope effectively with the different types of crises that they’ll face in “real life.”

Distressing emotions often come up in the course of treatment as our patients begin to challenge their disordered thoughts and confront various triggering situations. We walk beside them  as they learn to accept the negative emotions that emerge in the process, as they make use of their skills toolbox in their journey to recovery.

We celebrate every successful attempt to avoid impulsive, dysfunctional reactions because we believe that this makes it easier for our patients to overcome the next ones. Our therapists guide patients who suffer from setbacks while developing their tolerance for distress by encouraging them to approach these moments with curiosity and view them as learning opportunities.

In the end, our goal for building the skill of Distress Tolerance is to see our patients accept that sometimes there is simply no solution to their problem, but that they have the strength to deal with it, reduce—or even totally avoid—feelings of distress, and altogether avoid using problematic ways of coping.

Interpersonal Effectiveness 

Learning skills related to interpersonal effectives are a centerpiece of the ‘Ai Pono program. In particular, patients will learn and regularly practice the assertive communication formula. This formula becomes a foundation of communication that empowers patients to express their needs in a direct and effective manner.

Assertive communication is a way of expressing your feelings clearly, directly, honestly and kindly—in a way that respects your feelings as well as the feelings of others. Unfortunately, because very few of us are taught to speak this way, it’s a language that feels unfamiliar at first. But like any other skill—like swimming, or driving a car, or playing the piano—it’s one that anyone can learn. It doesn’t take some sort of special DNA. It just takes some practice.

What does assertive communication have to do with eating disorder treatment and recovery? At its core, disordered eating is often about communication—to ourselves, or to others. When we experience something that we don’t know how to put into words—or are perhaps afraid to put into words—our bodies communicate the emotion by using food behaviors. This is how we wind up restricting or stuffing our feelings.

Individual DBT Therapy for Eating Disorders

Individual DBT therapy focuses on boosting our patients’ motivation in changing their life, and guiding them as they apply the skills that they’re learning to the events and challenges that they face in the outside world. Individual therapy at ‘Ai Pono takes place three times per week and is a venue where patients can “test out” and discuss many of the DBT skills that they have been learning throughout the course of treatment. 

Why Trust ‘Ai Pono’s DBT for Eating Disorders?

Here at ‘Ai Pono, we utilize DBT as a therapeutic technique to help ED patients develop essential coping and relationship skills, which are especially helpful for them since disordered behaviors are often used to deal with distressing emotions or relationship issues.

Our eating disorder recovery center in Maui has a highly experienced and competent team of experts who specialize in treating people who are struggling with eating disorders. We have over 35 years of experience in treating Binge Eating Disorder, Bulimia Nervosa, Anorexia Nervosa, Avoidant/Restrictive Food Intake Disorder (ARFID), as well as other eating and feeding disorders. We’ve also treated patients who struggled with Night Eating Syndrome, Body Dysmorphia, Body Image Distortion, Laxative Abuse, and more.

We also treat comorbid conditions (i.e., those that usually go along with eating disorders) like depression, Obsessive-Compulsive Disorder (OCD), Post-Traumatic Stress Disorder (PTSD), anxiety, and so on.

We believe that eating disorders are the result of a complex interplay between biochemical, nutritional, psychological, and emotional factors. But we also believe that people who suffer from an eating disorder are very intuitive and sensitive individuals who merely formed bad habits when it comes to viewing and consuming food.

Through DBT, CBT, ACT, and other effective therapies, we enable our patients to acknowledge and identify the adaptive purpose of their disorder as we begin their journey to becoming free.

These are the top three reasons why you can entrust the recovery of yourself or your loved one to ‘Ai Pono Hawaii:

Our eating disorder treatment center accepts most insurances, including Veterans insurance. We are also in-network with Tricare to provide treatment for military spouses and their children. (ages 21 and under).