Dialectical Behavior Therapy for Binge Eating Disorder and Bulimia Nervosa
Dialectical Behavior Therapy for Binge Eating Disorder and Bulimia Nervosa (DBT for BED and BN) is an adaptation of DBT® designed for adults with binge eating disorder or bulimia nervosa. DBT for BED and BN aims to help participants “build a life worth living” by developing the skills needed to change patterns in their behaviors, emotions, thoughts, and interpersonal relationships. DBT for BED and BN’s approach is grounded in the idea that two seemingly opposing facts can both be true, most notably that the goals of therapy include both acceptance and change. DBT for BED and BN therapists strive to help participants both accept themselves and make changes in their behavior.
DBT for BED and BN typically includes two key components: (1) weekly sessions with a therapist and (2) therapist consultation team meetings. During the sessions, therapists provide both therapy and skills training. Therapists typically deliver BED sessions in a group format and BN sessions in an individual format. During the therapist consultation team meetings, therapists discuss any implementation challenges and receive support designed to improve their capacity to treat participants.
In the therapy portion of the sessions, participants and therapists establish target behaviors to increase or decrease (e.g., increasing mindful eating and decreasing binge eating or purging) and identify alternative behaviors to use in specific situations. In the skills training portion of the sessions, therapists teach behavioral skills over three modules: (1) mindfulness, (2) distress tolerance, and (3) emotion regulation. The mindfulness and distress tolerance modules focus on building acceptance-oriented skills, while the emotion regulation module focuses on building change-oriented skills. In the mindfulness module, therapists emphasize accepting current circumstances and being present. In the distress tolerance module, therapists strive for participants to learn to accept and tolerate painful situations without engaging in harmful behaviors such as binge eating and purging. In the emotion regulation module, therapists focus on helping participants learn to be less susceptible to painful emotions.
DBT for BED and BN is rated as a promising practice because at least one study achieved a rating of moderate or high on study design and execution and demonstrated a favorable effect on a target outcome.
Date Last Reviewed (Handbook Version 1.0): May 2024
Sources
The following sources informed the program or service description, target population, and program or service delivery and implementation information: the program or service manual, the program or service developer’s website, and the studies reviewed.
This information does not necessarily represent the views of the program or service developers. For more information on how this program or service was reviewed, download the Handbook of Standards and Procedures, Version 1.0
Target Population
DBT for BED and BN is designed for adults with binge eating disorder or bulimia nervosa.
Dosage
For participants with BED, therapists typically deliver 2-hour weekly sessions to groups of 8–12 participants. For participants with BN, therapists deliver the program in 50–60 minute weekly individual sessions.
For both BED and BN, therapists typically deliver the three skills modules over a 20-week period. Therapists start with two sessions of orientation and introductory content. Therapists then provide three sessions on mindfulness, eight sessions on emotion regulation, and five sessions on distress tolerance. At the end, therapists provide two closing sessions to review concepts and help participants plan for the future.
Therapist consultation teams meet weekly throughout the treatment period.
Location/Delivery Setting
Recommended Locations/Delivery Settings
Therapists typically deliver DBT for BED and BN in outpatient clinical settings, including therapists’ offices and outpatient clinics.
Location/Delivery Settings Observed in the Research
- University Research Laboratory
Education, Certifications and Training
Therapists are typically licensed mental health professionals.
Therapists can go through an optional process to be a certified DBT clinician. The pre-requisites to become certified include having a graduate degree in a mental health-related field, a license to practice as an independent mental health practitioner, prior training in DBT and in mindfulness, and clinical experience delivering DBT individual therapy and telephone coaching. To receive certification, therapists must pass a written exam and an assessment of videotaped treatment sessions in which they deliver individual therapy.
Program or Service Documentation
Book/Manual/Available documentation used for review
Safer, D. L., Telch, C. F., & Chen, E. Y. (2009). Dialectical Behavior Therapy for binge eating and bulimia: A skills building approach. Guilford Press.
Available languages
The DBT for BED and BN manual is available in English.
Other supporting materials
Linehan, M. M. (2014). DBT skills training manual: Second edition. Guilford Press.
Linehan, M. (1993). Cognitive-behavioral treatment of borderline personality disorder. Guilford Press.
