An eating disorder is a psychological condition that significantly affects one’s ability to eat and/or maintain proper nutrition. This might include restricting one’s diet to tiny amounts of food, excessive overeating, or unhealthy weight-management techniques such as over-exercise, laxatives, or vomiting.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is an evidence-based treatment that combines behavioral principles with cognitive principles. This specific type of treatment is based on the idea that our thoughts can influence our feelings and behaviors. As a result, CBT therapists work to help their clients identify negative or inaccurate thoughts that might be leading to unhealthy behaviors.
In numerous studies comparing CBT interventions to traditional forms of talk therapy, CBT was found to reduce the most symptoms, it was found to be the briefest treatment, and CBT was found to be associated with the lowest relapse rates. Rather than focusing on the causes of the disorder from the distant past, cognitive behavioral therapy focuses on immediate conditions that maintain eating disorders.
History of CBT
CBT was originally developed in the 1960s by Dr. Aaron Beck, a psychiatrist at the University of Pennsylvania. At the time, Beck was working with patients who experienced depression. He found that many of his patients exhibited similar thinking patterns, which he labeled “cognitive distortions.” Beck believed that by identifying and addressing these distortions, he could help his patients feel better.
Since then, CBT has been adapted and used to treat a variety of mental health conditions, including eating disorders.
How CBT Works
Cognitive behavior therapy is typically a short-term treatment, lasting around 12-16 weeks. During this time, the therapist and client will work together to identify the thoughts and behaviors that are maintaining the eating disorder. The therapist will also help the client develop healthy coping mechanisms to deal with difficult emotions and situations.
The goal of cognitive behavioral therapy is to help the client learn how to challenge and change their negative thoughts, which will in turn lead to healthier behaviors.
CBT’s Efficacy
Cognitive Behavior Therapy is considered a particularly effective means of treatment for eating disorders, especially bulimia nervosa. One study found that patients who were treated with CBT experienced greater decreases in both binge-eating and purging than those receiving interpersonal psychotherapy (IPT). CBT is done to help correct poor eating habits and prevent relapse.
Another study compared CBT to IPT, family therapy (FT), and supportive therapy (ST). The researchers found that patients treated with CBT experienced the greatest decreases in bulimic symptoms, followed by those receiving IPT.
This enhanced cognitive behavioral therapy for eating disorders (CBT-E) program is an outpatient program that provides therapy for people with bulimia nervosa, binge eating disorder, and other unspecified eating disorders. The CBT-E program has been found to be more effective than standard cognitive behavioral therapy
CBT: Levels of Treatment
CBT and E are science-backed effective treatment methods that are successful in diagnosing and treating eating disorders.. The interventions used in these effective treatments are manualized and have a high degree of fidelity. This means that the interventions are standardized, so that therapists delivering these treatments can be confident that they are providing an intervention that has been found to be effective.
There are three levels of care in which CBT can be delivered:
- Primary Care: This is the first level of care and includes outpatient treatments such as individual therapy, group therapy, and family therapy.
- Specialty Care: This level of care includes inpatient and residential treatments, such as partial hospitalization programs (PHP) and residential treatment centers (RTC).
- Tertiary Care: This is the most intensive level of care and usually includes treatment provided in psychiatric hospitals or trauma centers.
By their very nature, most patients will require more than one level of care before they are able to recover from an eating disorder.
CBT-E is the gold standard for the treatment of bulimia nervosa (BN). Cognitive behavior therapy (CBT) is a type of psychotherapy that helps people understand and change the thoughts and behaviors that contribute to their eating disorders.
Enhance Cognitive Behavioral Therapy (CBT-E)
(CBT-E) is best described as an enhanced form of CBT/E, suited to the specific needs of people with binge eating disorders. A key component of CBT-E is that it has been developed and refined over many years to address the range of problems and difficulties commonly presented by people who have bulimia nervosa (BN) and related conditions.
CBT-E is highly individualized and focused on the person and their progress. This treatment includes four stages:
- Assessment: This stage involves the therapist getting to know the person and their symptoms, as well as conducting a detailed disordered eating assessment.
- Treatment: In this stage, the therapist and client work together to identify the negative emotions, thoughts, and behaviors that are maintaining the eating disorder. The therapist will also help the client develop healthy coping mechanisms to deal with overwhelming triggers and feelings.
- Maintaining change: The focus of this stage is on helping the client maintain the progress they have made by continuing to problem-solve, learning new coping strategies, and exploring relapse warning signs.
- Relapse prevention: This final stage involves reviewing progress made at earlier stages of treatment, identifying future goals, and planning how to work toward the client’s future goals.
Cognitive-Behavioral Therapy (CBT) is a form of psychotherapy that is based on the idea that our thoughts cause our feelings and behaviors, not external things, like people, situations, and events. In other words, if we change the way we
CBT model of Eating Disorder
Usually, eating disorders begin small, but progressively become bigger and more problematic over time. Approximately 30 million Americans struggle with a serious eating disorder at some time during their lives. Eating disorders generally fall into three types: binge-eating disorder, bulimia, and anorexia nervosa. These disorders can become quite serious and have the potential to result in lasting physical damage or death. In CBT for eating disorders, there is a specific model for how eating disorder behaviors develop.
Binge-eating disorder
Binge eating disorder is defined as eating a large amount of food during a short period of time, while feelings of loss of control occur. Patients may not regularly engage in purging behaviors after a binge but may do so to avoid gaining weight.
