DBT versus CBT: Effective Therapy for Eating Disorders

Demystifying the DBT versus CBT debate for effective eating disorder therapy. Explore the differences and find the right approach for you.

June 30, 2024

Understanding Eating Disorders

To effectively compare and contrast the therapeutic approaches of Dialectical Behavior Therapy (DBT) and Cognitive Behavioral Therapy (CBT) for eating disorders, it is important to first understand what eating disorders are and why effective therapy is crucial in their treatment.

What are Eating Disorders?

Eating disorders are complex mental health conditions that are characterized by abnormal eating behaviors and distorted attitudes towards body weight and shape. They can have severe physical, emotional, and social consequences. The most common types of eating disorders include:

  1. Anorexia Nervosa: Individuals with anorexia nervosa have an intense fear of gaining weight, leading to severe restriction of food intake and a distorted body image.
  2. Bulimia Nervosa: People with bulimia nervosa engage in recurring episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, excessive exercise, or the misuse of laxatives.
  3. Binge Eating Disorder: Binge eating disorder involves recurrent episodes of consuming large amounts of food in a short period, accompanied by feelings of loss of control and distress.

The Importance of Effective Therapy

Effective therapy plays a crucial role in the treatment of eating disorders. It provides individuals with the tools and support needed to address the underlying psychological, emotional, and behavioral factors contributing to their disordered eating patterns. Therapy aims to help individuals develop a healthier relationship with food, their bodies, and themselves.

By engaging in therapy, individuals with eating disorders can:

  • Gain insight into the underlying causes and triggers of their disordered eating behaviors.
  • Learn coping strategies to manage negative emotions, body image concerns, and distorted thoughts surrounding food and weight.
  • Develop healthier behaviors and attitudes towards food, body image, and self-esteem.
  • Address co-occurring mental health conditions, such as anxiety or depression, which often accompany eating disorders.
  • Build a support network to foster ongoing recovery and prevent relapse.

In order to maximize the effectiveness of therapy for eating disorders, it is important to consider the specific therapeutic approaches available. This is where the comparison between DBT and CBT becomes relevant, as both approaches have shown promise in the treatment of eating disorders.

Overview of CBT

Cognitive-Behavioral Therapy (CBT) is a widely recognized and effective approach to treating eating disorders. It focuses on the connection between thoughts, feelings, and behaviors, aiming to identify and modify unhealthy patterns that contribute to eating disorders. Here is an overview of what CBT entails and how it is applied in eating disorder therapy.

What is CBT?

CBT is a form of psychotherapy that helps individuals understand the relationship between their thoughts, emotions, and behaviors. It is based on the premise that our thoughts influence our feelings and actions. By identifying and challenging negative or distorted thoughts, CBT aims to promote healthier thinking patterns and ultimately change harmful behaviors related to eating disorders.

The main goal of CBT in eating disorder therapy is to address the underlying cognitive distortions and beliefs that contribute to disordered eating behaviors. These cognitive distortions may include negative self-perceptions, body image concerns, or dysfunctional beliefs about food and weight. By replacing these distortions with more balanced and realistic thoughts, individuals can develop a healthier relationship with food and their bodies.

How CBT is Applied in Eating Disorder Therapy

In eating disorder therapy, CBT is typically implemented through a structured and goal-oriented approach. The therapist and the individual work collaboratively to identify specific thoughts, emotions, and behaviors related to the eating disorder. Key techniques used in CBT for eating disorders include:

  1. Self-Monitoring: Keeping a record of thoughts, emotions, and behaviors related to eating and body image. This helps individuals become more aware of their patterns and triggers.
  2. Cognitive Restructuring: Identifying and challenging negative or distorted thoughts about food, weight, and body image. This process involves replacing these thoughts with more accurate and balanced perspectives.
  3. Behavioral Techniques: Introducing new coping skills and strategies to manage urges, cravings, and emotional triggers related to disordered eating. This may include using relaxation techniques, practicing problem-solving skills, or engaging in pleasurable activities that are unrelated to food.
  4. Exposure and Response Prevention: Gradual exposure to feared foods or situations, accompanied by the prevention of associated rituals or compensatory behaviors. This helps individuals confront their fears and develop healthier coping mechanisms.
  5. Relapse Prevention: Developing strategies to maintain progress and prevent relapse after the completion of therapy. This may involve creating a support network, setting realistic goals, and engaging in ongoing self-care practices.

