BOOK REVIEWS: Dialetical Behavior Therapy for Binge Eating and Bulimia

Dialetical Behavior Therapy for Binge Eating and Bulimia

By Debra L. Safer, Christy F. Telch, and Eunice Y. Chen. Guilford Press, NY, 2009; 237 pages; $35

Dialectical Behavior Therapy (DBT) has gained considerable and well-deserved prominence as a treatment package to assist patients suffering from emotional dysregulation, self-harming behaviors and other behavioral manifestations of disinhibited undercontrol. Certainly, in caring for patients with self-harming behaviors in the context of borderline personality disorders, this treatment approach, developed, tested and elsewhere disseminated by Marcia Linehan and her colleagues at the University of Washington and elsewhere, has been increasingly used. This is due to the evidence-based research that has shown its effectiveness in reducing self-harming behaviors, emergency room visits and hospitalizations, compared to treatment as usual. Therapists of varied persuasions have sought training in these methods that combine cognitive behavioral therapy, mindfulness training, psychodynamically informed crisis intervention, and group and family work, combined with the use of medication as indicated.

DBT has been increasingly applied to diverse clinical populations of patients for whom settling into, adhering to and gaining full benefit from more traditional one-on-one treatments has not sufficed. It was therefore natural that DBT should be applied to patients with binge eating disorder (BED) and bulimia nervosa (BN), who also suffer from difficulties with emotional self-regulation, including those with concurrent severe personality and mood disorders. A variety of controlled clinical trials have shown initial promise for this approach. Parenthetically, many of the techniques employed in DBT, not surprisingly, also benefit patients with less severe forms of emotional dysregulation.

In this welcome volume, Safer and Telch, a psychiatrist and psychologist, respectively, at Stanford, and Chen, a psychologist now at the University of Chicago who studied with Linehan, all experienced clinicians and researchers who have applied DBT to the BED and BN populations, thoroughly review this area and carefully educate clinicians in the application of DBT to eating disorders populations. They explicitly suggest that clinicians first read Linehan’s two classic 1993 manuals, Cognitive-Behavioral Treatment of Borderline Personality Disorder and Skills Training Manual for Treating Borderline Personality Disorder, which they consider to be companion texts to this book. Laid upon that background, and rich with case examples, this book specifically focuses on the application of DBT techniques to BED and BN patients.

The book offers practical orientations and perspectives, exercises, homework assignments, and troubleshooting pointers that address getting started and motivational aspects of the “pretreatment stage,” core skills that attend to mindfulness, emotional regulation and distress tolerance – the heart of the program, and relapse prevention. The advice for clinicians gets very specific, including numerous specific scripts couched as “potential therapist replies” to questions frequently asked by patients. In a concluding section on future directions, the authors point out the increasing availability and use of online and CD-ROM-based sources (an online source that my patients have sometimes found useful is: www.DBTselfhelp.com.) A helpful resource appendix for researchers is an added bonus.

Since all clinicians working with eating disorders patients are likely to be seeing patients who might benefit from DBT, this book is a very welcome point of entry for those who have not yet learned about when to prescribe and how to apply these techniques, and will also be a useful aid to those who already recognize the benefits.

– J.Y.