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Cognitive-Behavioral Therapy for Eating Disorders

An Overview

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Updated May 21, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

What is Cognitive-Behavioral Therapy?

Cognitive-Behavioral Therapy (CBT) is a psychotherapeutic approach to treatment that combines aspects of cognitive therapy and behavioral therapy. It is based in the idea that a sufferer can learn to recognize negative thoughts (sometimes called "eating disorder thoughts" in eating disorder treatment) and work to challenge and replace them with more rational, positive thoughts. The idea is that as the negative thoughts are challenged and replaced, the negative emotions and disordered behaviors will also change.

Although CBT is used to treat many mental disorders, within eating disorder treatment it is based in the assumption that all eating disorders share a problem with thinking (cognition). This typically includes thinking that one’s self-worth is based on body shape, size and/or weight, resulting in disordered behaviors, such as restricting or purging.

Like most treatment approaches, CBT begins with the therapist getting to know the client and assessing the eating disorder and any co-occurring issues. As treatment continues, the therapist will typically assign various homework tasks, such as monitoring one’s food intake and the thoughts and feelings surrounding eating, or monitoring urges to act on eating disorder behaviors and looking for potential patterns and triggers. The therapist will then work with the client to recognize which thoughts are disordered and help the client learn how to challenge these thoughts.

Initially, treatment with CBT may focus on addressing thoughts and emotions connected with eating and the way the person perceives their body shape and size. It may then progress to addressing other topics, such as perfectionism, low self-esteem and relationship problems.

Does Cognitive-Behavioral Therapy Work?

Cognitive-behavioral therapy is considered one of the most effective and well-researched treatments for many mental disorders, including eating disorders. Research has shown its effectiveness at treating bulimia nervosa, anorexia nervosa, and binge eating disorder. The majority of studies have looked at bulimia nervosa, with 40-50% of people who complete treatment able to stop binge eating and purging completely.

Who Makes a Good Candidate for Cognitive-Behavioral Therapy?

CBT is considered quite flexible and can be adapted for use in both outpatient and inpatient settings. It can be adapted to allow the inclusion of family members or used in a group therapy setting as well. Many people suffering from eating disorders also suffer from symptoms of depression and/or anxiety disorders. These can often be treated with CBT as well. It is important to note that the majority of research studies using CBT to treat eating disorders have focused on adults.

Who is Not a Good Candidate for Cognitive-Behavioral Therapy?

Cognitive-behavioral therapy is often used when treating both adults and adolescents suffering from eating disorders. However, the developmental stage of adolescence often requires a family-based approach. Currently, Family-Based Treatment (or Maudsley) is the most researched treatment for adolescents with anorexia nervosa.

CBT may also be difficult to implement with clients who refuse to participate in the therapy process. It is also problematic to implement CBT with people who are misusing drugs or alcohol on a daily basis and is inappropriate for those who are experiencing psychotic states.

Sources:

Fairburn, C.G. (2008). Cognitive Behavior Therapy and Eating Disorders. New York, NY: Guilford Press.

Fairburn, C.G., Cooper, Z., & Shafran, R. (2003). Cognitive behavior therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41. 509-528.

National Institute for Clinical Excellence (2004). Eating disorders: Core intereventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders (Clinical Guideline No.9). London: Author. (Available at www.nice.org.uk/guidance/CG9).

Wilson, G.T., Grilo, C., & Vitousek, K.M. (2007). Psychological treatment of eating disorders. American Psychologist, 62(3). 199- 216.

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