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TBT-S is the acronym for Temperament Based Therapy with Support. It is an emerging and novel neurobiologically based treatment that works with clients’ temperament to motivate change and to manage and reduce symptoms. TBT-S fills the gap between research and clinical practice by acknowledging and treating underlying brain-based factors. It treats to clients' traits which tend to trigger their symptoms. The difference between traits and symptoms are:  

Symptoms:

• Are outward behavioral expressions 
• Are indicators or reactions to illnesses 
• Have the potential to be reduced and eliminated 

Traits: 

• Are genetically programmed innate features 
• Can be altered via intentionally shifting expressions 
• Cannot be eliminated 

Anyone who offers Support.  

They may be nearby or far away,

They could be a peer, older or younger.

Supports have included: spouse, partner, roommate, neighbor, pastor, friend nearby, friends in other states/countries, peer who is stable in their own eating disorder symptoms, adult children of the client, parents, sibling and other relatives.

It consists of traits that are the biological underpinnings to one's personality.  Temperament is to nature as one's character is to nurture.

Since 2009

TBT-S has been studied and refined through multi-site open trials and through adult client and Support feedback, the results have shown significant improvement by decrease in eating disorder symptoms, anxiety and depression over six months.  The neurobiological information integrated into the treatment is based on evidence from peer-reviewed, international research publications that focus on the genetic and neurobiological underpinnings of anorexia nervosa.  Randomized controlled trials are forthcoming.

It has been tested on anorexia nervosa and related eating disorders. A temperament based approach has the potential to be applied to other disorders that are trait based.

It has been developed to augment ongoing eating disorder treatments by focusing on temperament, Support persons, and movement/action dimensions to enhance motivation and long-term change.

Because it fills a major gap in eating disorders treatment by addressing why the illness develops; how brain response is different between those with eating disorders and those who do not have eating disorders; connects the underlying triggers to symptoms, and includes Supports in designated sessions with adults who have anorexia  nervosa (AN). 

Our research outcomes have found that TBT-S significantly increases motivation to change over time and reduces eating disorder and comorbid symptoms.

TBT-S has been developed and tested on adults ages 18 to over 60 years old with anorexia nervosa and related symptoms. There is a Young Adult version and a Severe-and-Enduring for Anorexia Nervosa (SE-AN) version.

Dr. Knatz Peck has also developed TBT-S applications and strategies for families and the parents of children and adolescents. 

TBT-S can be applied in a wide range of settings from outpatient through residential levels of care:

• TBT-S modules can be "seasoned" into ongoing therapy sessions.
• TBT-S modules offered in designated treatment sessions.
• A portion to all of an intensive outpatient program.
• As a free-standing 5- day or a one-week program, regularly offered within a larger eating disorder program setting.  (The 5-day free-standing program was the format in which TBT-S open trials were studied).
• As a 1-3 day free-standing program setting. 

An important element to treatment for anorexia nervosa (AN) is left out that impacts outcomes over time.  

Traditionally, clinicians are trained to exclude Supports from a client's treatment due to the developmental process of individuation, and adult client boundaries of confidentiality. Adult clients with AN often do not want Supports included in their treatment. It takes more time to organize the inclusion of Supports. 

It was the adult clients who requested to have their friends and loved ones come to designated sessions to learn the same information and the same tools so that everyone was on the same page. It was the adult clients who asked that their friends, family, peers or colleagues be referred to as "Supports" because they reported wanting "support" and not to be "taken care of" or solely family members to turn to. As a result, "Supports" was named and added to Temperament Based Therapy, creating the "S" of TBT-S.