Laxative abuse is the most common method of purging and is most common with anorexia. Most people with binge eating disorder also struggle with feelings of shame and guilt regarding their eating habits and weight, which are similar to those found in bulimia nervosa.
Bulimia Nervosa
The definition of bulimia nervosa includes binging followed by compensatory behaviors, such as self-induced vomiting, excessive exercise, or use of laxatives or diuretics. Patients with bulimia nervosa typically have a normal weight or are only slightly overweight.
They often try to disguise their behavior by eating in secret and fasting prior to binges. Bulimia nervosa is the most common type of eating disorder among people who seek treatment. Bulimia nervosa and borderline personality disorder have some features in common, such as impulsivity and difficulty regulating emotions.
Anorexia Nervosa
The definition of anorexia nervosa includes restrictive eating habits, intense fear of weight gain, and distorted body image. People with anorexia nervosa typically have a very low body shape and weight.
Many people with anorexia nervosa also engage in binge-eating and purging behaviors. However, because of their low body weight, these behaviors can be life-threatening.
The cognitive model of eating disorder behaviors suggests that there are three key steps in the development of eating disorders:
- Preoccupation with weight and shape
- Dieting and restricting food intake
- Disordered eating behaviors, such as binge eating, purging, and/or fasting
Patients with eating disorders tend to have thoughts that are in keeping with the cognitive model. Their behavior often follows a theme of either “all-good” or “all-bad.”
People who struggle with bulimia nervosa tend to hold an all-good view of themselves, thinking that they are only good when they are thin and engaging in healthy eating behaviors.
People with anorexia nervosa tend to have an all-bad view of themselves, thinking that they are only bad when they engage in any type of eating behavior that is not restrictive.
Components of CBT Treatment
The cognitive behavior therapy model has three components:
- Cognitive restructuring that allows patients to see their maladaptive thinking and beliefs about weight and shape.
- Eating Awareness Training (EAT), which helps individuals realize what they eat, why they eat it, when they eat, where they eat, and how much they need to eat to maintain a healthy weight.
- Behavioral Experiments, which allow patients to test their thoughts and beliefs about food and weight in a safe and controlled setting.
Cognitive behavior therapy is often used for common eating disorder diagnosis, as it helps people to understand and change the thoughts and behaviors that contribute to their disorder. Enhanced cognitive behavior therapy has been shown to yield better results than standard cognitive behavioral therapy alone.
Preparation for treatment and change
CBT is a collaborative treatment, which means that the therapist and patient work together to identify goals and strategies that will be helpful for the individual.
CBT treatment duration
Cognitive behavioral therapy is often short-term, with sessions occurring weekly or biweekly. During treatment, therapists assess for signs that the client is ready to move on to the next step in treatment.
Therapists also monitor for signs that a patient’s disorder is worsening and adjust accordingly. CBT is an open-ended treatment, so patients can continue to work with a therapist if they feel it is necessary.
Biweekly sessions are recommended initially while weekly sessions are recommended to prevent relapse. Weight regain is also monitored closely through weekly weigh-ins. In the version of CBT-E weight regain is integrated with addressing eating disorder psychopathology to prevent weight gain.
Responses of patients towards CBT
Therapists introducing CBT to their patients will often hear responses such as “I’ve tried that before” or “It’s not going to work.” It is important for therapists to be patient and understanding, while also remaining firm in their belief that CBT can be an effective treatment for eating disorders.
The majority of adult patients who complete CBT report a decrease in their symptoms. In a study of adolescents who completed CBT, 82% were free of eating disorder symptoms at the end of treatment.
This therapy for eating disorders is a successful treatment option that should be considered if you are struggling with an eating disorder.
Psychological treatments for bulimia nervosa and binging
Cochrane Database of Systematic Reviews is the leading journal on evidence-based medicine.
This evidence-based review of psychological therapies for bulimia nervosa compared different types of psychotherapy to one another, as well as to control groups that received no treatment or another type of treatment. Systematic exposure to forbidden foods is not addressed in CBT.
Eating Disorder Not Otherwise Specified (EDNOS)
CBT is the most commonly used treatment for eating disorder not otherwise specified (EDNOS).
A randomized controlled trial found that exposure-based CBT was effective for adults with EDNOS. Development of skills that apply to all eating disorders
Cognitive-behavioral therapy skills are not specific to any one disorder, but can be used to address a variety of problems.
Cognitive Behavioural Therapy Los Angeles is a therapy practice of expert psychologists with the highest level of training and experience in providing leading evidence-based treatment.
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How do you do CBT for anorexia?
The shape of CGBT is in relation to the dietary disorders and includes negative evaluative beliefs in esteem, as well as excess weight and shape. This includes behaviors as controlled as restricting consumption, cleansing the diet, excessive snacking, eating and other habits that are harmful.
Why does CBT work for anorexia?
It helps in identifying and resolving issues affecting the underlying causes of an obesity-related problem. Betty may learn to confront eating debilitating attitudes and beliefs. She would then have more control over their moods.
What is CBT for anorexia nervosa?
Cognitive behavioral therapy is talking therapy aimed to examine interactions between mind and behavior in people. Cognitive-behavioral-based interventions aimed at people with eating disorders are presented in four phases over the first three years.
How is CBT used to treat bulimia?
For CBT patients the psychotherapist works together with the client to dissipate and control factors affecting binge-purge to maintain abstensive lifestyle and behavior. These therapeutics generally are offered individually, but can usually happen through group therapy.