Note: The details on Dosage; Location; Education, Certifications, and Training; Other Supporting Materials; and For More Information sections above are provided to website users for informational purposes only. This information is not exhaustive and may be subject to change.
| Results of Search and Review | Number of Studies Identified and Reviewed for Dialectical Behavior Therapy for Binge Eating Disorder and Bulimia Nervosa |
|---|---|
| Identified in Search | 14 |
| Eligible for Review | 5 |
| Rated High | 0 |
| Rated Moderate | 2 |
| Rated Low | 3 |
| Reviewed Only for Risk of Harm | 0 |
| Outcome | Effect Size
 and Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
|---|---|---|---|---|
| Adult well-being: Parent/caregiver mental or emotional health |
0.53
20 |
2 (10) | 64 |
Favorable:
2 No Effect: 8 Unfavorable: 0 |
| Adult well-being: Parent/caregiver physical health |
0.13
5 |
1 (1) | 33 |
Favorable:
0 No Effect: 1 Unfavorable: 0 |
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group.
| Outcome | Effect Size
and Implied Percentile Effect
|
N of Studies (Findings) | N of Participants | Summary of Findings |
Months after treatment when outcome measured
|
|---|---|---|---|---|---|
| Adult well-being: Parent/caregiver mental or emotional health |
0.53
20 |
2 (10) | 64 |
Favorable:
2 No Effect: 8 Unfavorable: 0 |
- |
| Study 13206 - Adapted Dialectical Behavior Therapy vs. Waitlist (Cancian, 2019 - Not conducted in a usual care or practice setting) | |||||
| Difficulties in Emotion Regulation Scale |
0.67
24 |
- | 31 | - | 0 |
| Depression Anxiety Stress Scales – 21: Depression |
0.62
23 |
- | 31 | - | 0 |
| Depression Anxiety Stress Scales – 21: Anxiety |
0.32
12 |
- | 31 | - | 0 |
| Depression Anxiety Stress Scales – 21: Stress |
0.74
27 |
- | 31 | - | 0 |
| Binge Eating Scale |
0.78
*
28 |
- | 31 | - | 0 |
| Study 14783 - Dialectical Behavior Therapy for Binge Eating Disorder vs. Waitlist Control (Telch, 2001 - Not conducted in a usual care or practice setting) | |||||
| Eating Disorder Examination: Weight Concern |
0.71
26 |
- | 33 | - | 0 |
| Eating Disorder Examination: Eating Concern |
1.26
*
39 |
- | 33 | - | 0 |
| Positive and Negative Affect Schedule: Negative Affect |
0.44
17 |
- | 32 | - | 0 |
| Beck Depression Inventory |
0.18
7 |
- | 29 | - | 0 |
| Negative Mood Regulation |
-0.45
-17 |
- | 32 | - | 0 |
| Adult well-being: Parent/caregiver physical health |
0.13
5 |
1 (1) | 33 |
Favorable:
0 No Effect: 1 Unfavorable: 0 |
- |
| Study 14783 - Dialectical Behavior Therapy for Binge Eating Disorder vs. Waitlist Control (Telch, 2001 - Not conducted in a usual care or practice setting) | |||||
| Weight loss |
0.13
5 |
- | 33 | - | 0 |
*p <.05
Note: For the effect sizes and implied percentile effects reported in the table, a positive number favors the intervention group and a negative number favors the comparison group. Effect sizes and implied percentile effects were calculated by the Prevention Services Clearinghouse as described in the Handbook of Standards and Procedures, Version 1.0, Section 5.10.4 and may not align with effect sizes reported in individual publications. The Prevention Services Clearinghouse uses information reported in study documents and, when necessary, information provided by authors in response to author queries to assign study ratings and calculate effect sizes and statistical significance (see Section 7.3.2 in the Handbook of Standards and Procedures, Version 1.0). As a result, the effect sizes and statistical significance reported in the table may not align with the estimates as they are reported in study documents.
Only publications with eligible contrasts that met design and execution standards are included in the individual study findings table.
Full citations for the studies shown in the table are available in the "Studies Reviewed" section.
The participant characteristics display is an initial version. We encourage those interested in providing feedback to send suggestions to preventionservices@abtglobal.com.
