Breaking an addiction often involves some form of abstinence, yet for people addicted to food, abstinence isn’t an option. Eating disorders aren’t like addictions to drugs or alcohol, Sarah Adler, PsyD, and her colleague Debra Safer, MD, explained to me as we sat in Safer’s office discussing the origins of their new book, The DBT® Solution for Emotional Eating: A Proven Program to Break the Cycle of Bingeing and Out-of-Control Eating.
“You can stop drinking alcohol or using drugs by going cold turkey,” said Adler. “But you need food to survive. You can’t say, ‘I’m going to stay away from this drug of choice and never use it again.’”
“You have to develop a way to be in the world with food,” Safer said.
For people seeking assistance with an eating disorder, self-help books could be a useful treatment option, Safer and Adler explained. They caution, however, that seeking care from a medical provider is also important since eating disorders can cause serious physical complications.
Safer, Adler and Philip Masson, PhD, a psychologist practicing in Canada, were asked to write the book after they published research showing a guided self-help dialectical behavior therapy manual they developed successfully treated patients who binge eat.
At the time, only one evidence-based self-help book was available for patients who binge eat, and that book was based on cognitive behavioral therapy, they said. Cognitive behavioral therapy is a problem-focused type of therapy that involves modifying harmful thoughts and behaviors such as an over-focus on weight and excessive dieting. “Some people who want to treat binge eating may not respond to CBT, but may respond better to DBT, and vice versa,” Safer said.
The dialectical based thinking taught in the book incorporates Eastern and Western schools of thought, Adler explained. It’s an open frame of mind that allows an individual to hold two contradictory viewpoints simultaneously, such as the need to stop binge eating while accepting oneself as they are in the moment.
Mindfulness is a core part of the DBT frame of mind and helps the reader examine the link between his or her emotions and the behavior that interferes with his or her life. The book doesn’t target binge eating directly, Adler and Safer explained, instead it helps individuals identify the things that lead to binge eating, and teaches the skills to cope with those stressors in a more positive way.
“A lot of binge eating treatments — on some level — have an underlying idea that being overweight is bad. [Here], the behavior is not considered ‘bad’ or ‘good’ — it’s simply a behavior you would like to change because it interferes with your life.”
This book is “a crucial first step” for people who binge eat and for people who wish to lose weight as part of their treatment, the authors explained. “It’s hard to be adherent to a nutritional plan if you cannot control binge eating,” Adler said. “All diets work if you can stick to them, but if you don’t have the tools to stick to them over the long term you are going to gain the weight back.”
Fortunately, “the behavior is learned, therefore it can be unlearned,” Safer said. “You are not doomed.”
The DBT Solution for Emotional Eating can be used alone as a pure self-help book, with a therapist, or as part of a group therapy treatment plan. This is important, Adler said, “because very few specialists are trained in evidence-based care — the gold standard treatment for eating disorder — and access to eating disorder specialists is limited.”
Safer and Adler said they hope their book will help people who binge eat get access to the treatment they need. “We want patients to be able to take their treatment into their own hands,” Adler said.
Photo by Holly Alyssa MacCormick