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Role of Dialectical Behavior Therapy in Binge Eating Treatment Programs

People with binge eating disorder can greatly benefit from attending treatment programs that use dialectical behavior therapy (DBT) as a core element. This therapeutic approach helps with emotional regulation and management using a combination of psychotherapy and skill-building activities. Each therapy session provides patients with validation and helps them address their biggest challenges. While undergoing DBT at binge eating treatment centers, patients also have opportunities to identify and confront triggers head on to begin on the road to recovery.

By using DBT as a part of the binge eating treatment process, patients can eliminate emotional dysregulation as a complicating factor. This helps to ensure patients can effectively use their coping skills to manage their stress levels and remain recovered through the years. The DBT therapy sessions also help to identify disordered thought patterns and behaviors affecting the patient and provides the tools they can use as alternatives.

As they enter the binge eating disorder program, patients can explore this topic in more detail to understand how treatment can help them make a full recovery. They can use this guide to get started in learning more about using dialectical behavior therapy as an integral component of binge eating disorder treatment.

Emotional Dysregulation and Its Impact on Binge Eating Recovery

Emotional dysregulation centers around an inability to control emotions and respond appropriately to those feelings. When people cannot properly handle big or overwhelming emotions, they may experience impulsive behaviors they cannot control or even rely on dysfunctional behaviors to get by. Disordered thoughts and behaviors related to eating disorders tend to help temporarily relieve feelings of emotional dysregulation. People may focus on limiting food intake or completing extra exercise sessions in an effort to control the way they feel inside.

These disordered attempts at managing stress only serve to make the problem worse in the long run. The eating disorder behaviors tend to cause a host of emotions to arise, such as sadness, frustration, and confusion, which worsen stress levels and throw emotions further out of balance. As overwhelming emotions and high-stress levels build, patients may experience impulsivity that also serves to complicate their situation.

Without learning how to regulate their emotions and avoid impulsive or disordered behaviors, patients cannot work toward binge eating recovery with purpose. To help out, treatment centers make it their priority to resolve this complicated issue and help their patients better regulate their emotional responses. To accomplish this goal, they use dialectical behavior therapy along with other effective therapeutic approaches in helping their patients.

Dialectical Behavior Therapy as a Path to Binge Eating Recovery

With dialectical behavior therapy, people working toward binge eating recovery are given the framework they need to build a strong toolbox filled with coping skills. This therapy module gets to the heart of emotional dysregulation issues that complicate the process of becoming recovered. As a result, patients are able to address their unique challenges and learn how to handle their emotions without relying on disordered behaviors.

Before patients can manage their emotions, they must fully identify and accept what they are feeling and why. Accurately pinpointing where the emotions are coming from is a lot easier than it sounds. DBT address this area quite well by introducing mindfulness to the equation. Patients can tap into their inner feelings and find causes for those heightened emotional states to better understand themselves and their place in the eating disorder recovery journey.

As patients move through the DBT sessions, they are provided opportunities to build a tolerance to distress and improve their effectiveness in managing interpersonal relationships. By focusing on all these areas, this therapeutic approach sets patients up for success in becoming and remaining recovered. Patients will gradually develop the resilience and skill sets they need to make a full recovery from binge eating disorder.

Four Modules of DBT and Their Importance in Eating Disorder Treatment

To fully explore these important areas in binge eating disorder recovery, dialectical behavior therapy introduces four distinct learning modules. These modules explore each vital area in detail to provide patients the coping tools and insights they need to leave eating disorder symptoms behind. Exploring these modules can help patients and their families prepare for eating disorder treatment and dialectical behavior therapy.

Mindfulness provides individuals with binge eating disorder the insights into how they feel at any given moment. When effective at using mindfulness to assess their state of wellbeing, patients can better identify their main emotions and the causes of each. Through this approach, they can minimize internal misunderstandings about personal motivations and feelings. The ability to use mindfulness effectively does not always come naturally to individuals, necessitating intensive training.

Mindfulness training begins with regular check-ins that allow patients to gauge their emotional responses throughout the day. These individuals need to notice, acknowledge and let go of the emotions to start to effectively use this practice in daily life. Patients need to remain aware of any judgments they may carry and try to let those go as well.

Although mindfulness can inspire action, responding to the emotions and trying to manage them in any way is not a part of this process. Mindfulness simply centers around acknowledging emotions and accepting them as fact to provide self-validation. This also helps to build awareness about inner feelings and emotional responses that can act as a guide in the future.
Tolerance of Distress

While at binge eating treatment centers, patients must work on tolerating distressing emotions that may arise. Distressing emotions are common during treatment as patients challenge disordered thoughts and face triggering situations. They must accept the emotions that arise as they use their toolbox of skills to cope or high-stress levels could throw everything off balance.

