DBT vs. CBT in Treatment for Eating Disorders

Contributed Article by Debra Cooper, BS, Staff of Timberline Knolls Residential Treatment Center.

For some time, Cognitive Behavioral Therapy (CBT) has been the therapeutic road most taken in the treatment of eating disorders. This approach is based on the idea that one can control/change thoughts. The treatment involves changing the way a person thinks in order to feel better, even if the situation does not change.

Conversely, Dialectical Behavior Therapy (DBT) is an approach that integrates an acceptance strategy into the equation. The word “dialectical” simply means that two opposite things can be true at the same time; therefore, in DBT, an individual accepts her thoughts and behaviors without the immediate need to change them.

At Timberline Knolls, we utilize DBT in the treatment of mood disorders, substance abuse/addiction and co-occurring disorders. And we find DBT especially beneficial in the treatment of eating disorders because of the following: the value of a thought.

We have millions of thoughts every day; most have equal value. A thought isn’t intrinsically good or bad – it just is. If an anorexic thinks, “I am fat,” is that any more important than, “it’s a nice day.”  No, it’s not.  In fact, a thought is only given value if focused upon. We want our residents to acknowledge the thought, then practice the skills of mindfulness and distress tolerance, and move on. In early recovery, distress tolerance often means action: walking, playing a game, talking with a friend. As recovery progresses, it may be as easy as returning to the current activity, perhaps reading a book.

Prioritizing Thoughts

Since thoughts have equal value, why would a woman spend time dealing with the “I am fat” thought?  The truth is, we cannot control our thoughts, but we can control where we place our attention.

The Pink Elephant

The eating disorder mind has spent months, even years engaging overlearned automatic thoughts. It will not switch off in a day. We all know the more anyone tries to NOT conger a pink elephant, the more it will appear. “I am fat” will return relentlessly, which is its goal.

The Positivity of Practice

Practicing DBT skills when not under the barrage of negative thoughts means a woman is well-equipped when painful thoughts arise. Although the goal of DBT is not eliminating bad thoughts, we find that the more our residents are willing to accept the thoughts, the less they actually appear. 1

Both CBT and DBT have great value in the world of treatment. At Timberline Knolls, we have seen great success utilizing the tools and skills found in DBT.



1 Linehan, M. M. (1993). Cognitive-behavioral treatment of borderline personality disorder. New York, NY: Guilford Press



Last Reviewed By: Jacquelyn Ekern, MS, LPC on June 21, 2013

Page last updated: June 21, 2013
Published on EatingDisorderHope.com, Eating Disorder Assistance