It's Hard to Be a Saint In the City

Cognitive Behavioral Therapy (CBT) is often utilized in eating disorder treatment. CBT's younger sibling, DBT (Dialectical Behavioral Therapy) is more rarely employed, but certainly isn't unheard of, especially with the accompanying diagnosis of Borderline Personality Disorder, or a mood disorder (DBT came about to treat BPD, in fact). CBT can be individual- or group-based, but DBT is almost always both. Their shared main focuses are mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance. DBT works with these four ideas from a philosophical standpoint as much as a therapeutic one, drawing from Buddhist teachings as well as from Hegel (whence the "D"). A major difference, aside from the philosophical focus of DBT, is that DBT tends to be very. very. structured. The structure shows itself most in the group work; CBT group work can bleed into more generalized group therapy. I've done both CBT and DBT work. I found the CBT overlap of skills and talk therapy helpful at the time; and I carry with me the almost-drilled-into-me reflexes of DBT (when I can't be bothered to stifle the reflex, anyway). I have no idea what only one or only the other would impart to an eating disorder patient, but I'm glad I've had exposure to both.

This acronym-riddled, rambling paragraph is me saying, "I think structure is good. Yay for structure. But contextless structure is bad. Boo for contextless structure." DBT of course is not without context, so I exaggerate, but I can't see that DBT (the way I learned it) would have done me, as an eating disorder patient, as much good without a foundation of CBT...

... Sort of like it won't do you much good to slap the calories up on a fast food menu and then wait for the public to suddenly Get! It! about food choices. (Yes, that's really where I was going with the CBT vs. DBT thing.) (What? It's 1:00 a.m. You write something concise and relevant.) You can't shame people into eating healthier foods. But you can teach them about nutrition from the get-go, and you can retrain in adulthood to some extent. You can't solve body image issues by shaming everyone into eating fewer calories (which they don't do, anyway, according to this study). But you can promote respect and education, and so build a foundation for personal worth that isn't based on appearance. You can't toss someone a few arbitrary numbers (calories in a slice of Sbarro pizza) and expect them to suddenly and against all other logic start ignoring a set of NOT arbitrary numbers ($1.50 for a slice of pizza; $13.50 for a salad with grilled chicken at the place next door, as an example from my neighborhood). (And don't you dare get any dressing with that salad. The low-fat stuff has too much sodium, and we won't even discuss the full-fat stuff. Balsamic vinegar for you!) But shame on you if you eat that pizza slice, or that cheeseburger, or that Taco Bell burrito. Shame on you for being too lazy to work a second job so you can comfortably afford fresh produce at every meal (and snacks - processed snacks give you cancer!!1!). And shame on you for buying the 80% lean chuck instead of the 95% lean organic bison. Shame, shame, shame. What's that? How are you supposed to afford the more expensive stuff if you're already scraping by? Don't ask the City; it's not our problem.

This menu rule makes me ANGRY. It makes me DISTRESSED. So it's a damn good thing I have my CBT workbook all marked up under the bed. (What? You can't shell out for a CBT workbook because you're paying for daycare for your kid? Shame on you!! If you can't help yourself, nobody will help you!*)

Ugh. I'm going to bed. (Or, I will as soon as the drunk kid stops singing "Helena" at the top of his lungs out on the street. Ah, New York, New York.)

* They start for about $15 on Amazon. :-/