Traditional and Radically Open DBT for Eating Disorders: TIBs and the Treatment Hierarchy

Meet Your Instructor: Kirby Reutter, Ph.D., DBTC, LMHC, MAC

United States Department of Homeland Security

Key Points

Learning tends to be context-dependent. Even though the counseling office is a safe environment for learning new skills, it’s often difficult for clients to apply those skills in real-life situations outside of the counseling office.
DBT therapists need to provide between-session support so that clients can generalize skills learned in session to their own real-world settings.
Standard, traditional DBT was developed to treat disorders characterized by symptoms of underregulation, such as borderline personality disorder. Radically open DBT was designed to treat disorders characterized by symptoms of overregulation, such as obsessive-compulsive disorder.
Overall, standard DBT is more effective for treating symptoms of bulimia, whereas radically open DBT is more effective for treating symptoms of anorexia. However, since eating disorders can involve forms of both underregulation and overregulation, both approaches can be effective.
For clients who tend to be underregulated, it’s important to address treatment-interfering behaviors; otherwise, treatment will be undermined. For clients who tend to be overregulated, treatment compliance will not be an issue, but that does not mean they feel connected to the therapist—in which case, treatment will still be undermined. Therefore, for clients who tend to be overregulated, it’s important to address relationship ruptures instead.
When specifically treating symptoms of bulimia, treatment should also focus on the following priorities, in order:
- Eliminate any life-threatening behaviors.
- Decrease treatment interfering behaviors.
- Stop bingeing.
- Eliminate mindless eating and replace it with mindful eating.
- Decrease cravings/preoccupation with food.
- Decrease capitulating to urges.
- Decrease apparently irrelevant decisions.
- Learn other skills to foster an overall healthier life.