The table below displays locations, the year, and participant demographics for studies that received moderate or high ratings on design and execution and that reported the information. Participant characteristics for studies with more than one intervention versus comparison group pair that received moderate or high ratings are shown separately in the table. Please note, the information presented here uses terminology directly from the study documents, when available. Studies that received moderate or high ratings on design and execution that did not include relevant participant demographic information would not be represented in this table.
For more information on how Clearinghouse reviewers record the information in the table, please see our Resource Guide on Study Participant Characteristics and Settings.
| Characteristics of the Participants in the Studies with Moderate or High Ratings | ||||||
|---|---|---|---|---|---|---|
|
Study Location
|
Study Year
|
Age or Grade-level
|
Race, Ethnicity, Nationality
|
Gender
|
Populations of Interest*
|
Household Socioeconomic Status
|
| Study 13206 - Adapted Dialectical Behavior Therapy vs. Waitlist | ||||||
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| Campinas, São Paulo State, Brazil | -- | Average age: 40 years; Age Range:18-59 years | 100% Brazilian | 94% Female | -- | 52% Currently working/employed |
| Study 14783 - Dialectical Behavior Therapy for Binge Eating Disorder vs. Waitlist Control | ||||||
| Characteristics of the Adults, Parents, or Caregivers | ||||||
| California, USA | -- | Average age: 50 years | 94% Caucasian | 100% Female | 100% Met full DSM-IV criteria for Binge Eating Disorder; Lifetime psychopathology: 38% Major depression, 35% Anxiety disorder, 27% Substance use or dependence, 6% Bulimia nervosa, 3% Psychotic disorder not otherwise specified | -- |
“--” indicates information not reported in the study.
* The information about disabilities is based on initial coding. For more information on how the Clearinghouse recorded disability information for the initial release, please see our Resource Guide on Study Participant Characteristics and Settings. The Clearinghouse is currently seeking consultation from experts, including those with lived experience, and input from the public to enhance and improve the display.
Note: Citations for the documents associated with each 5-digit study number shown in the table can be found in the “Studies Reviewed” section below. Study settings and participant demographics are recorded for all studies that received moderate or high ratings on design and execution and that reported the information. Studies that did not report any information about setting or participant demographics are not displayed. For more information on how participant characteristics are recorded, please see our Resource Guide on Study Participant Characteristics and Settings.
Studies Rated Moderate
Study 13206Cancian, A. C. M., de Souza, L. A. S., Liboni, R. P. A., de Lara Machado, W, & da Silva Oliveira, M. (2019). Effects of a Dialectical Behavior Therapy-based skills group intervention for obese individuals: A Brazilian pilot study. Eating and Weight Disorders, 24(6), 1099-1111. https://doi.org/10.1007/s40519-017-0461-2
This study was not conducted in a usual care or practice setting (Handbook Section 6.2.2)Study 14783
Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical Behavior Therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69(6), 1061-1065. https://doi.org/10.1037//0022-006x.69.6.1061
Some contrasts that received a moderate or high design and execution rating in this study were not from research conducted in a usual care or practice setting (Handbook Section 6.2.2) [see Individual Study Findings section above for additional information on contrasts that did or did not meet this criterion]Studies Rated Low
Study 13223Dastan, B., Afshar Zanjani, S., Froueddin Adl, A., & Habibi, M. (2020). The effectiveness of Dialectical Behaviour Therapy for treating women with obesity suffering from BED: A feasibility and pilot study. Clinical Psychologist, 24(2), 133-142. https://doi.org/10.1111/cp.12197
This study received a low rating because it did not meet design confound standards.Study 13331
Rahmani, M., Omidi, A., Asemi, Z., & Akbari, H. (2018). The effect of Dialectical Behaviour Therapy on binge eating, difficulties in emotion regulation and BMI in overweight patients with binge-eating disorder: A randomized controlled trial. Mental Health and Prevention, 9, 13-18. https://doi.org/10.1016/j.mhp.2017.11.002
