What Is Dialectical Behavior Therapy and How Does It Help With Bulimia Nervosa Treatment Programs?

People with bulimia nervosawho enter specialized treatment programs often receive the benefit of dialectical behavior therapy (DBT) as a facet of their recovery plan. This now-commonplace form of therapy helps with emotional regulation and management using a combination of psychotherapy and skill-building activities. Each of these one-on-one sessions builds on the last, helping the individual regulate their distorted emotions and building coping skills that help to avoid the binge/purge cycle that defines bulimia nervosa. While undergoing DBT at bulimia nervosa treatment centers, individuals learn to identify and remove unwanted, negative thoughts and behaviors.

By using DBT as a part of the bulimia nervosa treatment process, it’s possible to isolate and remove emotional dysregulation as a complicating factor. DBT has been shown to be successful in self-regulation both in the short and long term, remaining useful in the years after active eating disorder treatment has been completed. Session by session, the therapist and the individual employ logic and mindful thinking to establish which thoughts are disordered and which are healthy. After being identified, they can work together to stop them. In essence, DBT trains a person with bulimia nervosa to, for example, be aware they are about to purge, recognize that this is a disordered behavior, and stop themselves. 

No single treatment can completely prevent eating disorders like bulimia nervosa from triggering again, even years down the line, however, relapses can often be reduced with the help of mindfulness training like DBT.

Emotional Dysregulation andBulimia Nervosa Recovery

Emotional dysregulation is common in all types of eating disorders and is often found in other forms of mental health disease. It’s a state of emotional being in which the person can’t control negative or distorted emotions. 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. As an example, a person with bulimia nervosa might irrationally feel that they are “fat,” and purge their last meal in an effort to control those negative feelings. These behaviors trigger dopamine releases in the brain, which can act almost like an addictive drug, prompting compulsive repetition of these behaviors when the negative feelings return.

These disordered attempts at managing stress and negative emotions can have dire consequences in the long run. Disordered eating behaviors often fuel further guilt and shame along with negative emotions such as sadness, frustration, and confusion. which worsen stress levels and throw emotions further out of balance. 

Without learning how to regulate their emotions and avoid impulsive or disordered behaviors, it’s more difficult for individuals with an eating disorder to become fully recovered. While traditional talk therapy is useful in treatment, a more goal-oriented procedure like DBT is also essential as a component of recovery.

Dialectical Behavior Therapy andBulimia Nervosa Recovery 

With dialectical behavior therapy, people working toward bulimia nervosa recovery are given the framework for regulating their emotional response to stress. This therapy module gets to the heart of emotional dysregulation that triggers disordered eating practices like binge eating sessions and excessive exercise. After identifying the disordered emotional patterns, the individuals are thencan address their unique challenges and learn how to handle their emotions without relying on disordered behaviors.Before learning to regulate their feelings, people using DBT as a therapeutic method must learn to isolate distorted emotions and behavioral impulses. 

However, accurately pinpointing where the emotions are coming from is a lot easier than it sounds. 

This is where mindfulness practices come into the picture. Mindfulness, or the state of being self-aware and “in the moment,” can be achieved through the practice of yoga or meditation, and those are often included in eating disorder treatment but can occur through guided therapy sessions like DBT as well. When a person is being mindful of their emotions, they can learn to “step back” and recognize that certain actions and emotions are unhealthy. From there, they can learn to avoid those feelings and forestall those actions.

The Four Cornerstones of DBT 

To fully explore these important areas in bulimia nervosa recovery, dialectical behavior therapy introduces four clearly delineated training disciplines. These cornerstones of learning allow the individual to identify, isolate, accept, and eliminate the disordered behaviors that surround bulimia nervosa and other eating disorders. 


Mindfulness provides individuals with bulimia nervosawith a self-aware understanding of their current emotions and thinking patterns. With training on how to use mindfulness training to assess their state of wellbeing, it becomes progressively easier to identify their emotions and the causes of each. Through this approach, they can minimize internal misunderstandings about personal motivations and feelings. The ability to employ mindfulness techniques often doesn’t come naturally; that’s why training exercises are often necessary during eating disorder treatment.

Mindfulness training begins with regular check-ins that encouragepeople in treatment to measure their emotional state at different times throughout the day.These check-insprovide a “map” of the individual’s emotions, which helps them eventually identify which feelings are adding to their disordered actions and which are positive, healthy emotions.

Although mindfulness can inspire action, the earliest mindfulness practices are usually centered around simply becoming aware of the emotions. Mindfulness centers around acknowledging emotions and accepting them. This baseline of self-awareness and self-understanding provides a template for taking future action pursuing a full recovery from bulimia nervosa and other eating disorders.

