Dialectical Behavior Therapy for Binge Eating Disorder and Bulimia Nervosa

Mental Health Promising

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 Research Evidence Last Reviewed: 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, visit the Review Process page or download the Handbook.

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

DBT Certification Information 

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 Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
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 Effect Size more info
and Implied Percentile Effect Implied Percentile Effect more info
N of Studies (Findings) N of Participants Summary of Findings Months after treatment
when outcome measured
Months after treatment when outcome measured more info
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, Section 5.10.4 and may not align with effect sizes reported in individual publications.

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@abtassoc.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 Location more info Study Year Study Year more info Age or Grade-level Age or Grade-level more info Race, Ethnicity, Nationality Race, Ethnicity, Nationality more info Gender Gender more info Populations of Interest* Populations of Interest more info Household Socioeconomic Status Household Socioeconomic Status more info
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.

Sometimes study results are reported in more than one document, or a single document reports results from multiple studies. Studies are identified below by their Prevention Services Clearinghouse study identification numbers. To receive a rating of supported or well-supported, the favorable evidence for a program or service must have been obtained from research conducted in a usual care or practice setting.

Studies Rated Moderate

Study 13206

Cancian, 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 13223

Dastan, 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).