DBT Program

Dialectical Behavior Therapy (DBT) is the core foundation of our eating disorders program. Every member of our staff is thoroughly trained and knowledgeable in the DBT skill sets, particularly as they apply to eating disorders. In addition to DBT group sessions, the clinical staff at Carolina House integrates DBT skills into every aspect of treatment.

Originally developed in the 1970s by Marsha M. Linehan, Ph.D., DBT is a well-researched approach proven to be highly effective in treating eating disorders through teaching effective coping skills. The DBT skills are Core Mindfulness, Emotion Regulation, Distress Tolerance, and Interpersonal Effectiveness.

Core Mindfulness involves developing the capacity to stop the “chatter” of the mind and nourish present-moment awareness of physical, emotional, and relational experiences. We strive to increase our awareness of present experience without judgment. Through the use of mindfulness skills, we can become alerted to potential triggers,  emotional states and problematic choices that can result in engaging in eating disorder behaviors. We also strive to increase our capacity to make wise choices when we function with awareness, and understand how our choices impact our experiences.

Interpersonal Effectiveness includes strategies for working through interpersonal conflicts with a balance of assertiveness and consideration for others. By learning appropriate ways to make requests, say no, and communicate feelings, clients find healthy ways to get their needs met without damaging their relationships or losing self-respect. Clients at Carolina House frequently put to use their “DEAR MAN” skills:

D: Describe

E: Express

A: Assert

R: Reinforce

M: Mindful

A: Appear Confident

N: Negotiate

Emotion Regulation helps eating disorder sufferers identify and process their emotions without becoming angry, depressed, or anxious. We teach various methods of learning to accept emotions as a necessary step toward effectively addressing our needs. Our patients are frequently very emotional and there is a strong component of emotional distress when we talk about disordered eating. As such, we work to help people understand, accept, reduce, and even change emotional states that can be painful.

Our emotion regulation module is dedicated to three related goals:

  1. Accurately identifying and labeling emotions and understanding their functions.
  2. Reducing vulnerability to negative emotion and increasing positive emotions.
  3. Working on changing emotional states through the use of various skills such as opposite action.

Emotion regulation skills also help patients make choices that help develop a healthy lifestyle, cultivate positive relationships, work toward personal goals, and take a positive outlook on life and non-judgmental stance on emotion.

Distress Tolerance emphasizes learning to deal with stress and painful emotions skillfully, without making the situation worse. The reality of life is that sometimes we will not be able to solve our problems, no matter how skillfully we act. The Distress Tolerance skills are not designed to change a situation, but to help us survive and eliminate suffering. Through the use of skills such as distracting, awareness exercises, and radical acceptance we can work to get through a situation, reduce suffering, and minimize potential long-term problems.

More than a therapeutic approach, DBT helps eating disorder sufferers develop life skills to create healthy relationships, resolve conflicts, and abstain from disordered eating both during and after treatment.

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