0:06 hi my name is Annie hanos and I'm a
0:08 graduate student at the University of Nevada
0:09 Nevada
0:13 raino in this video I will be providing
0:15 instructions on how to use techniques
0:18 from dialectical behavior therapy when
0:20 working with a client with an eaing
0:23 disorder specifically I'm going to be
0:25 walking you through an example of using
0:28 DBT skills during a food exposure exercise
0:30 exercise
0:32 when working with clients with eating
0:34 disorders it's important to understand
0:37 how to implement DBT skills in the
0:38 context of
0:42 eating this is because for clients with
0:45 eating disorders eating can often be a
0:49 very stressful the certainly necessary
0:51 task these skills that I'll be
0:54 demonstrating in this video can be used
0:57 either in a food exposure exercise as
1:00 we'll show um in the upcoming clip or
1:02 Els can be used during telephone
1:06 coaching calls um as a standard in
1:09 DBT in this video clip I'll be using
1:12 emotion regulation skills
1:14 specifically and the overall goal when
1:17 using emotion regulation techniques is
1:21 to help the client to number one
1:24 identify a Primary Emotion while
1:27 blocking any expressions of secondary
1:31 emotions two validate that Primary
1:34 Emotion helping the client to know that
1:37 this reaction makes sense and is
1:39 understood by the
1:42 therapist three figuring out with the
1:44 client how to treat this emotion using DBT
1:46 DBT
1:48 skills and
1:51 four reinforcing the client's use of
1:54 these DBT skills through cheerleading and
1:56 and
2:00 praise of note in this uh video clip I
2:03 will also be eating alongside the client
2:06 and this is in order to model a healthy
2:09 normative eating Behavior to the client
2:12 um as well as to demonstrate to her that
2:14 I'm willing to engage in the same
2:16 exposure exercises that I'm asking of
2:19 her so I hope you enjoyed the video and
2:37 what's going
2:42 on what are you feeling right now
2:45 um I'm feeling
2:49 disgust disgust about what I can't do
2:51 this like you can't do this so so tell
2:54 me what that feeling of disgust is what
3:00 about uh
3:03 just my body like just I don't know I
3:07 feel like eating that just makes my body
3:11 feel you know gross mhm like
3:13 like
3:16 uncomfortable I I don't know yeah well
3:18 it sounds like there's some judgments in
3:20 there right
3:22 so it sounds like probably you're having
3:25 some judgments like I'm feeling really
3:28 fat yeah yeah that sort of
3:31 thing but it but you did say it more
3:33 descriptively which is great which is
3:35 you're feeling uncomfortable right now
3:39 right just eating that makes me
3:43 feel icky I I don't know just yeah and I
3:46 can totally understand how you get to
3:50 there if you're thinking I'm feeling fat
3:52 I'm going to get fat you know it's an
3:55 easy place to get to okay okay but I
3:57 feel like we're missing something too
3:59 because I don't think it's just
4:02 disgusted I think there's another a
4:04 Primary Emotion in
4:08 there um what do you think that might
4:14 be well I feel like just looking at that
4:17 I that cake I feel like I just want to
4:19 run out the door I just I don't want to
4:22 be here sure so what what emotion do you
4:24 think that
4:29 is being afraid being fearful yeah of
4:31 what will happen if I eat that I think
4:33 that's exactly right that's what I'm
4:35 seeing you know I see you kind of curled
4:38 up over there you know you have a very
4:42 worried face you know and you're having
4:44 a hard time approaching it I think I
4:46 think that's absolutely right that
4:47 you're feeling
4:49 fear and I want you to know that makes a
4:52 lot of sense to me
4:54 um you
4:58 know when's the last time you've eaten cheesecake
5:01 cheesecake
5:04 I honestly I can't remember I don't know
5:06 yeah I know it's been it's been a really
5:08 long time you certainly didn't need it
5:11 all through you know when you were
5:13 really stuck in your eating disorder you
5:16 know I used to I used to like it I
5:18 remember that but it was such a long
5:20 time ago I that and so you've been
5:23 avoiding food like this for so long that
5:25 it totally makes sense that you're feeling
5:27 feeling
5:30 fear right and you had said this is one
5:32 of the hardest foods for you so that
5:35 makes sense to me right I just see it
5:40 like as a Big Blob of fat right that's
5:41 what it looks like to me that's what
5:44 what what is that it's a Big Blob of
5:49 fat a judgment yeah exactly you know I'm
5:50 not going to let you get away with
5:55 saying stuff like that all right okay so
5:56 because that's just not going to be
5:59 helpful right now so what I'm wondering
6:01 wondering is since we know that it's
6:03 fear that we're dealing
6:06 with maybe we can do some opposite
6:08 action to that emotion do you remember
6:11 what I mean by opposite action mhm what
6:12 do I
6:17 mean instead of um wanting
6:21 to turn and run away M
6:22 M
6:26 from the fear of eating this and and
6:29 just you know check out basically right
6:31 you want me
6:38 to go towards it and you know just
6:42 experience what I'm feeling and not go
6:45 away from it right exactly so you know
6:47 fear is associated with that urge like
6:50 you said to run out the door so instead
6:52 of running out the door we want you to
6:54 approach the thing that's scary which is
6:57 this cheesecake right now right right
7:00 okay so I see how hard hard it is for
7:03 you and I honestly it's hard for me to
7:05 watch and I wish I could just take that
7:09 away but as you know the reason opposite
7:12 action is so important is if you if I
7:14 just take that fear Away by saying no
7:17 more cheesecake right it's just going to
7:18 make you more fearful the next time you
7:20 come in front of some kind of food
7:22 that's tough for you make it worse yeah
7:25 so by doing this hopefully over time
7:28 your fear will go down okay okay so can
7:30 we have the fear right now and still
7:32 take a few more
8:13 so how was
8:18 that it's difficult yeah I can see how
8:21 difficult it is but I'm doing it but
8:23 it's difficult exactly doesn't feel
8:26 comfortable no I wouldn't imagine it
8:29 would but you did perfect out opposite
8:31 action right there which is you were
8:33 feeling really uncomfortable and I can
8:37 tell that but you still did it right do
8:39 you feel a little bit proud of yourself
8:43 yeah yeah a little bit okay so this
8:45 shows me that you can do it so let's try
8:49 again let's take a breath and then we'll
