Written by Laura Bumberry, PsyD and a DBT Client
Dialectical Behavior Therapy is an evidence-based treatment for eating disorders, an approach that assumes difficulty regulating emotions is at the core of the disorder. Yes, we all have emotions, but for some emotions are more intense, quick to be activated, and slow to calm, creating a need for additional tools to manage them effectively. Behaviors, such as binge eating, purging, self-harm, and substance use, may be relied on just to survive the day. We also know that these behaviors cause people a lot of additional problems, from increased guilt and shame to dangerous health complications. Please read on to hear from a previous client and DBT graduate about her experiences with DBT. Don’t just take my word for it!
“I first heard about DBT from another therapist. She thought I might find the skills useful. I was blind to my eating disorder; I was blind to how my eating disorder was hurting me. I refused to see the immensity of the problem, convincing myself and others that my weight wasn’t an issue and food was something that just helped me get through the day. The more we talked about the opportunity, about the program, the more I felt the skills might be useful – even though I didn’t believe I had a problem.
The first time I met Laura was during an evaluation to participate in a DBT skills learning group. But before I could justify an appointment, or even the commitment of an appointment, I felt I had to prescreen the experience. I talked with Laura over the phone, trying to explain how small the problem was while also trying to hide how much I wanted new skills. She encouraged me to come in and learn more, to decide together if the program might be right for me.”
Taking that first step to pick up the phone or make an appointment can be terrifying. Thoughts of “This isn’t a big deal,” “I don’t deserve the help,” and “It’s hopeless so why bother?” often plague the mind when trying to make such a decision. DBT knows that life with an eating disorder can be unbearable. It also knows that the indecision comes from fear; one of the eating disorder’s best tactics to prevent someone from seeking the help they need and deserve.
“I sat across from Laura and explained that while I knew my relationship with food was “unhealthy” I wasn’t willing to give it up. It had become the one thing left for me. In food, I found stability. I found relief. I found sanctuary. I knew those feelings were only temporary and then followed by feelings of guilt, shame, fear, and anger. But I wasn’t interested in letting go of the one coping mechanism I had that provided stability and relief, no matter how temporary. Laura listened calmly and then explained the program.
The goal isn’t to take something away, she said.
The goal is to give you more tools and resources to choose from, she said.
The goal is to give you a choice, she said.
In my head, I called bull. Another therapist lie, I thought. I was skeptical – at best.
I was also so very desperate.”
DBT is about finding freedom and choice, rather than being locked in to one way of doing things. It is about learning and discovering that we have options, even when our first response is to cling to the behaviors that we have learned to rely on for so long. DBT fully understands that eating disordered behaviors are functional, and at times, a survival tool. Sound like “another therapist lie?” There is good news. You can be skeptical AND give DBT a chance. You can call “bull,” AND throw yourself in and test it out for yourself.
“I was tired of the cycle of my eating disorder. I needed stability and relief but I needed it consistently over a period of time. I couldn’t absorb any more anger, guilt, shame, and fear. I know now what I need is compassion but at the time I didn’t even have the ability to express that need out loud.
And so I joined the group. And I went to the group. I did my homework. I learned the language. I started putting things together. Some weeks I was so angry the most I could do was walk into the room. Some weeks I went home and cried. But I did it. I went through all the skills. I started using them.
I began having choices.
I began to choose my skills over food.
It isn’t perfect, because nothing is. But DBT has become a lifestyle. I use it every day, all day long. Even when I still use food, I use my skills. The things I learned in DBT bring me relief and stability. As I increasingly use DBT skills, I even find happiness. DBT has singularly been the most effective therapy program I’ve participated in. I share the skills with my friends. I teach them to my children. I think about situations in light of them. I talk frankly with people about the skills I’ve learned because now I know what Laura was trying to tell me, back in the beginning:
We can have choices.”
This final paragraph really captures it. DBT is not just about learning new tools to stop self-destructive behaviors; it is about living a life you want to live, even when it’s difficult. It is about incorporating these tools into all aspects of your life, and it takes time. Making the commitment is the first step, even if you’re skeptical. As we can see from this individual’s candid account, there will be times when painful emotions, busy schedules, and life in general make our commitment more challenging to uphold. And then we recommit. It is hard work. It is about being gentle with yourself, learning and practicing new skills, and committing to the process.
It is about having choices.
Learn more about DBT treatment.
Dr. Bumberry earned her doctorate in Clinical Psychology at Xavier University with an emphasis on child and adolescent psychology. She is a licensed clinical psychologist at Webster Wellness Professionals and provides treatment services for eating disordered behaviors. Dr. Bumberry has specialized training in evidence-based treatments, including Cognitive Behavior Therapy (CBT), Dialectical Behavior Therapy (DBT), and Family-Based Treatment (FBT), also known as the Maudsley Approach. She treats children, adolescents, and adults, and has specific interest in the relationship between disordered