Eating Disorder DBT: Dialectical Behavior Therapy

Dialectical Behavior Therapy (DBT) was originally developed in the 1970‘s by a researcher named Marsha Linehan, PhD, for the treatment of Borderline Personality Disorder.  Since that time, DBT has been found to be highly effective for the treatment of mood disorders (such as Depression, Anxiety and Bipolar Disorder), recovery from sexual traumas, and addictions (including Chemical Dependency and Eating Disorders).  

Eating Disorder DBT combines cognitive-behavioral techniques with mindfulness strategies derived from Buddhist meditative practices.  DBT typically involves skills training in four areas: Mindfulness Meditation, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness.  

At Positive Pathways, our EDIT™ Certified Counselors and EDIT™ Counselor Interns can integrate the perspectives of Eating Disorder Intuitive Therapy (EDIT)™ along with Eating Disorder DBT.  What EDIT™ calls the “Intuitive Therapist,” DBT considers the “Wise Mind.”  EDIT-DBT Sessions can allow for the specific exploration and practice of the four DBT Skills outlined below.

Mindfulness Meditation

Mindfulness is the awareness that emerges through paying attention intentionally and non-judgmentally to the unfolding of experience moment-by-moment.  It is the ability to be aware of your thoughts, emotions, physical sensations, and actions while in the present moment. It is doing so without being critical or judgmental of your experience or yourself.  An essential mindfulness practice is to tune into your senses.  What you are seeing, tasting, smelling, feeling and hearing in this moment?  Many people do things on “auto pilot,” which can lead to a build-up of intense sensations, resulting in feeling overly stressed or depressed.  Being mindful can allow you to feel relaxed and confident.  Eating disorder behaviors are typically very mindless, while recovery involves mindfulness — as conveyed in the EDIT Principles, “Love Your Self” and “Be True To Your Self.”

Emotion Regulation

Emotion Regulation is a way to recognize your emotions and to be able to moderate high intensity emotional reactions.  Primary emotions are your initial reaction to what is going on.  These feelings usually happen quickly and intensely, and often overlook the whole picture of what is happening.  Secondary emotions are your emotional reactions to the primary emotion — or, having feelings about your feelings.  Emotion Regulation skills can help you to manage both primary and secondary emotions in more effective and healthy ways.  There are nine specific coping skills in Emotion Regulation, including:  being mindful of your emotions without judgment, reducing your emotional vulnerability, increasing your positive emotions, and doing the opposite of your emotional urges.  These teachings integrate with and guide the application of the third EDIT Principle, “Express Your Self.”

Distress Tolerance

We all experience pain or distress sometime in our lives. This can come in the form of emotional pain, physical pain or sometimes both. At times pain is unavoidable or unpredictable and often the best we can do is use coping skills to repair the hurt. Some people feel the pain in very intense ways and don’t know how to cope. This is called having overwhelming emotions. Often, people experiencing this use unhealthy coping strategies — such as eating disorder behaviors — to numb their pain. Instead, distress tolerance teaches people to use healthy coping strategies to overcome pain. Such strategies may include distracting, radical acceptance (not judging yourself or getting angry at the situation), self-soothing and relaxation techniques.  The development of healthy coping strategies and an overall routine of Intuitive Self-Care are key aspects of the EDIT Principle, “Give To Your Self.”  

Interpersonal Effectiveness

Interpersonal Effectiveness is a combination of assertiveness, listening, and negotiation skills.  Relationships with others are often center in our lives therefore keeping relationships healthy is of paramount importance.  Key components of interpersonal effectiveness include practicing mindful attention and recognizing both passive and aggressive behaviors.  You can learn how to ask for what you want, say no, and have disagreements without damaging relationships.  It is OK to put yourself first and get your needs met while still being kind and appropriate towards others!  This is an important aspect of the EDIT Principle, “Give To Your Self.”  In addition, Interpersonal Effectiveness also guides the development of healthy boundaries to support eating disorder recovery and relapse prevention, which are the teachings of the EDIT Principle, “Believe In Your Self.” 


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