There are several effective therapies for treating personality disorders and eating disorders. Cognitive behavioral therapy (CBT) helps patients identify and change dysfunctional core beliefs and behaviors. Dialectical behavior therapy (DBT) teaches skills to regulate emotions and improve relationships. Family and group therapies also play important roles by educating family/peers and providing support.

1. Personality Disorders and
Eating Disorders

2.  There are several therapies that are effective in
treating personality disorders.
 Cognitive behavioral therapy helps the patient
identify unhealthy, negative beliefs and behaviors
and replace them with healthy, positive ones.
 Dialectical behavior therapy is a type of cognitive
behavioral therapy that teaches behavioral skills to
help tolerate stress, regulate emotions and improve
relationships with others.
 Psychoeducational and Structural family therapy

3. CBT for personality disorders
 CBT conceptualizes all 10 personality disorders as dysfunctional
core beliefs about the self, others and the world. The cognitive
therapist helps people with these disorders learn to identify and
change these core beliefs
 To change dysfunctional beliefs like, "I'm defective, helpless,
vulnerable and bad,” the therapist must help patients revisit and
reinterpret early childhood experiences.
 Therapists ask patients to move beyond thinking of such events as
proof of inadequacy and instead explore alternative meanings.
 A challenge for CBT therapists is that patients with personality
disorders do not come into therapy ready to trust. Therapists should
be ready to help patients examine dysfunctional beliefs about the
therapist or therapy.
 ALL previous slides on CBT should be reviewed and sections read.

4. DBT
 Dialectical Behavior Therapy (DBT) has been found to be
very effective in treating most personality disorders,
mainly BPD.
 It is a modified CBT.
 DBT seeks to teach the client how to learn to better take
control of their lives, their emotions, and themselves
through self-knowledge, emotion regulation, and
cognitive restructuring.
 It is a comprehensive approach that is most often
conducted within a group setting. Because the skill set
learned is new and complex, it is not an appropriate
therapy for those who may have difficulty learning new
concepts.

5.  A key assumption in DBT is that self-destructive behaviors are learned coping
techniques for unbearably intense and negative emotions. Negative emotions like
shame, guilt, sadness, fear, and anger are a normal part of life. However, it seems
that some people are particularly inclined to have very intense and frequent
negative emotions. It could be the way their brain functions, it could be due to
severe emotional or physical trauma Additionally, sometimes clients have mood
disorders that are not controlled by standard medications and thus lead to
emotional suffering. A
 Any one of these can lead to a problem called emotional vulnerability. A person who
is emotionally vulnerable tends to have quick, intense, and difficult-to-control
emotional reactions that make his or her life seem like a rollercoaster.
 Extreme emotional vulnerability is rarely the sole cause of psychological problems.
An invalidating environment is also a major contributing factor. What is an
invalidating environment? The “environment,” in this case, is usually other people.
“Invalidating” refers to a failure to treat a person in a manner that conveys
attention, respect, and understanding. Examples of an invalidating environment can
range from mismatched personalities of children and parents (e.g., a shy child
growing up in a family of extraverts who tease her about her shyness); to extremes
of physical or emotional abuse.

6.  Clients in standard DBT receive three main modes of treatment –
individual therapy, skills group, and phone coaching. In individual therapy,
clients receive once weekly individual sessions that are typically an hour to
an hour-and-a half in length. Clients also must attend a two-hour weekly
skills group for at least one year. In group patients learn four sets of
important skills – Mindfulness, Interpersonal Effectiveness, Emotion
Regulation, and Distress Tolerance. Clients are also asked to call their
individual therapists for skills coaching prior to hurting themselves. The
therapist then walks them through alternatives to self-harm or suicidal
behaviors.
 It should be noted that in standard DBT, it is the individual therapist who
is “in charge” of the treatment. This means it is the individual therapist’s
job to coordinate the treatment with the other people – skills group leaders,
psychiatrists, and vocational counselors. In collaboration with the client,
the therapist keeps track of how the treatment is going, how things are
going with everyone involved in the treatment, and whether or not the
treatment is helping the client reach his or her goals.

7. Family Therapy Component
 Structural approach:
 Family as a whole organism, a system that presents its own
rules.
 These rules define the organization of the family.
 Process Vs. Content: The family therapist needs to pay
attention to the interactions that occur among family
members (the process) not to what they talk about (content) in
order to understand the organization.

8.  The focus of structural family therapy follows this
order:
 1. Joining and accommodating
 2. Assessing family interactions
 3. Monitoring family dysfunctional sets
 4. Restructuring transactional patterns

9. Psychoeducational family therapy
 It is important that the patient and the family
become knowledgeable about the patient’s symptoms.
 It is important that family members learn to provide
guidance to the patient when they feel frustrated
because of their symptoms.
 The therapist should monitor medication use.
 Previous slides and readings on this type of family
therapy should be reviewed.

