Around 50 percent of patients with binge-eating disorder and bulimia do not improve using standard treatment. In such cases, DBT’s focus on regulating emotions can be very helpful, particularly when focusing on a single DBT component: skills training. In cases of binging and purging or binging, we have seen how even simple DBT can work wonders.

We typically employ several therapeutic modalities in order to fully address each patient’s eating disorder from different angles. We saw that this technique produces the best and most lasting results in our patients. Here in ‘Ai Pono, we use DBT together with other research-backed and time-tested therapies to empower our patients to change their behavioral patterns. We often utilize DBT skills together with CBT and ACT.

An example of our multifaceted therapeutic approach includes:

• Nutrition therapy for our ED patients in order to guide them in building a healthier and more rational relationship with food. 

• Interpersonal group therapy to lessen feelings of shame by allowing our patients to interact with people who have similar struggles as them. 

• Experiential therapies (like art therapy, sound therapy, and dance therapy) to enable our patients to deeply connect with their own bodies through movement and arts.

DBT for Eating Disorder: Group Therapy

Often regarded as the pillar of DBT, skills training involves teaching important life skills to patients, usually in a group setting such as a weekly class. In these sessions, our group leaders teach important behavioral skills to patients and assign the latter to do homework tasks.

Our DBT Skills Groups includes therapeutic modules for these categories:

Mindfulness

We help our ED patients learn and hone the practice of being and staying fully aware and present in the moment to appreciate their physical, emotional, and relational experience in real-time. People are not naturally good at using mindfulness effectively, that’s why intensive training is needed to get better at doing this.

In our eating disorder treatment center, we help patients remain fully aware and avoid making judgments of themselves and their surroundings, especially during important times, such as when they are tempted to give in to their impulse to restrict, binge, or purge

We teach them how to concentrate on making decisions using their “wise mind”—which includes both their rational and emotional inputs—as they learn to manage the urge to give in to their disordered eating patterns.

Using their developed mindfulness skills, our patients become aware of their potential triggers, problematic emotional states and thoughts, and unproductive choices that can lead to disordered eating behavior.

Keep in mind that even though mindfulness can inspire action, we don’t encourage responding to emotions nor managing them in this part of the program. Rather, we simply want our patients to first learn how to acknowledge and accept their emotions.

At ‘Ai Pono, we practice mindfulness in DBT groups as well as through guided meditation, somatic therapy (mindfulness of movement), and mindful walks to the nearby beach.

Emotion Regulation

As we’ve discussed earlier, regulating one’s emotions is a key element of DBT. Hence, the first module in any DBT Skills Group is focused on helping our patients learn how to manage their feelings, particularly basic emotions like sadness, fear, and anger.

By helping our patients regulate these emotions, they can avoid such emotions from evolving into more intense feelings or even destructive behaviors such as the ones characteristic of eating disorders.

Part of learning how to regulate emotions is learning to accept emotions as gifts. So often, those who struggle with eating disorders have been taught or believe that being “emotional” is wrong or bad, but we know that is not the case. Those who struggle with eating disorders are typically highly sensitive, intuitive beings who have simply developed an obsession with food, fat, and dieting as a way of coping with social and psychological stress.

Here at ‘Ai Pono Hawaii, we help our patients identify, label, and then process their emotions. We also guide them on how to lessen and cope with their unpleasant emotions, accept highly negative emotions and strengthen their resilience to those, and boost their positive emotional experiences.

All of those promote the use of coping strategies instead of maladaptive responses such as restriction, binge eating, or purging.

Our goal is to help our patients do the following on their own:

• Accurately identify, label, and process their emotions and understand the importance of having those emotions

• Lower sensitivity to negative emotions and increase positive emotions

• Transform their negative emotional states into positive ones using different skills, such as opposite action

• Make decisions that support a healthy lifestyle, promote good and harmonious relationships with others, encourage their personal development

• Promote a positive disposition in life and non-judgmental view of emotions

   

We would also like to assure you that it is natural for patients to run into setbacks as they’re learning to regulate their emotions. Based on our 35+ years of experience in treating eating disorders, we’ve come to know that many of those who struggle with an eating disorder have been unable to regulate their emotions for pretty much their whole lives before they sought treatment.

Our therapists are aware of this, and patients should be as well. Patience is crucial as this process takes time, but it’s all worth it because developing this skill of emotion regulation can serve everyone well for the rest of their life.

Distress Tolerance

This second skill is important for ED patients to manage the different feelings that cause them distress.

Upsetting emotions often make ED patients feel desperate to make those negative feelings instantly go away. By teaching our patients other ways to cope with distressing feelings, they can avoid the need to perform problematic eating behaviors.

At ‘Ai Pono Hawaii, we build our patients’ distress tolerance by helping them identify the various emotions that they’re bound to feel, particularly the ones that are related to their eating disorder. We want to lessen their susceptibility to emotional extremes using techniques such as distraction, self-soothing, awareness exercises, and radical acceptance. Ultimately, we want to help our patients cope effectively with the different types of crises that they’ll face in “real life.”

Distressing emotions often come up in the course of treatment as our patients begin to challenge their disordered thoughts and confront various triggering situations. We walk beside them  as they learn to accept the negative emotions that emerge in the process, as they make use of their skills toolbox in their journey to recovery.

We celebrate every successful attempt to avoid impulsive, dysfunctional reactions because we believe that this makes it easier for our patients to overcome the next ones. Our therapists guide patients who suffer from setbacks while developing their tolerance for distress by encouraging them to approach these moments with curiosity and view them as learning opportunities.

In the end, our goal for building the skill of Distress Tolerance is to see our patients accept that sometimes there is simply no solution to their problem, but that they have the strength to deal with it, reduce—or even totally avoid—feelings of distress, and altogether avoid using problematic ways of coping.

Interpersonal Effectiveness 

Learning skills related to interpersonal effectives are a centerpiece of the ‘Ai Pono program. In particular, patients will learn and regularly practice the assertive communication formula. This formula becomes a foundation of communication that empowers patients to express their needs in a direct and effective manner.

Assertive communication is a way of expressing your feelings clearly, directly, honestly and kindly—in a way that respects your feelings as well as the feelings of others. Unfortunately, because very few of us are taught to speak this way, it’s a language that feels unfamiliar at first. But like any other skill—like swimming, or driving a car, or playing the piano—it’s one that anyone can learn. It doesn’t take some sort of special DNA. It just takes some practice.

What does assertive communication have to do with eating disorder treatment and recovery? At its core, disordered eating is often about communication—to ourselves, or to others. When we experience something that we don’t know how to put into words—or are perhaps afraid to put into words—our bodies communicate the emotion by using food behaviors. This is how we wind up restricting or stuffing our feelings.

Individual DBT Therapy for Eating Disorders

Individual DBT therapy focuses on boosting our patients’ motivation in changing their life, and guiding them as they apply the skills that they’re learning to the events and challenges that they face in the outside world. Individual therapy at ‘Ai Pono takes place three times per week and is a venue where patients can “test out” and discuss many of the DBT skills that they have been learning throughout the course of treatment.