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“In this book, Federici and Wisniewski bring MED-DBT to life with the same clarity, warmth, and clinical brilliance that they bring to their workshops. The book lays out a flexible treatment protocol that addresses the complex interplay of emotional, biological, and environmental factors that fuel eating disorders in multi-problem presentations. The authors’ voices are unmistakable—compassionate, direct, and wise—and their respect for clients permeates every page. With rich clinical examples, an accessible tone, and step-by-step guidance, this book is a ‘must have’ for both eating disorder clinicians looking to expand their repertoires and DBT therapists hoping to work effectively with people with eating disorders. It fills a critical gap for treatment of individuals who have not benefited from traditional therapies.”

—Cynthia M. Bulik, PhD, FAED, Distinguished Professor of Eating Disorders and Founding Director, University of North Carolina Center of Excellence for Eating Disorders; Director, Centre for Eating Disorders Innovation, Karolinska Institutet, Stockholm, Sweden


“From the very first pages of this book, the authors’ determination to relentlessly seek solutions to tough problems is evident. Federici and Wisniewski emphasize that when treatments for people with eating disorders and complex problems fail, it reflects limitations in our methods and skills, not shortcomings in the patient. Early in my DBT career, I realized that eating disorders presented challenges beyond my existing skills. This book addresses a significant gap for many practitioners, offering strategies and hope where we have often felt powerless. It stands out as a promising tool to help therapists facing extreme clinical needs, and encourages a relentless pursuit of more effective ways to help those at greatest risk.”

—Anthony P. DuBose, PsyD, Vice President for Institute Services, Behavioral Tech Institute, Seattle Washington


“Federici and Wisniewski offer a compassionate, evidence-informed lifeline to patients we too often label as ‘treatment resistant.’ The MED-DBT protocol embraces complexity rather than avoiding it, integrating the core tenets of DBT with deep expertise in eating disorders. This book is not only a transformative clinical guide, it is also a powerful tool for training and supervision. I will be using it with my teams and trainees across Latin America and beyond. A true gift to our field and to every clinician seeking to meet their most vulnerable patients with both science and soul.”

—Eva Trujillo-ChiVacuan, MD, CEO and Cofounder, Comenzar de Nuevo AC, Monterrey, Mexico; President (2025–2027), International Association of Eating Disorders Professionals; Clinical Professor, Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud

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Table of Contents

I. An Introduction to MED-DBT

1. The MED-DBT Program: Development and Foundations

2. Assessment for Treatment: Is MED-DBT a Good Fit for Your Client?

II. MED-DBT Theories and Treatment Assumptions

3. Introduction to the Adapted Biosocial Theory: A Focus on Biology

4. The Adapted Biosocial Theory: A Focus on Invalidating Environments

5. Assumptions about MED-DBT Clients

6. Building Your MED-DBT Team

7. Dialectical Dilemmas in MED-DBT Treatment

III. Getting Ready for Treatment

8. Laying the Foundation: Early Steps in the MED-DBT Pretreatment Phase

9. Strengthening Commitment: Later Tasks in MED-DBT Pretreatment

10. The Life Worth Living Discussion

11. What to Target and When

IV. The MED-DBT Protocol

12. Individual Session Structure

13. MED-DBT Diary Cards

14. Behavior-Chain Analysis and Missing-Links Analysis in MED-DBT

15. Considerations for Teaching DBT Skills

16. Adaptations for Phone Coaching

17. Contingency Management in MED-DBT

18. Consult Teams in MED-DBT

19. Transitions and Ending Well

List of Abbreviations

References

Index

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About the Authors

Anita Federici, PhD, CPsych, is founder of The Centre for Psychology and Emotion Regulation in Midland, Ontario, Canada. She holds an Adjunct Faculty position at York University and is a Fellow of the Academy for Eating Disorders. Internationally recognized for her expertise in eating disorders and dialectical behavior therapy, Dr. Federici specializes in building sustainable, evidence-informed care systems through strategic consultation, implementation support, and team-based training for hospitals and organizations worldwide. Her work integrates clinical expertise and systems design to support the development of scalable, person-centered care pathways, particularly for underserved populations and clients with complex treatment needs. Dr. Federici has delivered more than 400 lectures, workshops, and invited talks, and has published peer-reviewed articles and book chapters.

Lucene Wisniewski, PhD, is Adjunct Assistant Professor of Psychological Sciences at Case Western Reserve University and founder and Chief Clinical Officer of the Center for Evidence Based Treatment in Shaker Heights, Ohio. A Fellow of the Academy for Eating Disorders (AED), she has served on AED’s board of directors and as co-chair of the Borderline Personality Disorder special interest group. Dr. Wisniewski is a recipient of the Outstanding Clinician Award from AED and the Champion of Evidence-Based Psychological Interventions Award from the Association for Behavioral and Cognitive Therapies. She received a Fulbright Specialist Program Award to work with Comenzar de Nuevo AC, a nonprofit eating disorder facility in Monterrey, Mexico. Dr. Wisniewski has taught workshops and continuing education seminars worldwide and has authored numerous peer-reviewed articles and book chapters.

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Audience

Clinical psychologists, psychiatrists, social workers, and other mental health practitioners who treat clients with eating disorders.