Free Dialectical Behavior Therapy for Binge Eating and Bulimia by Debra L. Safer, Christy F. Telch, Eunice Y. Chen Page B

certain amount of antibiotics to take if you’re ill. It is important to take the whole dose, even if some days you don’t feel like it or are feeling as if you don’t need it. It takes a lot of effort to stop binge eating [and purging], and we want you to succeed, so receiving a full dose of the treatment is important.”
    Discussing Dates of Treatment and Making Up Missed Sessions During the pretreatment interview, the therapist should review the client’s avail— ability for the scheduled period of treatment. In our research studies, clients, during the assessment period, compared their schedules with the dates of scheduled sessions. Clients who, at the outset of treatment, determined that they would have to miss more than three group sessions were unfortunately not able to join the group.1 Of course, in individual treatment, scheduling can be more fexible, but every attempt should still be made to keep treatment as continuous as possible, with missed sessions rescheduled quickly. If sessions are carried out in a group format and are recorded on audio or video, the therapist explains at this juncture (to be revisited as needed subsequently) that clients who cannot avoid missing sessions (e.g., due to illness) are required to set up a time to make up the missed material by coming to listen to the recordings.
    1This differs from standard DBT (Linehan, 1993b, p. 23), in which clients who miss 4 weeks of scheduled skills training sessions in a row are dropped from treatment.

The Pretreatment Stage
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    Asking about the Client’s Prior Treatment Experience We recommend inquiring about the client’s prior therapy experiences. The therapist might say, “I am going to give you a general idea of the treatment, but frst I’d like to learn more about you. Have you been in a group before? Have you been in one like this? If yes, what did you like or did not like? Are there any issues you foresee?” In our experience, it was not unusual for clients to have obtained support for their eating concerns through such groups as Overeaters Anonymous, Weight Watchers support groups, and/or therapist-led groups. Therapists may wish to emphasize, particularly if clients report a negative past experience with such groups, the differences between this current treatment approach (i.e., a struc— tured, skills-based group with an eating-disorder focus) and what they have tried. We also try to help clients cope ahead of time with any reported diffculties they have experienced with past treatment attempts.
    Introducing the Emotion Dysregulation Model We have found it helpful to introduce the emotion dysregulation model of problem eating (i.e., binge eating and/or purging; Appendix 3.1) by having the client describe a typical problematic eating episode and using this as a basis for assess— ing the model’s personal relevance and ft for the client. The therapist might commence as follows: “Now I would like to ask you about a recent or typical binge [and purge]. Can you describe in as much detail as possible what was going on for you at the time? What circumstances preceded the binge [and purge]? What feelings were you having?”
    Following the client’s description, the therapist presents the emotion dysregulation model of problem eating (see Appendix 3.1) and uses particulars from what the client has revealed to describe the fow of events.
    During the discussion, the therapist looks for opportunities to make the following points:
    •• “This model assumes that emotions are reactions to internal or external events. In other words, something in your environment, such as an argument, and/ or something in yourself, such as your thinking, triggers an emotion or set of emotions.”
    •• “Emotions, whether they are negative emotions such as sadness or anger or positive emotions like happiness or joy, can be uncomfortable. Feeling any emotion too strongly or too intensely can be diffcult and therefore requires skillful emotion