What Is Dialectical Behavior Therapy? Here’s a Basic Guide

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Eating disorders affect millions of Americans and are the leading cause of death for those with mental illnesses, according to the National Association of Anorexia Nervosa and Associated Disorders (ANAD). In particular, nearly 3% develop binge eating disorder (BED).

However, an eating disorder is not a death sentence. With the right binge-eating recovery plan, even the worst situation can experience a positive turnaround.

Treatment facilities these days can already offer a wide range of treatment options they can tailor to the patient’s specific needs. These include dialectical behavioral therapy (DBT).

What Is DBT?

DBT stands for dialectical behavioral therapy. It is a modified version of cognitive behavioral therapy (CBT). CBT is the process that recognizes the interconnectedness between thoughts, actions, and behaviors. For example, persistent negative feelings can result in equally negative habits or behaviors, such as binge eating.

In CBT, a therapist challenges these behaviors, thoughts, and actions to effect change that will hopefully increase the chances of recovery and decrease the odds of relapse.

Many studies already show how CBT works for different mental illnesses, including eating disorders. In a 2014 research, for example, CBT alone reduced symptoms such as hypomania and depression.

Not everyone, though, responds to CBT. In the 1980s, Marsha Linehan, a University of Washington psychology researcher, learned that some patients were later uncooperative with their therapists.

This resulted in burnout for the specialists and dropouts of patients from the program. The problem also seemed more common among those with borderline personality disorder (BPD), especially suicidal women.

Poring through volumes of research and gleaning into expert experiences, Linehan developed DBT. The purpose of the evidence-based therapy is to help patients live a life worth living by taking the good and the bad and putting everything in a proper perspective. In turn, it allows people with binge eating disorders to:

  • Cope with stress
  • Regulate their emotions that lead to destructive behaviors
  • Decrease the risks or prevent negative behaviors, such as self-harm or substance abuse
  • Learn to connect with others

The Elements of DBT


woman with bulimia

In DBT, dialectical thinking plays a central role in a patient’s healing or recovery. It is a philosophy that balances two opposing views, believing that by doing so, one finds the truth. It also feeds on two essential factors for healing: acceptance and change.

  • Acceptance validates whatever it is the person is going through or is causing the binge eating disorder.
  • Change reinforces the fact that despite the situation, a patient can develop fresh ways of coping with reality—strategies that are positive and help improve their quality of life.

A typical DBT program promotes:

Mindfulness is being aware of the present. Although the concept is rooted in Buddhism, that of CBT is non-religious or spiritual. In this practice, patients learn to pay more attention to intense emotions and accept them as they’re happening but also taking the position of an observer. This way, they can go through their negative thoughts and feelings without judgment and resorting to destructive behaviors to cope.

Distress tolerance allows the patient to regulate their emotions better. It promotes radical acceptance—that is, whatever they’re going through is real, but it doesn’t mean they can be stuck with it.

The recovery process for people with BED doesn’t follow a straight line. But with the right support, they can get through every hump along the way.


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