DBT vs. CBT: Effective Therapy for Bulimia Nervosa

Article Contributed by Staff of The Meadows Ranch
DBT work while eating breakfast

Dialectical Behavior Therapy vs. Cognitive Behavioral Therapy (DBT vs. CBT) may seem to present opposing factions searching for one to surpass the other ineffectiveness in treatment. Yet, once the core premise of both modalities are evaluated, they tend to be more complimentary than not.

DBT from its origin is an enhanced form of CBT incorporating a systemic spectrum of therapeutic concepts and interventions. When addressing Bulimia Nervosa, using both CBT and DBT in unison, clients can discover the importance of addressing both one’s destructive thought processes, resulting in poor behavior and the need for emotional stability.

Cognitive Behavioral Therapy (CBT)

CBT is generally a short-term therapeutic approach that currently has research supporting its efficacy for treatment. A basic premise of CBT is that a person’s thoughts affect their feelings and thus perpetuate the particular behavior. This premise would hold true for patterns resulting in life-enhancing outcomes and those that result in life depreciating outcomes.

In a clinical setting, the initial treatment step is to use a Functional Analysis of a patient’s selected destructive thought, corresponding feeling and resulting behavior. This form of therapeutic intervention has its best results when used with a patient who has the ability for introspection, insight, and subsequent innate goal-directed motivation.

Once a person identifies the origins of a destructive thought leading to poor behavior, they begin to institute corrective measures with which to change that thought over time. The goal is to achieve a more favorable behavior. In its simplest form, CBT seeks to affect change in one’s thoughts that then alter destructive behavior into constructive behavior.

Dialectical Behavior Therapy (DBT)

DBT adds to this clinical equation by improving how a patient self-regulates their internal states of emotion. DBT maintains an initial perspective that patients are not aware of the causes of their states of dysregulated emotion, nor how these states of dysregulated emotion might correlate with their destructive thoughts and poor behavior.

pinky-swear-over DBT

DBT begins developing the process of self-regulation by including the concepts of “Awareness” of fluctuating emotion states and personal “Acceptance” that there is a need for change. The dialectic in play can be found in the need for the patient to “Accept” themselves for where they are or what their behavior is and subsequently recognize they have a need to change.

In regards to Bulimia Nervosa, for the sake of this article let’s reduce the multiple causal features often inherent for such disordered behavior to a single lineage. For example, a patient purges at 10:00 pm.

By facilitating a DBT intervention call the Behavioral Chain Analysis (BCA), which reverses in written form, the sequence of events leading to the purge action while identifying the corresponding thoughts and feelings. In treatment, a therapist might discover the following sequential dynamic.

  • 10:00 pm: Behavior of Purge; Thought – I deserve punishment; Feeling – calmness
  • 9:00 pm: Behavior of Binge; Thought – I am so full my stomach hurts; Feeling – shame
  • 7:00 pm: Behavior of Isolation; Thought – I am of no value; Feeling – despair
  • 5:30 pm: Behavior of Family gathering; Thought – I disappoint everyone; Feeling – anger
  • 10:00 am: Behavior of Employment; Thought – All project deadlines must be met; Feeling – fear
  • 6:00 am: Behavior of Waking up; Thought – How can I get through this day; Feeling – anxiety
  • 12:00 am: Behavior of Sleep; Thought – I’m not able to get to sleep at a reasonable time; Feeling – irritable, distractible

Happy woman talking about DBTUsing the above scenario, a CBT based approach may initially focus on the thought regarding the action of purging by seeking to alter the corresponding thought of “I deserve punishment.”

Interventions seeking a gradual change to an improved thought of “I deserve love”, may be the end goal. Examples of activities such as improving self-care by way of a pedicure, or “paying it forward” at a local coffee house, or providing volunteer services for the elderly, could be utilized to enhance a core sense of self-value. The end goal of seeing oneself as having meaning is of significant value, yet this may or may not be enough to achieve a long-term favorable shift in the patient’s core function.

In the same simplified scenario, a DBT approach could view this episode of purging as the result of emotion dysregulation stemming from an earlier experience that the patient is not aware has a direct correlation.

Using BCA

By implementing use of a BCA, the patient can be guided to consider the incremental development through previous behavior with correlating thoughts and feelings, leading to an event of origin such as experiencing poor sleep patterns similar to what has been illustrated above.  Having less than adequate sleep affect one’s mood state, memory and their ability to behave in top form.

The experience of poor sleep patterns if habitual combined with stressful events such as a sense of failure, may contribute to an increase in a temperamental sensitivity leaving one vulnerable to impulsive behavior such as a binge episode. Consequently following a significantly large volume binge episode, the subsequent purge episode would reasonably follow suite for a patient who experiences a calming effect from such an action.

Yoga and Relax and DBTThrough the use of a BCA, once a patient grasps the concept that their self-care habits and life experiences contribute to various states of emotion regulation or dysregulation, they may choose to learn better ways to manage details such as their sleep habits as a starting point. To gain a more robust foundation from which to improve one’s life, a patient would be taught Mindfulness and Distress Tolerance skills.

With practice, these skills based interventions will permit the patient to begin implementing a moment to moment routine of self-care. The intentional use of self-care habits can permit the patient to see each life encounter as an opportunity to identify their state of emotion, as well as chose to implement a skill for maintaining a state if “self-regulation” even when they encounter some form of discomfort.

Both CBT and DBT seek to stop destructive behavior and enhance productive behavior. Together they both promote mental health education and use a plethora of interventions focused on improving one’s circumstances.

They both propose that one’s life experiences affect thought patterns and behavioral actions.  DBT takes this a step further by considering that one’s progressive state of emotion is a core element facilitating unhealthy or healthy life patterns. DBT use a more systematic series of education modules with defined skills.  In considering the features of both treatment modalities, the outcome is less of a CBT vs. BDT mindset, as it is more of a CBT + DBT integration that may best serve a patient afflicted with Bulimia.

For over 25 years, girls and women with eating disorders and co-occurring disorders, such as social anxiety disorder, have recovered, restored and renewed their lives at The Meadows Ranch. The Meadows Ranch utilizes both DBT and CBT as well as other treatment modalities to successfully treat patients with eating disorders through their Inpatient and Residential levels of care.

A world-class clinical team of industry experts examines core issues through a host of proven modalities. Providing individuals with tools to re-engage in a healthy relationship with food – and with themselves – disempowers eating disorders and empowers individuals with a renewed enthusiasm for life.  To learn more, visit www.remudaranch.com or call 866.390.5100.

Article Contributed by Staff of The Meadows Ranch:

For over 25 years, The Meadows Ranch has offered an unparalleled depth of care through its unique, comprehensive, and individualized program for treating eating disorders and co-occurring conditions affecting adolescent girls and women. Set on scenic ranch property in the healing landscape of Wickenburg, Arizona, The Meadows Ranch allows for seamless transitions between its structured multi-phase treatment. A world-class clinical team of industry experts leads the treatment approach designed to uncover and understand the “whys” of the eating disorder through a host of proven modalities. Providing individuals with tools to re-engage in a healthy relationship with food – and with themselves – disempowers eating disorders and empowers individuals with a renewed enthusiasm for life. Contact us today at 888-496-5498 and find out why The Meadows Ranch is the best choice for eating disorder treatment and recovery. For more information call 1-888-496-5498. or visit www.themeadowsranch.com.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.  

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors.  If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Recently Reviewed By: Jacquelyn Ekern, MS, LPC on July 2, 2017. Published on EatingDisorderHope.com