Dialectical Behavioral Therapy (DBT) is one of the leading evidence-based practices for treating eating disorders. DBT has a plethora of skills and many of these skills have acronyms, sometimes it can feel overwhelming just simply trying to remember them all. It’s hard to know what DBT skills to use and what will be specifically helpful for eating disorder recovery, even for those who have been using DBT for years. Here is a list of helpful 6 DBT skills for eating disorder recovery.
DBT Skills for Eating Disorder Recovery:
I’m putting this first as this really is the foundation of skills. As I say to my clients, “if your SEEDS are out of balance, you’re going to feel out of balance”. You can think of your SEEDS, like a seed you plant in the ground. SEEDS is an acronym for Sleeping, Eating, Exercise, Downtime, Socializing/Substances and it is an emotion regulation skill. It’s helpful to write down where you would like each of your SEEDS to optimally be and then what you need to work on to get there. For example, “Eating” is a huge part of the work you will do in eating disorder recovery. You can set goals to utilize the hunger scale, have a food that you may often avoid, or practice following your meal plan. Another example is eating disorders are often very isolative in nature. You can set a goal to spend time with loved ones during your week, where you otherwise may have been engaging in your eating disorder.
2. Opposite to Emotion
Opposite to emotion is yet another emotion regulation skill, or an “everyday skill.” Our emotions all have hard-wired responses. For example, anger makes us want to attack, shame makes us want to hide, fear makes us want to run away or avoid, and sadness makes us want to isolate or withdraw. Our emotions can lead us away from living by our values or making wise-minded decisions that are going to be helpful for us. Identify which emotions you tend to struggle with and how you react to these emotions. An example with your eating disorder may be with your negative body image.
You may experience shame or anxiety around your body, which in turn may lead to you to avoid looking in the mirror, not eating certain foods, or wearing certain kinds of clothing to hide your body. To practice this skill, ask yourself, “What emotion is showing up right now?” “Is this going to be helpful or hurtful for me to act on this?” “Does this reaction align with my values and beliefs.” (Spoiler alert: it’s usually not helpful to make decisions solely on an emotion) Then, if it is not going to be helpful for you to act on, practice doing the opposite of this emotion. So instead of avoiding looking at your reflection in a mirror, practice looking at yourself in the mirror without judgment.
3. Riding the wave
The infamous “ride the wave” skill. This is a distress tolerance skill that can be used when you are feeling heightened or distressing emotions. Sometimes our emotions can feel so intolerable that we’ll do anything to “just get rid of them”. Unfortunately, sometimes the only ways that we know to get rid of our intense emotions are unhealthy behaviors. Some people may use restricting, bingeing, over-exercising, or purging as a way to cope with big feelings.
It’s best to instead identify five things (tasks or skills) you can do when you feel distressing emotions. So that when you are experiencing distressing emotions practice using one or maybe all five for 20-30 minutes. Usually, distressing emotions will last about 20 minutes. You can use this skill before eating, after eating, or to cope with urges to binge, purge, or over-exercise.
These are distress tolerance skills but they can also be used every day. Self-soothing skills are the “grounding” skills and don’t have to only be used when experiencing crisis emotions. You can use them to help practice relaxation and calming your nervous system. Knowing how to comfort yourself or how to calm down an overactive nervous system is highly beneficial. A lot of times one’s eating disorder behaviors are what they are turning to regulate their emotions. Self-soothing skills are essentially the five senses: taste, smell, sight, sound, and touch. You can identify which of the senses may benefit you, and you may have to try out using different senses to know. It’s a good idea to have a plan in place to know which self-soothing techniques you will utilize. These may be different when you are trying to relax versus when you are in crisis emotions. You can use this skill to help with managing everyday anxiety, coping with urges to use eating disorder behaviors, or coping with negative body image emotions and thoughts.
Simply put, Mindfulness is being present. Mindfulness is the cornerstone or “at the heart” of every skill you will use in DBT. It’s pretty difficult to use a skill if you’re not aware of what is going on or if you need to use a skill. Mindfulness has many benefits ranging from greater awareness of self, others, and emotions to a greater ability to sit with emotions. This helps us learn to not get caught up in our thoughts and regulate our nervous system. With eating disorder recovery, mindful eating is essential to improve your relationship with food.
In addition, a lot of times when someone is struggling with an eating disorder, they have a hard time being present in their body or struggle with a preoccupation with eating disorder thoughts. Practicing mindfulness can help not only improve your relationship with food and your body, but manage disruptive thought patterns or difficult emotions. It is recommended you practice some form of mindfulness for 10 minutes a day to work this mental muscle and build a greater sense of being present in your life.
6. Radical Acceptance
Last but certainly not least is radical acceptance. This is, to many a surprise, a distress tolerance skill because sometimes it really can feel so radical to have to accept something. Radical acceptance is a distress tolerance skill. It sounds much easier said than done. The first concept I try to make clear to my clients is you don’t have to feel accepting to practice radical acceptance. The opposite of acceptance is suffering. Some questions you can ask yourself to see if you are suffering are the following: is there anything I’m doing to change my situation or my emotions right now? Am I questioning myself, others, my emotions, or the situation? Am I fighting reality? Knowing when you are suffering is helpful to be able to stop, take a step back, and proceed through practicing acceptance. Even though you may emotionally not be there yet. Sitting in suffering does not help you.
To practice acceptance ask yourself: what would I be doing if I accepted this situation or emotion? Then challenge yourself to behave in a way that aligns with acceptance. Remind yourself that it is okay to feel and that there are a series of casual factors that lead up to any event as to why it had to occur just this way, and you’ll never be able to know all of those “why’s”. Practice turning your mind back to the present and acting in a way that aligns with acceptance. With your eating disorder, you may have to accept your body, that you need food to survive, difficult emotions with eating food, and so on.
Article written by Julie Raymond, LCPC
For more on eating disorders see NEDA