General Introduction & Outline 13 1 Dialectical Behaviour Therapy (DBT) was originally developed for people with severe borderline problems [45]. DBT is an elaboration of Cognitive behaviour Therapy where the emphasis is on learning and applying new skills to deal more effectively with emotions and life problems. DBT has a number of (coaching) strategies (including cognitive behavioural therapy, validation, and dialectics) that are specific to this therapy and have been studied for their effectiveness in group therapies in the clinical setting [27-28, 38, 46-47]. Emotional eaters can seek help from the specialized dietician, who has knowledge of emotional eating [48-49], and from the mental health care worker in the General Practice. This employee, usually trained as a social psychiatric nurse, social worker or (basic) psychologist, supports the General Practitioner in the supervision and treatment of patients with (mild) psychological, psychosocial or psychosomatic complaints [50-51]. Obese emotional eaters can also be treated in combined lifestyle interventions with a multidiciplinary approach [52]. Psychologists in primary mental health care provide short-term training in emotion regulation, mindfulness, intuitive eating [53-54]. Psychologists and psychiatrists in the secondary mental health care provide long-term clinical programs in Dialectical Behaviour Therapy and Cognitive Behavioural Therapy [55]. What holds back treatment? Unfortunately, the current provision of care does not fully meet the needs of the emotional eater. Firstly, there is a perceived distance to health care among emotional eaters. They are ashamed of their eating problem [56] and will not readily seek care [56-59]. Emotional eaters do not tend to share their problems with friends or family, nor will they discuss with their GP (General Practitioner) that they have a problem with eating behaviour [56], thus, a significant proportion of emotional eaters remain invisible to the outside world [60-62]. If they come to the GP for help at all, it is not the eating problem itself that is discussed, but problems arising from obesity, such as diabetes or knee problems [16]. There is little chance that the eating problems will be recognized or even diagnosed [60, 63]. Secondly, only limited care is available. Emotional eaters in the Netherlands have difficulty accessing existing health care services. Only a restricted group of dieticians has (nutritional) knowledge of emotional eating behaviour [48-49]. Dieticians often lack specialist skills to provide best practice care for people with eating disorders [64].
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