This study received a low rating because it did not meet design confound standards.Study 13345
Safer, D. L., Telch, C. F., & Agras, W. S. (2001). Dialectical Behavior Therapy for bulimia nervosa. The American Journal of Psychiatry, 158(4), 632-634. https://doi.org/10.1176/appi.ajp.158.4.632
Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical Behavior Therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69(6), 1061-1065. https://doi.org/10.1037//0022-006x.69.6.1061
This study received a low rating because it did not meet design confound standards.Studies Not Eligible for Review
Study 13209
Carter, J. C., Kenny, T. E., Singleton, C., Van Wijk, M., & Heath, O. (2020). Dialectical Behavior Therapy self‐help for binge‐eating disorder: A randomized controlled study. International Journal of Eating Disorders, 53(3), 451-460. https://doi.org/10.1002/eat.23208
This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).Study 13213
Chen, E. Y., Cacioppo, J., Fettich, K., Gallop, R., McCloskey, M. S., Olino, T., & Zeffiro, T. A. (2017). An adaptive randomized trial of Dialectical Behavior Therapy and cognitive behavior therapy for binge-eating. Psychological Medicine, 47(4), 703-717. https://doi.org/10.1017/S0033291716002543
This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).Study 13226
de Souza, L. A. S., Cancian, A. C. M., de Castro, T. G., & da Silva Oliveira, M. (2019). Problematic and adaptive eating in people with obesity after a DBT-based skills training intervention: 3- and 8-month follow-up and mediation analysis. Psicologia, 32(1), Article 1. https://doi.org/10.1186/s41155-019-0116-5
This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4)Study 13272
Klein, A. S., Skinner, J. B., & Hawley, K. M. (2013). Targeting binge eating through components of Dialectical Behavior Therapy: Preliminary outcomes for individually supported diary card self-monitoring versus group-based DBT. Psychotherapy, 50(4), 543-552. https://doi.org/10.1037/a0033130
This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4)Study 13283
Lammers, M. W., Vroling, M. S., Crosby, R. D., & van Strien, T. (2020). Dialectical Behavior Therapy adapted for binge eating compared to cognitive behavior therapy in obese adults with binge eating disorder: A controlled study. Journal of Eating Disorders, 8, Article 27. https://doi.org/10.1186/s40337-020-00299-z
This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).Study 13298
Marino, J., Hardin, R., Gasbarro, A., Dansereau, V. A., & Fischer, S. (2020). Outpatient treatment for adults with complex eating disorders and co-morbid conditions: A decision making model and case example. Eating Disorders, 28(2), 171-183. https://doi.org/10.1080/10640266.2020.1723372
This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4)Study 13300
Masson, P. C., von Ranson, K. M., Wallace, L. M., & Safer, D. L. (2013). A randomized wait-list controlled pilot study of Dialectical Behaviour Therapy guided self-help for binge eating disorder. Behaviour Research and Therapy, 51(11), 723-728. https://doi.org/10.1016/j.brat.2013.08.001
This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).Study 13301
Mazzeo, S. E., Lydecker, J., Harney, M., Palmberg, A. A., Kelly, N. R., Gow, R. W., Bean, M. K., Thornton, L. M., Tanofsky-Kraff, M., Bulik, C. M., Latzer, Y., & Stern, M. (2016). Development and preliminary effectiveness of an innovative treatment for binge eating in racially diverse adolescent girls. Eating Behaviors, 22, 199-205. https://doi.org/10.1016/j.eatbeh.2016.06.014
This study is ineligible for review because it is not a study of the program or service under review (Study Eligibility Criterion 4.1.6).Study 13340
Safer, D. L., Robinson, A. H., & Jo, B. (2010). Outcome from a randomized controlled trial of group therapy for binge eating disorder: Comparing Dialectical Behavior Therapy adapted for binge eating to an active comparison group therapy. Behavior Therapy, 41(1), 106-120. https://doi.org/10.1016/j.beth.2009.01.006
Safer, D. L., & Joyce, E. E. (2011). Does rapid response to two group psychotherapies for binge eating disorder predict abstinence? Behaviour Research and Therapy, 49(5), 339-345. https://doi.org/10.1016/j.brat.2011.03.001
Robinson, A. H., & Safer, D. L. (2012). Moderators of Dialectical Behavior Therapy for binge eating disorder: Results from a randomized controlled trial. The International Journal of Eating Disorders, 45(4), 597-602. https://doi.org/10.1002/eat.20932
This study is ineligible for review because it does not use an eligible study design (Study Eligibility Criterion 4.1.4).