By integrating these techniques, CBT aims to empower individuals to challenge their negative thoughts and develop healthier behaviors and coping mechanisms. The structured nature of CBT provides individuals with a framework to actively participate in their recovery journey.

Understanding the basics of CBT is essential for individuals considering eating disorder therapy. However, it's important to remember that the effectiveness of therapy approaches can vary based on individual needs and preferences. Collaborating with a professional is key to determining the most suitable treatment approach for each person.

Overview of DBT

What is DBT?

Dialectical Behavior Therapy (DBT) is a type of psychotherapy that was initially developed to treat individuals with borderline personality disorder. However, it has also been found to be effective in the treatment of eating disorders, such as anorexia nervosa, bulimia nervosa, and binge eating disorder. DBT combines elements of cognitive-behavioral therapy (CBT) with concepts from Eastern philosophies, emphasizing mindfulness, acceptance, and the development of coping skills.

DBT focuses on helping individuals regulate their emotions, manage distress, and improve interpersonal relationships. It recognizes that eating disorders often stem from difficulties in emotion regulation and self-destructive behaviors. By targeting these underlying issues, DBT aims to promote healthier coping mechanisms and enhance overall well-being.

How DBT is Applied in Eating Disorder Therapy

In eating disorder therapy, DBT is typically delivered in both individual and group settings. The treatment involves a combination of individual therapy sessions, skills training groups, phone coaching, and therapist consultation meetings. These components work together to provide a comprehensive and structured approach to treatment.

During individual therapy sessions, the therapist and the individual with an eating disorder work collaboratively to identify and address specific challenges related to their eating disorder. The therapist helps the individual develop skills to manage emotions, tolerate distress, and navigate difficult situations. They also work on enhancing self-acceptance and promoting a positive body image.

Skills training groups are an essential aspect of DBT for eating disorders. These groups provide education and training in four key areas: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Through these groups, individuals learn practical skills and strategies to cope with triggers, regulate their emotions, and improve their relationships.

Phone coaching is an integral part of DBT and allows individuals to access support outside of therapy sessions. It provides individuals with the opportunity to receive guidance and assistance from their therapist when facing challenging situations or experiencing distress.

Lastly, therapist consultation meetings are regular meetings where the therapists providing DBT for eating disorders come together to discuss their cases and seek guidance from experienced colleagues. This ensures that therapists are effectively implementing DBT techniques and maintaining fidelity to the treatment model.

DBT for eating disorder therapy is a comprehensive and structured approach that focuses on building skills, enhancing emotional regulation, and promoting healthier behaviors. It can be an effective treatment option for individuals struggling with eating disorders, offering them the tools and support they need to achieve lasting recovery.

The Differences Between CBT and DBT

When it comes to eating disorder therapy, two commonly used approaches are Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT). While both are effective in their own right, they have some key philosophical differences and distinct focuses and techniques.

Philosophical Differences

CBT is rooted in the belief that thoughts, feelings, and behaviors are interconnected. It aims to identify and modify negative thought patterns and behaviors that contribute to eating disorders. CBT focuses on challenging and replacing distorted thoughts with more realistic and adaptive ones, which in turn leads to healthier behaviors.

On the other hand, DBT takes a more holistic approach. It emphasizes acceptance of oneself and the current situation while simultaneously working towards change. DBT recognizes that individuals with eating disorders often struggle with emotional regulation and interpersonal difficulties. Therefore, it incorporates mindfulness techniques, acceptance, and validation to help clients develop new coping skills.

Focus and Techniques

CBT primarily targets cognitive distortions and maladaptive behaviors related to eating disorders. It helps individuals recognize and challenge unhealthy thoughts and behaviors, such as rigid dietary rules, body image concerns, and binge-eating episodes. CBT techniques may include self-monitoring, cognitive restructuring, exposure therapy, and behavioral experiments.

