Tag - coping skills

Plate with sad face (River Centre Clinic)

DBT For Eating Disorders

When people are struggling with binge eating behavior or weight management issues, they are sometimes told to simply eat less and exercise more. This advice, perhaps well intended, will potentially make the situation worse and create an unhealthy diet cycle that focuses on a negative body image and deprivation. People need a sound treatment plan that addresses the complexity of the behaviors, thinking patterns, and relationship with food. This is where a type of treatment known as Dialectical Behavior Therapy (DBT) is helpful. DBT is a type of therapy that combines elements of cognitive behavioral therapy with principles of from Zen Buddhism. DBT has been proven an effective theoretical framework that helps promotes changes that are necessary to treat binge eating as well as other eating disorders.

What is DBT?

Dialectical behavior therapy is a specific type of cognitive-behavioral psychotherapy developed in the late 1980s by psychologist Dr. Marsha M. Linehan. The original goal of DBT was to find better treatment options for people suffering from borderline personality disorder. Dr. Linehan, who is currently a professor at the University of Washington actually developed DBT as a response to her own borderline personality disorder, which had previously not been properly treated. However, since the development of this therapy, it has been used to treat other kinds of mental health disorders.

Dialectical behavior therapy is a type of psychotherapy (talk therapy) that utilizes a cognitive-behavioral approach that emphasizes the psychosocial aspects of treatment. The main concept behind DBT is the view that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations. These emotional situations are primarily triggered by romantic, family and friend relationships. DBT theory advocates that some people’s arousal levels in such situations can increase far more quickly than the average person’s, attain a higher level of emotional stimulation and thereby take significantly more time to return to baseline arousal levels.

Dialectical behavior therapy understands that there are times when people act on emotions that do not match a social situation. This is when a skill from dialectical behavior therapy (DBT) called “opposite action” is invaluable. It’s a skill that helps us to manage our emotions, enhance our relationships and enhance our lives. It’s a skill that helps us make more healthful decisions. DBT would advocate that an opposite action is required in these situations, because it allows people to recognize that their thoughts are not facts. Individuals learn how to experience emotional urges, but take the opposite action and not act on these urges. This provides a level of self-regulation and allows people to have more control over their thoughts, feelings and actions. Not surprisingly, dialectical behavior therapy is an effective treatment approach for people struggling with eating disorders.

A summary of how DBT works:

The term dialectical is based on the principle of blending two key ideas together, acceptance and change. In therapy, both of these ideas produce better results when they are combined together. DBT has patients focus on accepting their experiences, but simultaneously working on changing unhealthy behaviors. A major goal is to provide patients with the necessary skills that allow them to cope with, and change, these unhealthy behaviors. This form of therapy was initially designed to treat people with suicidal behavior and borderline personality disorder. But, DBT has been successfully adapted to treat other mental health problems that threaten a person’s safety, relationships, work, and emotional well-being.

Traditional dialectical behavior therapy focuses on behavioral skills for four domains:

  1. Emotion regulation: Recognizing, labeling, and adjusting emotions.
  2. Interpersonal effectiveness: Navigating conflict and interacting assertively.
  3. Distress tolerance: Feeling intense emotions like anger without reacting impulsively or using self-injury or substance abuse to dampen distress.
  4. Mindfulness: Becoming more aware of self and others and attentive to the present moment.

DBT takes these four domains and applies them in a linear, multistep approach. The first step is to treat the most self-destructive behavior (suicide or self-injury). The next step is to control behavioral response such as emotional regulation, distress tolerance, and interpersonal effectiveness. The third and fourth steps promote better personal relationships and self-esteem while encouraging a sense of happiness and connection.

For additional information or questions about dialectical behavior therapy for eating disorders, contact the staff at River Centre Clinic (RCC). Their programs provide a full range of treatment options for both adolescents and adults. River Centre Clinic is located in Sylvania, Ohio.

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Six Tips to Prevent Relapse

A residential treatment program can become a safe space for many patients. It may feel scary going back to your home, job, or school. While in treatment, you have invested time working on your recovery and hopefully whatever environment you are returning to can foster a pro-recovery environment. Despite the environment, many patients have a few slips during the recovery process post-treatment. River Centre Clinic’s hope is that you have learned strategies to prevent those slips from becoming a relapse. These five tips are not all-inclusive, but they are some of the best strategies to ensure recovery.

Meal plan.

While in treatment you have learned how to meal plan and it most likely began to feel like a normal process towards the end of your stay. However, directly after treatment, meal planning may feel inflexible. It may be tempting to not follow your plan precisely or to completely stop planning. Rest assured that you will not have to meal plan forever to maintain your recovery. While the timeline differs for each individual as to when they can stop meal planning, patients who stick to their meal plan as ordered are less likely to relapse. Be open and honest with your outpatient therapist regarding your concerns with meal planning and create a strategy that works for both of you.

Connect with your outpatient treatment team regularly.

Before you leave residential treatment, you will have hopefully connected with an outpatient therapist and set up your first appointment post-treatment. Talk to your therapist to determine who else you should connect with to create a team of health professionals that advocate for your recovery. Often a team including a therapist, dietitian and primary care physician, all skilled in treating eating disorders, are highly beneficial for post-treatment care.

Utilize your team.

Connecting with a team of skilled health care professionals post-treatment is a vital part of recovery. Just as important, is connecting with a team of friends and family. Your tribe should include people that you feel comfortable talking to about your eating disorder, meal plan and urges. Take time to talk to these special individuals about the type of support you need. Ask your therapist if you can schedule a designated appointment for your tribe to help them understand your recovery
process and how they can help.

Define one self-care ritual and stick to it!

Stress is inevitable and it can make recovery more difficult. But you can combat stress by taking care of yourself and incorporating self-care into your daily routine. Self-care can look different depending on the individual. Do you enjoy reading, a nice hot bath, journaling, listening to music, meditation? These types of activities can be incorporated into your routine to help manage stress.

Know the difference between a slip and relapse.

A slip usually happens suddenly and may take you by surprise. Maybe you were having a particularly busy day and realized at 4:00 p.m. that you missed your afternoon snack. If you’re able to get right back to your planned meals and squeeze in the missed calories, consider that a slip. While a slip is still a setback, it’s much more minor than relapse. Relapse is when a slip turns into consistent eating disorder behaviors. To prevent this from happening, acknowledge a slip if it occurs. Call someone in your tribe or your therapist, if you are able to, so that they can help prevent guilt and shame that you may feel from your slip. These feelings will only exacerbate the problem. Focus on the progress you have made and brainstorm
solutions to prevent a future slip.

Make your own stoplight list.

How will you know when you are falling back into old eating disordered habits? By creating a personalized red, yellow and green flag list with the help of your therapist, you will have a written set of guidelines which will help you to recognize when you need to reach out for assistance. Look specifically at your own personal relapse cues and recovery behaviors and create a comprehensive list. Being sure to identify high-risk indicators that you are doing poorly (red flags), warning signs that you are slipping back into old habits (yellow flags), and signs that you are living a recovered lifestyle (green flags) is integral to keeping on track. Be sure to include both physical and emotional indicators of each.

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