In Brief: What is Temperament-Based Therapy with Supports (TBT-S)?

18 Mar, 2019

The renown US eating disorder expert Dr Laura Hill recently toured Australia (with EDFA) teaching carers and clinicians about a new and emerging therapy called Temperament-Based Therapy with Supports, or TBT-S for short.

(You might know Dr Hill from her TEDx talk in 2012 in which she gives a unique insight into the brain of someone with an eating disorder. Watch it HERE)

While in Sydney, we had the chance to sit down with Dr Hill and ask about TBT-S.

So, what exactly is TBT-S?

“Temperament-Based Therapy with Supports is a therapeutic model that examines the roots of an eating disorder,” says Dr Hill.

TBT-S uses talk therapy to help the person with an eating disorder (and their support people) understand how their symptoms can be explained by their temperament. Where temperament is used as an umbrella term involving biology, brain functioning, genetics and personality traits.

For example, personality traits such as perfectionism, impulsivity, harm avoidance and determination are common among people with eating disorders.

TBT-S asks: How can you learn to use and express those personality traits productively instead of destructively?

How does TBT-S help?

Dr Hill says that when a person understands their unique temperament, “it helps them to realise why their tendency toward bingeing or purging or restricting from food, or need to over-exercise, is occurring.”

“We have developed ways to help clients and their supports to understand how and what is going on, and how they can address it and respond to it,” she says.

TBT-S also has a focus on understanding what is going on in the brain. Dr Hill says she uses a 3D model of a brain to show clients and their support people about how certain pathways fire during or after a meal.

She has also designed games that help loved ones to understand what it is like to have an eating disorder.

How is TBT-S different from other therapies?

Dr Hill says that temperament is an area that eating disorder treatment approaches have generally ignored.

“When it is included, it tends to be approached from a pathological perspective with the implication that traits need to be eliminated,” she says.

“Clients are left with feelings of failure that they cannot change, and invalidated by currently available treatments that are focused on changing these traits.”

TBT-S upholds the philosophy that while eating disorder symptoms can be minimised or eliminated, traits are a part of who we are. Through TBT-S, a person and their carers can learn about their individual traits and how to utilise them as tools for recovery.

“People’s motivation to actively participate in the treatment process increases because they no longer hold guilt, shame and loss about their inability to simply eat like everyone else,” she says.

However, Dr Hill says we shouldn’t throw out other therapies. TBT-s is used in addition to therapies such as Cognitive Behavioural Therapy and Family-Based Therapy. TBT-S explores the root or foundation of the eating disorder, while CBT and FBT address the outward expressions of the illness.

Where did TBT-S come from?

TBT-S emerged after years of research at two sites in the United States, one in Ohio and the other at the University of California, San Diego.

“At UC San Diego, around 2006, they were developing increasing amounts of fMRI studies that were identifying what is going on in the brains of those that have eating disorders,” Dr Hill said.

“We began seeing what was going on in the brain and understanding the way the brain is over-firing and under-firing compared to those who don’t have eating disorders.”

“The term itself, TBT-S, was just developed in 2018.”

While the bulk of the research has been looking at Anorexia Nervosa, studies are now starting to look at Bulimia Nervosa and Binge Eating Disorder.

“We’ve been looking at how this type of treatment and understanding of the biology from the perspective of the clients, and their supports, would impact them understanding and moving towards a better phase of health.”

What is the evidence?

TBT-S has been tested in open trials over the last four years that show promising initial results and warrant further investigation.

One study into Anorexia Nevosa found significant acceptability and feasibility both at the end of treatment and follow up for TBT-S.

Research into how the brain is affected in people with eating disorders is ongoing. The TBT-S model and approach will continue to develop and evolve as understanding of the genetic, neurobiological and personality trait findings advance.

To learn more about TBT-S, click here.