Traditional Workshop 10 - The Moving Target of What to Focus on When Your Patient’s Eating Disorder Is One of Several Problems

The work of professionals who treat clients diagnosed with an eating disorder (ED) and significant other comorbidities such as depression, anxiety, suicidality, or BPD can be complicated. First and foremost, multi-diagnostic ED clients can be ambivalent about treatment and recovery. Professionals are often in the position of having to “sell” the treatment we believe is needed to individuals who often have not been helped by multiple previous interventions. Furthermore, EDs can be life threatening illnesses and professionals may become unclear about priorities when attempting to help a client who has more than one life-threatening condition:  e.g., what if my client is self-harming and is medically unstable – which do I deal with first? The work of the ED professional is further complicated by behaviors that can interfere with the treatment delivery.  Behaviors such as angry outbursts, failure to complete homework, lying, water-loading, and cancelling sessions are considered therapy-interfering behaviors (TIBs) and can interfere with clients’ abilities to benefit from treatment, remain in treatment, or both. Finally, the professional’s own burn out and frustrations can interfere with treatment, as well. 
Mulitdiagnostic Eating Disorder- Dialectical Behavior Therapy (MED-DBT), provides a clear and systematic model for dealing with ambivalent, multiple-problem cases, as well as life-threatening, and therapy-interfering behaviors.
In this workshop participants will be exposed to MED-DBT theory and practice. Particular attention will be given to how to conceptualize and organize patient behavior in terms of priorities, and how to identify and address therapy-interfering behaviors on the part of the patient and therapist.  Using lectures, case examples, small group exercises and role plays, participants will have the opportunity to practice and observe MED-DBT treatment strategies for those diagnosed with an eating disorder. The current presentation will describe how a MED-DBT treatment model can effectively and comprehensively address eating disorder issues and their comorbidities across the DBT targets.

Recommended Reading 1: Ben-Porath, D., Duthu, F., Luo, T., Gonidakis, F., Compte, E., & Wisniewski, L. (2020).  Dialectical behavioral therapy: an update and review of the existing treatment models adapted for adults with eating disorders.  Eating Disorders: The Journal of Treatment and Prevention, 28, 101-121.  https://www.tandfonline.com/doi/full/10.1080/10640266.2020.1723371

Recommended Reading 2: Brown, T., Wisniewski, L., & Anderson, L. (2020). Dialectical Behavior Therapy and Eating disorders: State of the Research and New Directions.  Eating Disorders: The Journal of Treatment and Prevention, 28, 97-100.

Recommended Reading 3: Navarro-Haro, M.V., Botella, V.G., Badenes-Ribera, L. et al. Dialectical Behavior Therapy in the Treatment of Comorbid Borderline Personality Disorder and Eating Disorder in a Naturalistic Setting: A Six-Year Follow-up Study. Cogn Ther Res 45, 480–493 (2021). https://doi.org/10.1007/s10608-020-10170-9

Recommended Reading 4: Wisniewski, L. & Ben-Porath, D. (2015).  Dialectical Behavior Therapy and Eating Disorders:  The Use of Contingency Management Procedures to Manage Dialectical Dilemmas.  American Journal of Psychotherapy, 69 (2), 129-140

Recommended Reading 5: Reilly, E. E., Orloff, N. C., Luo, T., Berner, L. A., Brown, T. A., Claudat, K., … Anderson, L. K. (2020). Dialectical behavioral therapy for the treatment of adolescent eating disorders: a review of existing work and proposed future directions. Eating Disorders, 28(2), 122–141. https://doi.org/10.1080/10640266.2020.1743098

Outline:
Introduction (15 mins)
Overview of workshop objectives and MED-DBT model
Theoretical Foundations (30 mins)
Review of DBT targeting hierarchy and MED-DBT adaptations
Case Conceptualization and Prioritization (30 mins)
Mapping client behaviors onto Targets I-III
Clinical Vignettes and Small Group Exercises (45 mins)
Role-playing therapy-interfering behaviors and clinician responses
Skill Application and Troubleshooting (30 mins)
Diary card use, addressing suicidal behavior and burnout
Q&A and Summary (30 mins)
Addressing audience challenges, summary of key takeaways