A comprehensive treatment guide to CBT for eating disorders

Cognitive Behavioural Therapy is considered a leading evidence-based treatment program for eating disorders. It is a psychotherapeutic approach that includes a variety of techniques. With the help of this approach, people learn ways to establish interaction between their thoughts, behaviours, and feelings and design strategy to alter unhelpful behaviours and thoughts to improve functioning and mood.

CBT is a time-bound, goal-oriented therapy involving homework outside the sessions. CBT focuses more on the coordination between client and therapist and active client participation throughout the process. CBT has turned out effective for several mental health conditions, including generalized anxiety disorder, depression, OCD and phobia.

A cognitive model of eating disorder

The cognitive model of eating disorders put forward the core maintaining problem in all eating disorders, which is over-concern with weight and shape. Although the ways through which this concern manifest may vary from person to person. It can be any of the following conditions

  • Low weight
  • Compensatory behaviour such as laxatives, excessive exercise and self-induced vomiting.
  • Strict dieting
  • Binge eating

All these components can interact to create the symptom of an eating disorder. Strict dieting, including eating a small amount of food, skipping meals, and avoiding forbidden foods, can become the reason for low weight or the condition of binge eating. Low weight leads to the situation of malnutrition and also becomes the reason for binge eating.

However, bingeing leads to a state of intense shame and guilt and a renewed attempt to diet. It leads to efforts to undo purging through compensatory behaviour. Patients generally feel trapped in this cycle.

An important component of CBT treatment

CBT is a structured form of treatment. It takes 20 sessions, and goals are fixed in it. During the session, the therapist weighs the patient's situation, reviews the formulation of the case, and reviews homework, problem-solving and teaching skills.

CBT includes enlisted components

  • Confront their dietary rules:- This includes identification of their dietary rules and challenging them.
  • The accomplishment of a food record is essential after eating and recording your feeling, thoughts and behaviour.
  • Expansion of continuum thinking to replace nothing or all thinking
  • Designing strategies to prevent compensatory and binges behaviours like the use of alternatives, delays and problem-solving strategies.
  • Detailed exposure to your food-related fear: - once the eating pattern becomes well established and compensatory behaviours are under control, patients are gradually reintroduced to the food they fear.
  • Planning of meal: - It is suggested to the patients to plan their meals ahead of time so they may know when and what/her next meal will be.
  • Psychoeducation to make the patient++ understand what maintains medical and psychological consequences and eating disorders.
  • Regular weighing to track the progress
  • Relapse prevention to identify both helpful strategies and how to deal with potential future blocks
  • Use of behavioural experiment

Final words

Usually, CBT doesn't recommend as the first-line treatment. But if the condition of the patient becomes adverse with time, then CBT is suggested. People with binge eating disorders, bulimia nervosa and other specified eating disorders are considered good patients for CBT.