DBT focuses on distress tolerance to teach patients to wait through frustrating, confusing or overwhelming emotions rather than pursue instant gratification through dysfunctional coping behaviors. Eating disorder therapists help their patients acknowledge the emotions without responding in a maladaptive manner. As they work on limiting the big, impulsive responses, healthier ways of coping tend to come through instead. With each big step forward in tolerance distress, patients can shift to relying on their coping skills rather than worrying about having an uncontrollable emotional response.

Each success in avoiding impulsive reactions makes the next easier to achieve. If patients experience any setbacks while working on this skill, their therapists can help them find their footing and try again another day to make progress once again. Patients must continue to move forward in trying to tolerate distress to start to manage their emotions effectively and learn to trust themselves.
Regulation of Emotions

Another DBT module focuses on the regulation of emotions that are identified through mindfulness practices. This requires a willingness to leave behind disordered behaviors that are instantly gratifying but detrimental to the health and happiness of people with binge eating disorder. In regulating their emotions, they must acknowledge and validate how they feel before moving onto the control stage.

Once they have assessed their feelings without judgment, patients can work on applying coping skills in managing their emotions. The coping skills assist patients in working through their strong feelings without outbursts or other impulsive actions. This process takes time and requires a lot of practice to master. Patients may practice at the eating disorder treatment centers or go on outings to try out their toolbox of coping skills.

It is natural to experience setbacks along the way, especially when dealing with something as big as emotional regulation. Many people with eating disorders struggle with emotional dysregulation for their entire lives before seeking treatment. This means all of those learned behaviors and perceptions will need to be left behind before patients can effectively manage their emotions.
Interpersonal Effectiveness

Maintaining beneficial relationships can prove entirely too difficult when emotional dysregulation and binge eating disorder symptoms complicate each day. Patients may feel exhausted from simply attempting to control impulse actions and address the emotions that come rolling in day after day. They do not often have much energy left to give to developing and maintaining relationships with friends, family and significant others.

Dialectical behavior therapy aims to sort out this problem by introducing strategies patients can use to better manage interpersonal relationships. These strategies help mitigate the issues caused by binge eating disorder symptoms and emotional dysregulation as patients work on building their social network. This approach helps limit the outbursts and other impulsive responses to strong emotions to keep relationships intact and stronger than ever before.

This therapy module also helps patients learn how to be assertive and demand satisfaction of their own needs. They may learn how to stand up for themselves and set firm boundaries that protect their wellbeing. Patients also tend to develop an increased level of self-respect as they use their interpersonal skills to build respectful relationships.

While at eating disorder treatment centers, patients focus on moving through these four modules, building skills along the way. Eating disorder therapists may use worksheets and other educational materials to focus on particular skill sets each week. As patients build their skills, they are given opportunities to practice in real-life situations. Their challenges and success in practicing their DBT skills help to guide subsequent therapy sessions to keep patients on track to becoming recovered from binge eating disorder.

How Binge Eating Treatment Centers Use Dialectical Behavior Therapy

As developing emotional regulation skill is an integral part of binge eating recovery, effective treatment centers make dialectical behavior therapy part of their care process. By using this therapeutic approach to help their patients, it is possible to provide them the skills they need to become and remain recovered. Binge eating treatment centers may offer DBT sessions on a daily basis for those who need this care tactic most.

Patients can attend DBT sessions alongside their peers at group therapy or on their own during individualized sessions. Many patients elect to do skill-building activities as a group, but prefer to complete the psychotherapy sessions individually. Eating disorder therapists structure each patient’s care plan around their treatment preferences and needs. As a result, patients may start with this arrangement before moving onto a different therapy structure that better supports their continued recovery.
At each DBT session, patients are given opportunities to practice mindfulness and assess how they are feeling. With that information in mind, they can then go over their homework and discuss the skills learned in the prior week. The homework worksheets allow patients to identify insights about their binge eating disorder and the treatment process.

The result of the sessions focuses on teaching patients new skills and identifying how to use them effectively in becoming and remaining recovered. These new skills center around one of the four key modules used for DBT. Patients can then pick and choose from those skills to build a toolbox filled with coping methods that help them regulate their emotions and avoid disordered behaviors.
If this therapeutic model offers great benefits, patients can continue attending DBT sessions through binge eating treatment and well after graduating. This allows them to continue to build their skills and receive the support they need to remain recovered.


Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.