Regulation of Emotions

Another pillar of DBT focuses on the regulation of emotions that are identified through mindfulness practices. This step requires an acceptance that certain behaviors and feelings are detrimental to the mental and physical health of the individual with bulimia nervosa. Before attempting to regulate their emotions, Individuals using DBT must acknowledge and validate how they feel before moving onto the control stage.

Once they’ve learned to identify and understand their feelings without judgment, emotional regulation and stress-coping skills can begin to be put into place. These coping skills might include self-validation, simple mindfulness control techniques like a five-minute meditation session, or the simple act of asking a friend to talk instead of engaging in disordered behaviors. This process takes time and might require a fair amount of practice to master. Positively, many of these techniques can be practiced alone, meaning they remain useful even after a person has left active residential treatment.

Relapses and other setbacks are certainly natural; any form of behavioral health disorder tends to be chronic. Many people with eating disorders struggle with emotional dysregulation for their entire lives before seeking treatment. This means there is a lot of distorted thinking and emotions to be “un-learned,” which is the essential function of therapies like DBT.

Distress Tolerance

Challenging disordered thoughts and facing triggering situations can produce exceptional stress. In many cases of bulimia nervosa, people have come to rely on disordered eating behaviors as a way to counteract distress in their lives and may feel ever more distress at the prospect of leaving those behaviors behind.

DBT focuses on distress tolerance to help individuals to find ways to counter frustrating, confusing, or overwhelming emotions in a rational, measured way rather than engage in the same old unhealthy actions when stressed out. Eating disorder therapists help their clients acknowledge their emotions without taking any action. This essential pause between thought and action makes a huge difference. When aware that experiencing an emotion doesn’t mean there is a required action, individuals using DBT practices can shift to relying on their coping skills rather than worrying about having an uncontrollable emotional response. 

Each success in identifying and avoiding impulsive reactions makes the next time easier. During active DBT treatment, therapists can help their clients by providing an outside perspective on their behaviors and to keep trying. Stress and emotional distress are the main triggers of relapses, so distress tolerance becomes perhaps the most important aspect of DBT following discharge from treatment.

Interpersonal Effectiveness

Emotional dysregulation can often interfere with a person’s ability to cultivate and maintain interpersonal relationships.The day-to-day process of hiding disordered eating behaviors, and the stress of dealing with them, can be exhausting and isolating. People struggling with bulimia nervosa often don’t have the energy left to give to developing and maintaining relationships with friends, family, and significant others.

Dialectical behavior therapy assists in improving interpersonal relationships by introducing a familiarity with self-acceptance and personal openness. These strategies help mitigate the issues caused by bulimia nervosa symptoms and emotional distress. This approach helps limit social withdrawal and debilitating feelings of shame, especially around mealtimes, that can hold relationships back.

This therapy module also helps people learn how to ask for help.  Many individuals with bulimia nervosa have low self-esteem and are unused to putting their own needs first. They may learn how to stand up for themselves and set firm boundaries that protect their wellbeing.

Undergoing DBT treatment sessions at an eating disorder treatment center, people with bulimia nervosa learn to improve their self-awareness and self-control with the help of their therapists. They may use worksheets and other educational materials to focus on particular skill sets each week. 

The individual can then move on from in-treatment worksheets to practice mindfulness and emotional regulation in real-life situations. Their challenges and success in practicing their DBT skills help to guide subsequent therapy sessions to keep the recovery process on track.

How Bulimia Nervosa Treatment Centers Use Dialectical Behavior Therapy

Since emotional regulation and mindfulness are central facets of bulimia nervosa recovery, most modern treatment centers make DBT part of theirrecovery plans. DBT, in addition to various other therapeutic and psychiatric treatment methods,makes it possible to learn the skills needed to become and remain recovered. Bulimia nervosa treatment centersoften provide weekly or even daily DBT sessions for those clients struggling with self-control and emotional awareness. 

While DBT is usually performed as individual therapy, there are also group session methodologies available. Many people getting treatment for bulimia nervosa choose to do skill-building activities as a group and self-assess alone or with the help of an individual counselor.Oliver-Pyatt Centers’ therapists structure each of our clients’ care plan around their treatment preferences and needs. 

During each DBT session, there are opportunities to practice mindfulness, self-assess, and build upon the progress made in prior sessions. Each interaction with their therapist can provide a new lesson and a new stepping stone to emotional regulation. There are specialized homework worksheets that allow clients to maintain their recovery whether in a step-down program or after becoming fully recovered.

Lastly, as a central component of any proper aftercare program, the DBT therapeutic model offers great benefits. By continuing to employ the skills for coping and emotional self-control learned in treatment,individuals who’ve recovered from bulimia nervosa can continue attending DBT sessions through bulimia nervosa treatment and well after graduating. This allows them to continue to build their skills and receive the support they need to remain recovered.