What Is DBT and How Is It Used in Eating Disorder Recovery?

There are many advantages for a person in eating disorder recovery to attend treatment programs that use dialectical behavior therapy (DBT) in their treatment plans. This therapeutic approach helps with emotional regulation and management by synthesizing the most effective parts of talk therapy and skill-building exercises. Each therapy session provides people with validation and helps them address their biggest challenges. DBT is an evidence-based form of therapy, meaning it has been proven effective through trial and error by professionals.

People in eating disorder treatment are often in emotional turmoil; DBT is useful because it can provide objectiveness and regulation to a person’s emotions. 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 can also help people in recovery work with others, and the therapists involved can also help to identify disordered thought patterns and behaviors affecting the patient and provides the tools they can use as alternatives.

Emotional Dysregulation Can Cause and Complicate Eating Disorders

Emotional dysregulation is a common circumstance in which people can’t control their emotions (or feel out of control) productively and helpfully. When people cannot properly process their feelings, they may act impulsively or use disordered behaviors to regain a sense of control. Disordered thoughts and behaviors related to eating disorders tend to help temporarily relieve feelings of emotional dysregulation. Examples of these activities might be the binge eating episodes associated with binge eating disorder, for example, or the food restriction associated with anorexia nervosa.

These kinds of coping mechanisms act as triggers for further emotional dysregulation. The eating disorder behaviors tend to cause feelings of guilt or shame, which can cause stress, prompting the person to engage in the disordered behaviors, and so on. It’s a dangerous cycle that can be difficult to break.

Without learning how to regulate their emotions and avoid impulsive or disordered behaviors, people in recovery may find it easier to return to their disordered behaviors. That’s why eating disorder treatment centers often use forms of therapy that help to identify and regulate emotions. To accomplish this goal, they use dialectical behavior therapy along with other effective therapeutic approaches in helping their clients.

Dialectical Behavior Therapy Builds on Previous Sessions

Dialectical Behavior Therapy is built around a framework of repeated sessions that slowly reshape the way a person processes and identifies their feelings. This therapy module gets to the heart of emotional dysregulation issues that complicate the process of becoming recovered. As an example, a feeling of stress from work might prompt someone to binge eat as a coping mechanism. DBT allows them to identify this behavior as compulsive and detrimental, and work on replacing it with a healthier coping skill.

Before patients can manage their emotions, they must fully identify and accept what they are feeling and why. DBT address this area quite well by introducing mindfulness to the way a person thinks about themselves and their emotions. The more a person engages in DBT sessions, the more objectively self-aware they become; a greater understanding of how emotions arise and how they can be responded to means a greater ability to regulate them without disordered eating behaviors.

DBT sessions are also vital to mental health treatment with a focus in disordered behaviors because it provides opportunities to build a tolerance to distress and improve trust in others. By focusing on all these areas, this therapeutic approach sets patients up for success in becoming and remaining recovered.

Outlining the Four Modules of DBT

As developed by psychiatrists and other mental health professionals over decades, dialectical behavior therapy introduces four distinct learning modules. These modules explore each vital area in detail to build emotional regulation, establish coping skills, and focus on understanding the self. They’re a road map to recovery, tried and tested by thousands of therapists over the years.


Mindfulness provides individuals suffering from an eating disorder a way to understand their own emotions and live “in the moment,” without worrying about the past or the future. When effective at using mindfulness to assess their state of wellbeing, it’s easier to understand that the negative emotions are fleeting and not permanent. Through this approach, they can minimize urges to engage in disordered behaviors. The ability to use mindfulness effectively does not always come naturally to individuals, so the therapists using mindfulness techniques at an eating disorder treatment center normally start slow and built their client’s skills up over time.

Mindfulness training begins with regular talk therapy and meditation sessions that normalize thinking mindfully for clients who have not explored mindfulness in the past. These individuals need to notice, acknowledge, and let go of the emotions to start to effectively use this practice in daily life. People with eating disorders are often perfectionists and feel a need to control certain aspects of their lives; mindfulness techniques can relieve some of the stress and self-judgment they experience.

