What is TBT-S?
What is TBT-S? My Perspective on Temperament-Based Therapy with Support for Eating Disorders
If you’re supporting a loved one with an eating disorder, you’ve likely seen how challenging it can be to navigate their emotions, behaviours, and needs. That’s where Temperament-Based Therapy with Support (TBT-S) comes in—a fresh, evidence-based approach that doesn’t try to “fix” your loved one but instead helps you understand and work with their natural temperament and brain biology. TBT-S has been transformative for many families, as it offers practical, personalised strategies that align with who the person really is.
What is TBT-S?
TBT-S is designed to address the temperamental traits that are often at the root of eating disorders, like high anxiety, rigidity, perfectionism, and harm avoidance. These traits are not flaws; they’re part of who the person is and, in many ways, can be their strengths. TBT-S helps families and individuals understand these traits, recognising that they’re biologically based and ingrained. The aim is to learn how to work with these characteristics rather than against them, using them as a foundation for recovery.
Why TBT-S Feels Different
What I love about TBT-S is that it’s not about changing who someone is but about building strategies around their natural tendencies. The approach brings in family members and Supports so everyone understands what’s happening from a neuro-biological and emotional perspective. It’s a team effort, and that’s what makes it powerful. Here are some aspects that stand out:
Understanding Temperament: TBT-S helps families and individuals get to the heart of the matter—recognising how traits like anxiety, sensitivity, or perfectionism can influence eating disorder behaviours. This understanding is a game changer. It helps to shift the focus away from blame or frustration and towards empathy and effective support.
Personalised Interventions: Every person’s temperament and biology are different, and TBT-S honours that. It’s about creating strategies that align with the individual’s specific needs and traits. For example, if someone struggles with high anxiety, we learn techniques that work with their nervous system to help them manage and soothe their anxiety in a way that fits who they are.
Supports Involvement: TBT-S really values the role of families and carers. In my experience, when everyone is on the same page and has the tools to support their loved one, it creates a more cohesive and supportive environment. The program provides practical skills and education, so Supports know how to respond in a way that feels supportive rather than controlling. It’s about being there for the person you care about, making them feel safe and understood.
What Makes TBT-S Unique: Supports and Rationale
TBT-S takes a fresh approach by blending neurobiological insights with practical support strategies. Here’s what makes it different and why it works:
A Neurobiological Understanding: TBT-S goes beyond just looking at behaviours—it dives into the brain. Research shows that eating disorders often involve changes in brain function, like heightened sensitivity to anxiety and differences in how the brain processes rewards. TBT-S directly addresses these neurobiological traits:
Anxiety and Fear Response: Many people with eating disorders have an intense fear response. TBT-S teaches specific skills for managing this, like mindfulness and grounding exercises, helping individuals learn to manage their anxiety in ways that feel natural for them.
Cognitive Rigidity: If you’ve ever noticed how your loved one struggles with flexibility or adapting to change, it’s likely linked to how their brain processes information. TBT-S uses techniques to help them develop cognitive flexibility, allowing them to see new possibilities and move away from rigid patterns.
Practical, Skills-Based Learning: TBT-S isn’t just theoretical; it’s hands-on. It teaches real skills tailored to specific traits:
Emotion Regulation: Given how intense emotions can be for those with eating disorders, TBT-S offers practical tools, like breathing exercises and distress tolerance techniques, to help manage and navigate these emotions.
Building Supportive Relationships: TBT-S focuses on improving communication and relationships. It gives families and individuals the skills to connect in meaningful ways, creating a safe and supportive environment where everyone feels heard and valued.
Realistic, Sustainable Support: One of the most impactful parts of TBT-S is that it sets realistic expectations. It acknowledges that temperament is a lifelong part of who someone is—it’s not something that changes overnight. Instead of trying to alter these traits, TBT-S helps the person and their family find ways to manage them effectively, turning what may have felt like challenges into strengths.
The Neurobiology Behind TBT-S
Eating disorders don’t just “happen”; they’re often linked to the way the brain processes emotions, rewards, and fear. TBT-S uses this understanding to target the underlying biology driving the disorder. Here’s how:
Reward Systems: People with eating disorders might have brains that respond differently to food and body image. For some, restricting food brings a sense of reward due to heightened dopamine sensitivity. TBT-S helps individuals develop new ways to achieve that sense of satisfaction without relying on harmful behaviours.
Executive Function and Flexibility: Many individuals with eating disorders struggle with decision-making and adapting to new situations, often getting stuck in rigid patterns. TBT-S incorporates cognitive exercises and strategies that promote flexibility, helping individuals learn how to shift their focus and adapt their behaviours more easily.
Managing Intense Emotions: Those with eating disorders often have hyperactive limbic systems, which regulate emotions. This can lead to overwhelming feelings that drive the disorder’s behaviours. TBT-S provides emotion regulation skills that help calm the nervous system, making it easier to manage these intense experiences.
How TBT-S Empowers Individuals and Families
TBT-S offers a fresh, compassionate way to support recovery from eating disorders. Recognising that temperamental traits and brain biology play a key role creates a personalised, collaborative approach that works with, rather than against, the individual’s nature. For families like mine, it’s been a lifeline—giving us the tools and understanding to support our loved one in an authentic and effective way.
If you or your loved one are struggling with an eating disorder, TBT-S provides a path that respects who they are while offering practical support. It’s about building a future that works with their unique traits, using their strengths as a foundation for recovery.