CBT for Eating Disorders

An eating disorder is a psychological problem that significantly interferes with eating and/or overall nutrition. This can include restricting one’s diet to small amounts of food, extreme overeating, or engaging in unhealthy ways of regulating weight, such as over-exercise, laxatives, or vomiting. 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.

Cognitive Behavioral Therapy (CBT) has proven to be the most clinically effective treatment for all eating disorders. In numerous studies comparing CBT 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 causes of the disorder from the distant past, cognitive behavioral therapy focuses on immediate conditions that maintain eating disorders. CBT for eating disorders varies by disorder. Generally, CBT treatment for eating disorders involves several of the following components:

Cognitive restructuring: Cognitive restructuring helps people to identify unhelpful or distorted thinking patterns, and modify them with more reality-based or effective thinking. With eating disorders, this often focuses on targeting people’s unhelpful assumptions and beliefs about food, body image, and emotions.

Behavioral chain analysis: Chain analysis is a tool to help clients identify the factors maintaining behaviors they want to change. By identifying immediate factors contributing to their disorder, inventions are more easily designed to target the symptoms.

Emotion regulation strategies:  Significant research has shown than many people with eating disorders use disordered eating behavior to manage difficult emotions. This is supported by the statistic that about 50% of people with an eating disorder also have clinical depression. By helping people regulate and better cope with intense emotions, CBT helps people reduce the urge to engage in problematic eating behavior.

Distress tolerance training: Because powerful urges are usually at the heart of eating disorders, distress tolerance training can help people better tolerate harmful urges. Distress tolerance involves helping people learn to experience urges without giving in to them.

Mindfulness: People with eating disorders often spend a large amount of time ruminating about food and body image. This can increase with time, making it very difficult to change disordered eating behavior. Mindfulness training is a tool that can help people get out of their thoughts and connect to the present moment, disrupting the rumination cycle, and making healthy behavior possible.

Generally because anorexia nervosa requires a higher level of treatment initially, we refer all individuals who have anorexia to intensive outpatient and residential programs. Bulimia and binge-eating disorder however, can be safely treated in weekly outpatient CBT therapy.