This content demonstrates the application of Dialectical Behavior Therapy (DBT) emotion regulation skills, specifically opposite action, during a food exposure exercise for a client with an eating disorder. The goal is to help the client confront and manage the fear and disgust associated with eating challenging foods.
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hi my name is Annie hanos and I'm a
graduate student at the University of Nevada
Nevada
raino in this video I will be providing
instructions on how to use techniques
from dialectical behavior therapy when
working with a client with an eaing
disorder specifically I'm going to be
walking you through an example of using
DBT skills during a food exposure exercise
exercise
when working with clients with eating
disorders it's important to understand
how to implement DBT skills in the
context of
eating this is because for clients with
eating disorders eating can often be a
very stressful the certainly necessary
task these skills that I'll be
demonstrating in this video can be used
either in a food exposure exercise as
we'll show um in the upcoming clip or
Els can be used during telephone
coaching calls um as a standard in
DBT in this video clip I'll be using
emotion regulation skills
specifically and the overall goal when
using emotion regulation techniques is
to help the client to number one
identify a Primary Emotion while
blocking any expressions of secondary
emotions two validate that Primary
Emotion helping the client to know that
this reaction makes sense and is
understood by the
therapist three figuring out with the
client how to treat this emotion using DBT
DBT
skills and
four reinforcing the client's use of
these DBT skills through cheerleading and
and
praise of note in this uh video clip I
will also be eating alongside the client
and this is in order to model a healthy
normative eating Behavior to the client
um as well as to demonstrate to her that
I'm willing to engage in the same
exposure exercises that I'm asking of
her so I hope you enjoyed the video and
what's going
on what are you feeling right now
um I'm feeling
disgust disgust about what I can't do
this like you can't do this so so tell
me what that feeling of disgust is what
about uh
just my body like just I don't know I
feel like eating that just makes my body
feel you know gross mhm like
like
uncomfortable I I don't know yeah well
it sounds like there's some judgments in
there right
so it sounds like probably you're having
some judgments like I'm feeling really
fat yeah yeah that sort of
thing but it but you did say it more
descriptively which is great which is
you're feeling uncomfortable right now
right just eating that makes me
feel icky I I don't know just yeah and I
can totally understand how you get to
there if you're thinking I'm feeling fat
I'm going to get fat you know it's an
easy place to get to okay okay but I
feel like we're missing something too
because I don't think it's just
disgusted I think there's another a
Primary Emotion in
there um what do you think that might
be well I feel like just looking at that
I that cake I feel like I just want to
run out the door I just I don't want to
be here sure so what what emotion do you
think that
is being afraid being fearful yeah of
what will happen if I eat that I think
that's exactly right that's what I'm
seeing you know I see you kind of curled
up over there you know you have a very
worried face you know and you're having
a hard time approaching it I think I
think that's absolutely right that
you're feeling
fear and I want you to know that makes a
lot of sense to me
um you
know when's the last time you've eaten cheesecake
cheesecake
I honestly I can't remember I don't know
yeah I know it's been it's been a really
long time you certainly didn't need it
all through you know when you were
really stuck in your eating disorder you
know I used to I used to like it I
remember that but it was such a long
time ago I that and so you've been
avoiding food like this for so long that
it totally makes sense that you're feeling
feeling
fear right and you had said this is one
of the hardest foods for you so that
makes sense to me right I just see it
like as a Big Blob of fat right that's
what it looks like to me that's what
what what is that it's a Big Blob of
fat a judgment yeah exactly you know I'm
not going to let you get away with
saying stuff like that all right okay so
because that's just not going to be
helpful right now so what I'm wondering
wondering is since we know that it's
fear that we're dealing
with maybe we can do some opposite
action to that emotion do you remember
what I mean by opposite action mhm what
do I
mean instead of um wanting
to turn and run away M
M
from the fear of eating this and and
just you know check out basically right
you want me
to go towards it and you know just
experience what I'm feeling and not go
away from it right exactly so you know
fear is associated with that urge like
you said to run out the door so instead
of running out the door we want you to
approach the thing that's scary which is
this cheesecake right now right right
okay so I see how hard hard it is for
you and I honestly it's hard for me to
watch and I wish I could just take that
away but as you know the reason opposite
action is so important is if you if I
just take that fear Away by saying no
more cheesecake right it's just going to
make you more fearful the next time you
come in front of some kind of food
that's tough for you make it worse yeah
so by doing this hopefully over time
your fear will go down okay okay so can
we have the fear right now and still
take a few more
so how was
that it's difficult yeah I can see how
difficult it is but I'm doing it but
it's difficult exactly doesn't feel
comfortable no I wouldn't imagine it
would but you did perfect out opposite
action right there which is you were
feeling really uncomfortable and I can
tell that but you still did it right do
you feel a little bit proud of yourself
yeah yeah a little bit okay so this
shows me that you can do it so let's try
again let's take a breath and then we'll
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