DBT, on the other hand, places a strong emphasis on emotional regulation and interpersonal effectiveness. It aims to help individuals identify and manage intense emotions that contribute to disordered eating behaviors. DBT techniques may include mindfulness exercises, emotion regulation strategies, interpersonal skills training, and distress tolerance techniques.

To summarize the differences between CBT and DBT in eating disorder therapy, the table below provides a side-by-side comparison:

It's important to note that while CBT and DBT have their own unique approaches, the choice between the two depends on the individual's specific needs and preferences. Collaborating with a qualified mental health professional is essential to determine which therapy approach aligns best with the individual's goals and circumstances.

Which Approach is Right for You?

When it comes to choosing the right therapy approach for eating disorders, it's important to consider various factors that can influence the effectiveness of the treatment. Both DBT and CBT have shown positive outcomes in eating disorder therapy, but the choice ultimately depends on individual needs and preferences. Here are some considerations to keep in mind when selecting the most suitable approach:

Considerations for Choosing Therapy

It's important to evaluate these considerations and discuss them with a mental health professional who specializes in eating disorders. They can provide valuable insights and help you make an informed decision based on your unique circumstances and treatment goals.

Collaborating with a Professional

Collaboration with a professional is crucial in determining the most appropriate therapy approach for your specific needs. A mental health professional, such as a psychologist or therapist, can conduct a thorough assessment and provide a comprehensive evaluation of your situation. They will consider factors such as the severity of the eating disorder, any co-occurring conditions, and your personal preferences.

During the assessment process, the professional will gather information about your symptoms, history, and treatment goals. They will also discuss the different therapy options available, including DBT and CBT, and explain how each approach can address your specific challenges. This collaborative process ensures that you are actively involved in the decision-making process and have a clear understanding of the treatment plan.

Remember, therapy is not a one-size-fits-all solution. Each individual is unique, and what works for one person may not work for another. By working closely with a mental health professional, you can identify the therapy approach that aligns with your needs, preferences, and treatment goals, ultimately increasing the likelihood of a successful outcome in your journey towards recovery.

FAQs about CBT and DBT

Here are some common questions and answers about Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) for eating disorders:

Q: How long does therapy typically last?

A: The length of therapy can vary depending on individual needs and circumstances. Generally, both CBT and DBT for eating disorders involve a structured and goal-oriented approach that can range from several months to a year or more.

Q: Will I be required to attend group therapy sessions?

A: Both CBT and DBT for eating disorders may include group therapy sessions as part of the treatment plan. These groups offer education, support, and skills training in a supportive environment with peers who are also working towards recovery.

Q: Can I continue seeing my current therapist while receiving CBT or DBT?

A: It's important to discuss this with your mental health professional. In some cases, therapists may be able to integrate CBT or DBT techniques into their existing treatment approach. However, it's essential to ensure that the therapist has the necessary training and expertise in the specific therapy approach.

Q: What if I have co-occurring conditions?

A: Both CBT and DBT can be effective treatments for individuals with co-occurring conditions, such as anxiety or depression. However, it's essential to discuss any co-occurring conditions with your mental health professional during the assessment process so that they can develop an appropriate treatment plan.

Q: How do I know which approach is right for me?

A: The choice between CBT and DBT ultimately depends on individual needs, preferences, and circumstances. It's important to collaborate with a mental health professional who specializes in eating disorder therapy to determine which approach aligns best with your goals and challenges. They can provide valuable insights into each approach's benefits and drawbacks based on your specific situation.


Both CBT and DBT are effective approaches in treating eating disorders. While they have their own unique philosophies and techniques, the choice between the two ultimately depends on individual needs and preferences. It's essential to collaborate with a qualified mental health professional who can conduct a thorough assessment of your situation and help you determine which approach aligns best with your goals.

It's important to remember that recovery from an eating disorder is a journey that requires commitment, patience, and support. Both CBT and DBT offer structured and evidence-based treatment options that can help individuals develop healthier coping mechanisms, regulate their emotions, improve interpersonal relationships, and achieve lasting recovery.

If you or someone you know is struggling with an eating disorder, seeking professional help is crucial. By working closely with a mental health professional who specializes in eating disorder therapy, individuals can access the resources and support necessary to overcome their challenges and move towards a happier and healthier life.