Although mindfulness can inspire behavioral changes, the main purpose of mindful understanding is to simply experience emotions and understand them without action. Mindfulness simply centers around acknowledging emotions and accepting them as fact to provide self-validation. This also helps to build awareness about how emotions arise and how they affect us.

Regulation of Emotions

Building on mindfulness practices and self-understanding, another DBT module focuses on the regulation of emotions that are affecting behavior. The is the first step in replacing coping mechanisms like disordered eating behaviors with healthier alternatives. In regulating their emotions, people receiving DBT treatments must acknowledge and validate how they feel before moving onto the control stage.

After they’ve identified and accepted their feelings without judgment, DBT recipients can work on replacing disordered behaviors with better reactions to stressors. Being able to understand that these feelings can be experienced without requiring action is a big first step to avoiding disordered eating behaviors entirely. This process takes time and requires a lot of practice to master.

Emotional regulation is not easy; it is natural to experience setbacks along the way, and practices that usually help regulate emotions may not always work. Many people with eating disorders struggle with emotional dysregulation for their entire lives before seeking treatment. One way to help emotional regulation in place is to also teach stress tolerance skills.

Stress Tolerance

Proper coping skills for trauma and other stressors are virtually always taught at eating disorder treatment centers.Both in treatment and back in the “real world,” stress is a powerful trigger for relapse. Managing stress and the emotions that come with it are essential to maintaining long-term recovery.

DBT focuses on distress tolerance, helping individuals to resist urges to react impulsively to stressful situations and emotions rather than attempting to relieve the stress through disordered coping behaviors. With the help of a professional DBT therapist, healthier responses to stress can be taught. The individual can learn to hit the “pause button” when experiencing stress.

One important aspect of DBT is its building nature. After each session and each time DBT skills are used in real life, it becomes easier to do the next time. Although setbacks are a given, they can be overcome as long as the coping skills are continuously used.If a relapse or other setback does occur, their therapists and support system can help them find their footing again.

Interpersonal Effectiveness

A person struggling to cope with dysregulated emotions may find it difficult to maintain healthy relationships and connect with people. Dealing with raging emotions is an internal struggle that can sometimes spill out to external relationships. Without meaning to, a person in emotional stress can lash out, damaging their relationships and causing further stress.

Dialectical behavior therapy aims to correct relationship struggles by reintroducing trust and appropriate interpersonal skills to people who have struggled to form and maintain relationships. These strategies help mitigate the relationship issues and emotional dysregulation caused by their eating disorder.Mindfulness is useful in this arena as well; individuals can assess how their responses to other people may be construed more easily if they know how to objectively assess them.

This therapy module also helps people in treatment learn how to stand up for themselves in their relationships. Many DBT sessions show people how to avoid codependency and a willingness to put other people’s needs before their own. Mutual respect and trust can be built between client and therapist in DBT, setting the pace for similar trust-building in their other relationships.

A full DBT program will see a client all four of these life skills, improving their stress tolerance, mindfulness, interpersonal skills, and emotional regulation. It’s common for the eating disorder treatment facility that use DBT to include worksheets and other self-study guides to supplement their DBT sessions with a therapist. As the individual continues to practice their newfound coping skills, they are given opportunities to practice in real-life situations.

DBT Is Part of a Comprehensive Eating Disorder Treatment Program

Dialectical Behavior Therapy, for all its effectiveness, is not the only component of a comprehensive eating disorder treatment plan. The psychiatric aspect of an eating disorder must be treated of course, but a full-spectrum treatment plan will incorporate contributions from nutritionists, dieticians, and alternative therapists such as yoga instructors or art therapists. This entire spectrum of treatment combines to treat every aspect of the person; it’s essential for a full recovery.  If you or a loved one is struggling with an eating disorder, you should remember that early intervention is key to effective recovery. Reach out to an eating disorder treatment center that features DBT as a core element of its programming, and get started on recovery today.


With 20 years of behavioral health business development experience, Carrie combines world-class marketing, media, public relations, outreach and business development with a deep understanding of client care and treatment. Her contributions to the world of behavioral health business development – and particularly eating disorder treatment – go beyond simple marketing; she has actively developed leaders for her organizations and for the industry at large.