Using DBT Skills to Prepare for the Holidays

By Megan Samuels, MSW, LMSW, Outreach Coordinator

Dialectical Behavior Therapy, or DBT for short, is a treatment modality that has research to support its effectiveness for the treatment of suicidality, borderline personality disorder, eating disorders, and self harm behaviors.  It has four sections, also known as modules, which are mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.  All of these components are helpful to the process of recovering from an eating disorder. 

One skill in the emotion regulation module of DBT is learning to cope ahead for future situations that may be triggering.  For a lot of folks in eating disorder recovery, the holidays can be an activating time.  Here are some ways that the holidays can bring up eating disorder thoughts and behaviors (please note that this list is not exhaustive):

• Change in schedule/routine
• Traveling
• Being with family
• Increase emphasis on food
• Taking time off work

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There are five steps in the cope ahead skill.  I will outline the steps below and then I will walk you through an example.

1. Describe the situation and think about what may trigger the problem behavior.  By problem behavior, this could be an eating disorder behavior, such as restricting, binge eating, or purging.  Spend some time thinking through the situation and identifying when the urge to use the problem behavior will arise.  
2. Decide what coping skill or problem solving skill you want to use to reduce the problem behavior.
3. Imagine the situation as vividly as possible.
4. Rehearse the situation in your mind and imagine coping effectively.  This could also entail rehearsing in your mind how you would handle the worst case scenario.  
5. Practice relaxation after rehearsing.  We want to associate coping effectively with relaxation or a positive state.  So, after you rehearse the situation in your mind, engage in some relaxation behaviors, such as taking a warm bath, engaging in some deep breathing, or doing some progressive muscle relaxation.

Example:

1. I am going to Christmas eve dinner and seeing all the food may make me have urges to binge eat.  
2. I can cope by texting a friend or playing games on my phone to distract myself.
3. I can imagine going to Christmas eve dinner and seeing the ham, the desserts, and all of the other food.  I can imagine smelling the food coming out of the oven and I can imagine feeling the heat that radiates out of the oven.  I can see my family members sitting around the fireplace.
4. I can see myself at Christmas dinner and I can imagine sensing the urge to binge eat.  I see myself pulling out my phone and texting my friend for support.  She is texting me back and helping me distract and engage in more adaptive behaviors.  I am able to eat the amount of food that feels intuitive to me, and I do not binge eat during this meal.  I see myself feeling proud of myself for getting through this meal without engaging in eating disorder behaviors.
5. After I imagine this scene in my head (step 4), I will now watch some TV to relax and regulate my nervous system.  This will help my body connect the sense of feeling proud and the ability to resist eating disorder urges with the feeling of relaxation.

**It’s important to note that it is not helpful to beat yourself up for binge eating and that binge eating and other eating disorder behaviors may be a resilient attempt at coping with experiences of oppression, trauma, difficult emotions, etc. AND in the long-run it is likely not serving you. 

This skill can be practiced for any event or situation that may trigger a problematic behavior.  If you are not sure where to start, you can think about the eating disorder behaviors that you engage in and what potential holiday situations may increase the likelihood of those behaviors occurring.  

Another note about this skill, we want to begin to use this skill when we are feeling regulated (ventral vagal nervous system state) and not activated in order to strengthen the adaptive coping neural networks in our brain.  

For an introduction on what DBT is and how it can be applied to eating disorder recovery, please check out this blog:

• https://www.theeatingdisordercenter.com/blog/the-importance-of-dialectical-behavior-therapy-dbt-in-eating-disorder-treatment

Want more?  The majority of the therapists at The Eating Disorder Center have extensive training and experience in using Dialectical Behavior Therapy (DBT) as an effective treatment modality for eating disorders.  Contact us for a free 15-minute consultation today!

References:
DBT Skills Training Handouts and Worksheets, Second Edition by Marsha M. Linehan. Copyright 2015 by Marsha M. Linehan.

*Disclaimer: The information is provided for educational and informational purposes only. It is not intended to be a substitute for your independent medical decision-making nor a recommendation or endorsement for any particular treatment plan, organization, provider, professional service, or product. You assume all responsibility and risk for any use of the information.​

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The Eating Disorder Center is a premier outpatient eating disorder therapy center founded by Jennifer Rollin. We specialize in helping teens and adults struggling with anorexia, binge eating disorder, bulimia, OSFED, and body image issues. We provide eating disorder therapy in Rockville, MD, easily accessible to individuals in Potomac, North Potomac, Bethesda, Olney, Silver Spring, Germantown, and Washington D.C. We also provide eating disorder therapy in Arlington, Virginia and virtually throughout Virginia. Additionally, we offer eating disorder therapy virtually in New York (NYC), Florida, and California. We provide eating disorder recovery coaching via Zoom to people worldwide. Connect with us through our website at www.theeatingdisordercenter.com