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The Dialectical Behavior Therapy Skills Workbook for Bulimia: Using DBT to Break the Cycle and Regain Control of Your Life Paperback – August 1, 2009
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"This self-help workbook is an excellent tool to help alleviate bulimia nervosa symptoms. It is also a useful guide for the practitioner who is assisting the patient in his or her quest to overcome an eating disorder. I highly recommend this workbook to sufferers and mental health professionals alike."
—Daniel le Grange, Ph.D., professor and director of the eating disorders program at the University of Chicago
"DBT has taught me how to meditate more effectively throughout the day, regulate my emotions, and tolerate the most uncomfortable and painful of times. I never knew how to ride the rollercoaster of life without resorting to bingeing until DBT helped to change my behavior and my life. Because DBT centers on mindfulness—being in the present moment—and having both acceptance of my condition as well as the willingness to change, I can now show up for my life without resorting to bingeing or other crutches. DBT has changed my life, and I have faith that it can change yours!"
—Sharon, client of coauthor Ellen Astrachan-Fletcher
"At my first dialectical behavior therapy (DBT) skills training session, I found it easier to speak without using vowels than to speak without judgment. I was skeptical, but desperate to have a life without my eating disorder, and once desperation won the battle over skepticism, I was in. Once I was able to chip away at the judgment, I began to think it might be possible there was a way to deal with distress that didn’t involve binge-purging. Before DBT, my emotions were something that required treatment. Happy, sad, angry, or glad, if I felt something, bulimia was right there to take me back to a state of numbness. Being able to radically and mindfully accept, without judgment, that I could actually experience an emotion and not have it end with a binge was a fascinating revelation. I still fight with bulimia, but I am armed with the tools of DBT and it’s now a battle I have a chance of winning."
—Ilene, client of coauthor Ellen Astrachan-Fletcher
"At first, I was very reluctant to join a DBT group, as I thought that I had control over my eating disorder. However, once I decided to participate in a group, I was hooked. For over two years, I have been involved in DBT. DBT has been a life-altering experience and my commitment has truly helped me to be present and create a life worth living."
—Carissa, client of coauthor Ellen Astrachan-Fletcher
"My commitment to DBT has brought me to an understanding of living in the moment. I now carry the benefits of instinctively knowing how to embrace life in an effective way. It is amazing how the exercises brought me to the awareness of just how little time I am now spending thinking obsessive thoughts about exercise and food!"
—Eileen, client of coauthor Ellen Astrachan-Fletcher
"DBT has given me an appreciation for what I believed to be the most insignificant pieces in life: what is going on around me in the present moment. My eating disorder had taken away the familiarity of the simplest joys in life and had focused my attention to my body, exercise, and food. DBT had helped me refocus my attention to the present moment, rather than the past or future."
—Annie, client of coauthor Ellen Astrachan-Fletcher
From the Publisher
In The Dialectical Behavior Therapy Skills Workbook for Bulimia, two psychologists specializing in eating disorders and dialectical behavior therapy (DBT) show readers how to regulate negative emotions and behaviors and overcome bulimia.
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There are many exercises aimed toward helping the bulimic understand herself. These are often taxing to do because when one isn't in "bulimic mood", it's difficult to imagine how one feels in "bulimic mood". I found the benefit from the exercises not during or even soon after completing them -- their effect would often hit me weeks later as I came to understand their full implications.
Two exercises stood out to me in particular. One was wherein the patient needed to write out a "purpose" for her life (an important step of DBT). Many bulimics will have trouble with this, as they consider their lives purposeless. The book offers the suggestion of "to be healthier", which is a practical purpose that will appeal to anyone. The other exercise consisted of writing a letter to oneself from the perspective of one's body -- I felt very touched and ashamed as I realized all that my body did and tried to do for me, despite receiving my scorn instead of appreciation.
I subtracted one star because the authors do at times seem a bit patronizing and overly firm -- too clinical and too little compassion -- and being the sensitive issue that bulimia is, I imagine it could turn off patients.
On the one hand it does provide an OK overview of DBT and how it relates to recovery from bulimia. But that's about what you'll get - an overview, not much detail on anything. They give you an overview of mindfulness, but there are much better books on mindfulness out there. They give you an overview of interpersonal skills, but there are certainly better resources on interpersonal skills out there, including probably better books on DBT interpersonal skills.
Maybe my issue with the interpersonal skills section is partially with this book and maybe partially with DBT interpersonal skills in general, which have always seemed to be a little too basic (at least in the presentations that I've heard). In general, the advice here lacked substance - a little bit of general advice on conflict resolution and assertiveness and stuff like that, but a lot of it seemed like common sense.
Given that the authors seem to be saying that many of us will have significant skill deficits in this areas, I don't see how what they present here will be enough. Yeah, I guess you could read other books later, but if you do that, why bother with this one? What's the value-add beyond "here, let me give you these quick tips with a cute acronym?"
The emotion regulation section's a complete joke. Most of it boils down to "see if you're being realistic." How do you do that? Well, the book doesn't say. Thanks for that one Lucy - here's 5 cents. Nothing like what you'd get in CBT.
Finally, a few of their ideas for how to break behavior chains are almost laughably impossible to implement. For example, they describe an example of a guy who got in an argument with his wife over something to do with money (don't remember the exact circumstances offhand) and then later did behaviors over it. They pointed out that if he had used interpersonal skills to avoid the argument, he wouldn't have done the behavior. True, but non-bulimics sometimes get in arguments with their wives without binging over it; it's totally unrealistic to base my recovery on never, ever having an argument with my wife. (Actually, I'm single, but you get the point). They then take the behavior chain back further and point out that if he had done a better job with his budgeting he could've avoided it too. So, not only is my recovery contingent on never arguing with my wife, it's contingent on me managing my finances perfectly too now? Seriously - are these guys for real?
Also, the results that this book describes were genuinely unimpressive. The person in one of their examples did X, Y, and Z and as a result "was able to reduce their binging behavior." And then they found five dollars. Talk about an anticlimactic ending - if all they can promise from their program is that I'll be able to "reduce my binging behavior" if I manage my finances perfectly and never argue with my wife then deal me out, I'll take my chances with other programs.