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DBT-Informed ED Counseling


This Table Talk happened on Monday, September 16, 2019

The skilled (yet humble) Stefanie Boone, MS,RD,CED came to VFED in September to teach us the nuances of using DBT to help w/ ED treatment.

Traditional Dialectical Behavior Therapy(T-DBT) skills emphasize “wise mind”, distress tolerance, emotional regulation, and interpersonal effectiveness; the aim is to get through tough times w/o making things worse. These skills help with overeating and purging behaviors- traits of the emotional undercontrolled (UC); they work toward building a life worth living.

A more recently developed form of DBT, Radically Open (RO-DBT) is now available- which aims to build a life worth sharing as well. These skills activate social safety systems and target overcontrolled personality styles (OC). This system can help with symptoms of food restriction and overexercise.

After a brief discussion of these T-DBT and RO-DBT skills, Stefanie then took us through the biosocial theoretical underpinnings of the 2 varying populations they may target. UC clients may arise out of a mismatch between their highly sensitive temperament and a pervasively invalidating environment- during which adaptation meant turning up the volume of their feelings to be heard. Conversely, OC patients may have had perfectionistic caregivers, adding to an innately high threat response, resulting in a lifestyle that lacks spontaneity.

We were reminded that sessions can be extremely stressful for our generally overcompliant clients who have a hard time working on this material. We are encouraged to be looking for the “pushback” responses we get as they instinctively “protect” themselves from the inherent pain of recovery.

Ultimately, we are- all of us- blends of overcontrol (OC) and undercontrol (UC). So an understanding of both T-DBT and RO-DBT which has been built on it- is ideal.

Further reading is listed below, including one penned by Stefanie, herself- outlining the four core DBT concepts that inform Nutrition Therapy for ED’s. It was a great room; thank you to all who attended and participated!