Treating BN is often a complex process that requires a comprehensive approach, though thankfully, a number of therapies have been found to help. And one of the most popular and effective types of psychotherapy for people struggling with BN is dialectical behavioral therapy (DBT).
What Is DBT?
Dialectical behavior therapy (DBT) is a therapeutic regimen that was first developed for people struggling with borderline personality disorder (BPD), a mental health disorder involving intense emotions and issues with emotional regulation. 
And while the technique has proved helpful for people with BPD, it was also adapted to help with a number of other mental health concerns, including eating disorders.
Dialectical behavioral therapy was originally an offshoot of another very successful therapeutic technique, cognitive behavioral therapy (CBT). Both concepts draw connections between thoughts and feelings, and the patterns of behavior they can work to uphold. And both generally follow a pre-set treatment schedule, where a patient is taught to recognize these patterns, and introduced to new, healthier coping strategies. 
Where CBT and DBT differ is in their overall focus. While patients in CBT work to redirect their unhelpful thoughts, those practicing DBT are taught instead to seek out a sense of balance within themselves, and understand that they can simultaneously work toward change while finding acceptance.
How Does DBT Treatment Work?
Much like cognitive behavior therapy, dialectical behavior therapy follows a regimented schedule of treatment. This is generally broken down into four phases, including: 
- Phase One: Addressing someone’s most serious and self-destructive behaviors.
- Phase Two: Addressing issues, complications, or behavioral patterns that most affect someone’s quality of life.
- Phase Three: Addressing issues or complications connected to someone’s self-esteem or interpersonal relationships.
- Phase Four: Working on long-term strategies for creating and maintaining positive changes.
To help someone achieve these therapeutic goals, DBT treatment introduces them to several key strategies meant to help build distress tolerance, emotional regulation skills, and interpersonal effectiveness, among other benefits. 
Mindfulness is perhaps the most prominent focus in DBT treatment.
The practice helps patients zero in on the present moment, including what’s going on both within and without them. Emphasis is put on experiencing feelings, sensations, and thoughts, without fighting them or without placing judgment.
Overall, mindfulness skills can be used to help someone begin to separate themselves from their thoughts and feelings, giving them the chance to react to upsetting or even mundane situations in more measured, helpful ways.
Distress Tolerance Skills
As the name implies, distress tolerance skills are designed to help someone more easily and aptly deal with emotionally intense situations.
Some techniques that are commonly taught include distracting oneself from the situation; using self-soothing words or actions to calm down; thinking of pros and cons of a situation; and finding silver linings, or ways to improve the moment. 
Interpersonal Effectiveness Skills
Interpersonal effectiveness skills are a group of strategies designed to help someone build and maintain healthy and positive relationships.
These concepts teach people how to more effectively communicate, respectfully maintain boundaries, and deal with people who may themselves be emotionally intense or difficult, among other helpful approaches to interpersonal relationships.
Emotion Regulation Skills
DBT was first developed to help people who experienced intense emotions and had trouble managing them. As such, emotional regulation skills became a core aspect of dialectical behavior therapy.
This group of strategies centers around learning how to recognize intense or unhelpful feelings. The idea is, once someone understands what these emotions look or feel like, they can practice subverting, redirecting, or otherwise managing them in ways that produce healthier outcomes.
How Does DBT Help With Bulimia Nervosa?
Dialectical behavior therapy can introduce someone to many new ways of thinking, which can help them reevaluate or break away from unhelpful thought patterns that drive so many disordered eating behaviors.
Many patients with eating disorders like BN, anorexia nervosa (AN), and binge eating disorder (BED) engage in black-and-white thinking, called cognitive rigidity. This often manifests as a hyper attention to detail and can drive low self-esteem, anxiety, and depression, which, in turn, often work to sustain an eating disorder. 
But the entire idea behind dialectical behavior therapy is that two concepts can be true at once. This can help someone expand their perspective, and learn to treat themselves with a little more love and care, which may help them ease up on some disordered eating behaviors connected to low self-image, depression, or anxiety.
This is in addition to the focus DBT has on helping a person better understand the way their mind and emotions work. Learning to identify thoughts and emotions that may be unhealthy is often a critical part of recovering from an eating disorder. Even when stressful or triggering situations occur, someone will have the knowledge and skills to react to those scenarios in a more thoughtful or positive way.
Is DBT the Ideal Bulimia Treatment?
Though it has been found to be helpful for treating eating disorders, DBT isn’t generally used as the first-line treatment for BN. Instead, most patients will first be asked to try CBT, possibly while using supplemental treatment approaches such as medication or nutritional counseling. 
But that doesn’t mean that DBT isn’t an ideal treatment for everyone.
The approach may be particularly helpful for those with trouble regulating their emotions, those with difficulty navigating interpersonal relationships, or those with particular co-occurring conditions, such as depression or anxiety. Likewise, DBT may be a good course of action for someone in a state of emotional crisis, including someone experiencing suicidal ideation. 
DBT could also be used as a supplemental or secondary course of treatment for someone who may benefit from learning the additional skills taught in this technique.
Finding Treatment for Bulimia
If you or a loved one are struggling with bulimia nervosa or another eating disorder, it’s important to seek out help. These conditions are dangerous and could even be deadly if left untreated.
If you don’t know where to begin looking for help, you can speak with your primary care physician, therapist, or a trusted medical professional. These experts are often educated in eating disorder treatment and may be able to help point you in the direction of a successful program or determine your next best steps.
If you’d rather not discuss this sensitive topic in person, there are a number of eating disorder hotlines that offer additional information and resources on eating disorders and different treatment options.
But regardless of where you start, making the decision to seek out help is the most important step. At their worst, eating disorders may seem impossible to overcome, but with the right kind of help, it’s possible to start the journey toward a healthier and happier future.
- Jackson K. (2013). Dialectical Behavioral Therapy for Eating Disorders — Therapeutic Tool of Acceptance and Change. Social Work Today; 13(6):22.
- Vaughn S. (2022, November 30). The 4 Stages and Targets of DBT Treatment. Psychotherapy Academy. Accessed May 2023.
- Chapman AL. (2006). Dialectical behavior therapy: current indications and unique elements. Psychiatry; 3(9):62–68.
- MacNeil B, Leung P. (2022). Evaluating thinking styles in adults with an eating disorder: Associations with life satisfaction, psychological symptoms, and treatment engagement. Journal of Psychiatric Research; 153:30-36.
- Treatment – Bulimia. (2023, November). United Kingdom National Health Service. Accessed May 2023.