Dialectical Behavior Therapy and Eating Disorders: The Use of Contingency Management Procedures to Manage Dialectical Dilemmas

Am J Psychother. 2015;69(2):129-40. doi: 10.1176/appi.psychotherapy.2015.69.2.129.


Several researchers have adapted and/or applied dialectical behavior therapy (DBT) for populations with eating disorders. There is a growing body of research that indicates that DBT is an effective treatment option for this population, including those who have co-occurring Axis II disorders. The goal of the current paper is to summarize the research conducted in the area of DBT with those individuals who present with eating disorders only as well as those who present with both eating disorders and Axis II disorders. We also describe a dialectical dilemma, apparent compliance vs. active defiance, which is commonly observed in the group with comorbidities A DBT change strategy, contingency management, is discussed as an intervention to target apparent compliance and active defiance.

MeSH terms

  • Anorexia Nervosa / complications
  • Anorexia Nervosa / psychology
  • Anorexia Nervosa / therapy
  • Behavior Control* / methods
  • Behavior Control* / psychology
  • Behavioral Symptoms* / diagnosis
  • Behavioral Symptoms* / etiology
  • Behavioral Symptoms* / therapy
  • Binge-Eating Disorder / complications
  • Binge-Eating Disorder / psychology
  • Binge-Eating Disorder / therapy
  • Bulimia Nervosa / complications
  • Bulimia Nervosa / psychology
  • Bulimia Nervosa / therapy
  • Cognitive Behavioral Therapy / methods*
  • Comorbidity
  • Depressive Disorder / complications
  • Depressive Disorder / psychology
  • Depressive Disorder / therapy
  • Disease Management
  • Humans
  • Patient Compliance / psychology
  • Psychotherapeutic Processes
  • Reinforcement, Psychology