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August 11, 2015

What does it mean if a program says they "do Dialectical Behavioral Therapy"?

by Lucene Wisniewski, PhD Mark Warren, M.D.

Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partnered in 2014.

By Drs Lucene Wisniewski and Mark Warren

Over the last 15 years Dialectical Behavioral Therapy (DBT) has gone from being virtually unknown to being a term utilized by many treatment programs. DBT is an evidence based therapy, initially designed for Borderline Personality Disorder, and more lately for other diagnoses including eating disorders (Wisniewski, L., Safer, D., & Chen, E.Y., 2007). With its increase in popularity among treatment providers it is important to be clear about what it means to "do DBT" so an individual knows if they're receiving evidence based care.

Comprehensive DBT treatment, initially described by Marsha Linehan, has four components: Individual therapy, skills group, 7 day week phone consultation availability, and consultation team for therapists known as "therapy for therapists". Unless all four of these components are present, a program is not providing comprehensive DBT treatment. Additionally, in order for a therapist to be capable of providing DBT, a significant training process is generally required. This training process necessitates a therapist taking a non-judgmental stance, the ability to encourage motivation and commitment with their client, extensive knowledge and understanding of the DBT skills and therapeutic techniques, and the balance of accepting where a client is while moving them towards change.

For these reasons, as well as other reasons related to the complexity of providing any new therapy, comprehensive DBT programs are in fact very difficult to create and to maintain. If you are evaluating a treatment program and they say that they "do DBT" it is important that you find out exactly what this means. In many instances programs use the term "DBT" as short hand for skills groups based on DBT skills. Other programs or therapists may have had DBT training and are attempting to use the stance of the DBT therapist but may not have many of the components necessary to meet the rigorous criteria for fully providing comprehensive DBT. The interested consumer should be aware that there is some data suggesting that DBT skills alone may be adequate for people suffering from Binge Eating Disorder or Bulimia Nervosa who have very few symptoms (for example, binge eating 2 times per week or less). There is no data to suggest that skills alone are helpful for clients with anorexia or those with higher frequency bingeing and/or purging behavior, or for those eating disorder patients who also suffer from co-morbid disorders such as depression or PTSD. So while programs may be strengthened by the inclusion of some DBT components, the current expert option suggests that patients with complex eating disorders will benefit from comprehensive DBT treatment.

Wisniewski, L., Safer, D., & Chen, E.Y. (2007) Dialectical Behavior Therapy for Eating Disorders. In L.A. Dimeff & K. Koerner (Eds.), Dialectical Behavior Therapy in Clinical Practice (pp. 174-221). New York, NY.

Contributions by Sarah Emerman

About the Author

Mark Warren, M.D.

Mark Warren, M.D.

Mark Warren is the chief medical officer of The Emily Program. He is also one of the original founders of the Cleveland Center for Eating Disorders, which recently merged to become The Emily Program – Cleveland. A Cleveland native, he is a graduate of the Johns Hopkins University Medical School and completed his residency at Harvard Medical School. He served as Chairman of the Department of Psychiatry at Mt. Sinai Hospital and Medical Director of University Hospital Health System's Laurelwood Hospital. A past vice-chair for clinical affairs at the Case School of Medicine Department of Psychiatry, he continues on the Clinical Faculty of the Medical School, teaching in both the Departments of Psychiatry and Pediatrics. He is currently a faculty member and former chair of the Board of Governors at the Gestalt Institute of Cleveland. Dr. Warren is a Distinguished Fellow of the American Psychiatric Association, a two-time recipient of the Exemplary Psychiatrist Award of the national Alliance for the Mentally Ill, and a winner of the Woodruff Award. He leads the Males and Eating Disorders special interest group for the Academy of Eating Disorders.
Lucene Wisniewski, PhD

Lucene Wisniewski, PhD

Lucene Wisniewski, PhD, FAED is Chief Clinical Integrity Officer of The Emily Program and is an Adjunct Assistant Professor of Psychological Sciences at Case Western Reserve University. From 2006-2014, she served as Clinical Director and co-founder of the Cleveland Center for Eating Disorders, a comprehensive eating disorder treatment program. Her research and clinical interests include using empirically founded treatments to inform clinical programs. She provides workshops on the CBT and DBT treatment of eating disorders internationally and publishes in peer reviewed journals as well as invited book chapters. Dr. Wisniewski has been elected fellow and has served on the board of directors and as the co-chair of the Borderline Personality Disorder special interest group of the Academy for Eating Disorders (AED). In 2013 the AED awarded Dr. Wisniewski the Outstanding Clinician Award to acknowledge her contribution to the field of eating disorder treatment.

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