10. Eating disorders
 There are several treatments that work well with
eating disorders. They are
 CBT
 DBT
 Family therapy
 Group therapy

11. CBT
 CBT is widely used in counseling for eating disorders to change the way
patients think about their bodies and their relationship with food. CBT
helps patients understand how their thinking and negative self-talk and
self-image can directly impact their eating and negative behaviors.
 CBT focuses on the present and is an active and practical approach for
solving problems and changing self-defeating thought patterns. With new
skills, patients are able to reduce eating disorder symptoms, recognize
triggers and avoid relapse.
 Cognitive-behavioral therapy will often focus on identifying and altering
dysfunctional thought patterns, attitudes and beliefs, which may trigger
and perpetuate the person’s restrictive eating. At the foundation of CBT is
helping a patient understand, identify and change their irrational thoughts,
and helping a patient make the changes real through specific behavioral
interventions (such as promoting health eating behaviors through goal
setting, rewards, etc.).
 Review all CBT slides and reading.

12. DBT
 Another effective therapy used to treat eating disorders is Dialectical Behavior Therapy, or DBT.
DBT is designed to teach patients new coping strategies to more effectively handle difficult
emotions. Rather than turning to eating disorder behaviors, patients develop a set of life skills
they can draw from for lasting recovery.
 The four DBT skill sets are:
 Mindfulness – Staying present in the moment with a deep awareness of one’s thoughts,
feelings and actions. Rather than judging a thought or feeling, mindfulness practice helps
patients learn to accept whatever they are experiencing in a given moment. With greater
awareness, patients are better able to regulate their thoughts and feelings and shift their
attention in another direction when their thought pattern is becoming unproductive or
unhealthy.
 Distress Tolerance – Learning to accept distress and other difficult emotions that are an
inevitable part of life, rather than resorting to eating disorder behaviors. Part of distress
tolerance is delaying gratification and avoiding impulsive behaviors, and finding healthier ways
to cope such as self-soothing, distracting, and assessing pros and cons.
 Emotion Regulation – Identifying emotions and working to let go of painful feelings to make
room for positive ones.
 Interpersonal Effectiveness – Improving interpersonal relationships by increasing
assertiveness and communication skills. Some of the skills patients learn include asking for
what they need, setting healthy boundaries, and coping with conflict effectively without hurting
others or jeopardizing their self-respect.

13. Family Therapy
 Eating disorders affect the entire family, causing frustration and
concern and drawing attention away from siblings. Recovery isn’t an
isolated event, it takes time and involves the family.
 Studies show that family involvement is essential for successful
eating disorder recovery, particularly for teens. In family therapy,
patients have the opportunity to discuss underlying issues and
conflicts with their family in the presence of an objective therapist.
 The goals of family therapy are to:
 Educate family members about eating disorders and the recovery process
 Instill new conflict resolution skills and communication strategies
 Prepare family members for the patient’s return home (if applicable)
 Help family members learn how to support their loved one’s recovery
 Connect with other families to share stories and support (multi-family therapy)
 Ensure that family members have a support network of their own and a healthy
sense of self
 With guidance, families can take care of their own needs while offering support
and encouragement for their loved one.

14. Family Therapy
 Family therapy is usually conducted with the person who has
anorexia and their family. However, in some instances, a few
family therapy sessions may involve therapy without the
person who has anorexia present. This may help the family
understand the roles they are playing in supporting the
disordered eating, and suggest ways the family can help the
person with anorexia acknowledge the problem and seek out
treatment.
 Family therapy helps a person with anorexia see and
understand the often-times dysfunctional role they play
within the family, and how their eating behaviors maintain
that role.

15. Group Therapy
 Group therapy is a critical aspect of eating disorder treatment. For
many people, hearing about the experiences of others and receiving
honest feedback from people who are facing similar struggles is one
of the most beneficial aspects of treatment.
 In a safe, nurturing setting, patients share their pain and in doing
so, realize that they are not alone. The relationships that develop in
the group can build self-esteem and serve as a model for trusting,
supportive relationships. The group setting is also a safe place to
practice new communication skills and the art of acceptance of both
self and others.
 In group therapy, patients help one another identify and resolve
problems with the guidance and expertise of a professional
therapist. With a spirit of caring, they can question each other's
distorted thoughts and destructive behaviors and facilitate the
process of change. They also learn about nutrition, the process of
recovery, relapse prevention, assertiveness techniques, coping skills
and other important topics.