Individual psychotherapy for bulimia nervosa is a powerful component of any recovery program. Therapy is effective in treating bulimia.
But what kind of therapy do you choose? Most important is to find a therapist and a form of counseling that work for you. Research consistently finds that the quality of the therapeutic relationship is one of the most important contributors to treatment success.
Cognitive-Behavioral Therapy for Bulimia
Without doubt, recent literature has deemed cognitive-behavioral therapy (CBT) the treatment of choice for bulimia. As is true for many psychological disorders, CBT has been the preferred therapy in most studies on bulimia treatment. CBT lends itself to a very structured approach that is easy to repeat, and therefore easy to study.
CBT helps clients to change irrational thoughts and unhealthy behaviors surrounding body weight and eating patterns. CBT examines thoughts closely to learn when they are irrational (and often untrue). Negative thoughts may lead to negative behaviors, and vice versa. CBT challenges these thoughts and behaviors and encourages healthy substitutes.
CBT appears to end symptoms of binging and purging in 30 to 50% of clients. In the world of eating disorders, these are good numbers. Also, CBT reduces symptoms in many others who choose to stick with the treatment.
Psychodynamic/Psychoanalytic Therapy for Bulimia
Psychodynamic therapy focuses on how client and therapist view each other, noting where past events get replayed in the therapeutic relationship. This lets the client work directly on underlying issues that can strengthen eating disorder symptoms. Psychodynamic therapists offer interpretations of current events and attitudes that challenge the client.
It is harder to perform statistical research on psychoanalysis and similar kinds of therapy. Thus, though there is much anecdotal evidence for the effectiveness of psychodynamic treatment, research studies are relatively scarce.
Could it be a good option for you? If you believe that your problems lie only in the eating symptoms themselves, you may find psychodynamic treatment to be slow. If you believe there are underlying issues to address, and that your eating disorder is just an expression of them, then psychodynamic therapy may seem to cut straight to core problems.
An Integrated Approach
What about a combination of CBT and psychodynamic therapies? A preliminary study tried infusing psychodynamic therapy with behavioral components like keeping logs of eating patterns and emotions. The study found that binging and purging in those with bulimia dropped significantly, and the results held steady six months after treatment ended.
Interpersonal Psychotherapy (IPT)
An interpersonal psychotherapist works to help a patient deal more adaptively within an interpersonal situation she finds herself in, helping to decrease some of the "fuel" maintaining the symptoms. Some of these situations may include:
- Interpersonal disputes result from differing expectations between the client and important people in the client's life.
- Role transitions occur when a person's circumstances change, whether in the person's job, living situation, or any other significant area. IPT works to help the client adapt to the new role, reducing stress.
- Grief due to the death of an important person in the client's life may not have proceeded smoothly. If grief is seen as a contributor, IPT intervenes to encourage it toward resolution.
- Interpersonal deficits in a client make it hard to form good relationships. The IPT therapist can use the relationship between client and therapist to model new behaviors.
While IPT has not been shown to be as good as CBT at reducing symptoms by the end of a course of treatment, there is some support for IPT achieving similar results to CBT at post-treatment follow-ups (e.g., a year or more later). In other words, those undergoing IPT may not do as well at the end of treatment, but they may improve on their own over time.
It is only speculation, but one can argue that this trend makes sense. CBT deals directly with symptoms, while IPT deals with dynamics that contribute to symptoms. If IPT is effective, it's reasonable to expect a slower improvement in symptoms of bulimia as clients put what they have learned into practice and work toward results.
The Best Situation: Therapy Coupled With Other Treatments
Comprehensive treatment for bulimia will include psychotherapy plus other components:
- Medical Treatment
A qualified doctor will monitor general health and may prescribe medications. In some cases, a psychiatrist will manage medications. - Nutritional Adjustment
A registered dietitian delivers accurate nutritional information and dispels harmful myths. - Social Support
Developing good social networks is key to decreasing loneliness. Those with bulimia are often isolated due to the secrecy and shame that accompany binging and purging rituals. For some, social development can begin in well-constructed support groups. Members can find understanding from others who have dealt with bulimia. Besides talking about obstacles to recovery and successes, members use social skills in the process of group interaction. These skills are helpful for improving or developing outside relationships.
As with other eating disorders, it is best that the person with bulimia have many supportive voices. An eating disorder takes time to overcome. Having others on the journey offers the best chance of success.
Sources:
Beck AT, Rush AJ, Shaw BF, and Emery G. Cognitive Therapy of Depression. New York: Guilford Press; 1979.
International Society for Interpersonal Psychotherapy. "Interpersonal Therapy: An Overview." Accessed 5 March 2009.
Mitchell JE, Agras S, and Wonderlich S. Treatment of bulimia nervosa: Where are we and where are we going? International Journal of Eating Disorders 40 (2007): 95-101.
Murphy S, Russell L, and Waller G. Integrated psychodynamic therapy for bulimia nervosa and binge eating disorder: theory, practice and preliminary findings. European Eating Disorders Review 13 (2005): 383-391.
Wilson GT, Grilo CM, and Vitousek KM. Psychological treatment of eating disorders. American Psychologist 62 (2007): 199-216.
