Eating disorders often involve a preoccupation with shape and weight. There is also a need to please others, to avoid failure and maintain a sense of control – this is likely to be created from a sense of no control and chaos, it’s the one thing a person with an eating disorder feels they can control.
How CBT helps deal with eating disorders
Self-monitoring is introduced in the initial session and continues to occupy an essential and central role throughout most of treatment. Self monitoring enables further understanding of the eating problem and it identifies progress. Second, and more importantly, it helps patients to be more aware of what is happening in the moment so that they can begin to make changes to behavior that may have seemed automatic or beyond their control.
Weekly weighing is also important with no weighing allowed inbetween. This addresses the maintaining processes of excessive body weight checking or its avoidance and helps individuals to see that varying weight is NORMAL.
An important element of treatment is education about weight and eating, as many patients have misconceptions that maintain their eating disorder. Some of the main topics to cover are as follows:
- • The characteristic features of eating disorders including their associated physical and psychosocial effects
- • Body weight and its regulation: the body mass index and its interpretation; natural weight fluctuations; and the effects of treatment on weight
- • Ineffectiveness of vomiting, laxatives, and diuretics as a means of weight control
- • Adverse effects of dieting: the types of dieting that promote binge eating; dietary rules versus dietary guidelines.
Establishing “Regular Eating”
Establishing a pattern of regular eating is fundamental to successful treatment whatever the form of the eating disorder. It addresses an important type of dieting (“delayed eating”); it displaces most episodes of binge eating; it structures people’s days and, for underweight patients, it introduces meals and snacks that can be subsequently increased in size. Early in treatment (usually by the third session) patients are asked to eat 3 planned meals each day plus 2 or 3 planned snacks so that there is rarely more than a 4-hour interval between them. Patients are also asked to confine their eating to these meals and snacks.
Stage three – main body of treatment – what is maintaining the eating disorder?
Briefly there are 3 related problems: first, self-evaluation is overly dependent on performance in one area of life with the result that domains other than shape and weight are marginalized; second, the area of controlling shape and weight is one in which success is elusive, thus undermining self-esteem; and third, the overevaluation is responsible for the behavior that characterizes the eating disorder (dieting, binge eating, and so forth).
Other activities need to be increased to take away preoccupation on body and weight.
Stop/reduce repeated body checking.
Encourage acceptance of body as it currently is.
Exploring the origins of overevaluation
Toward the end of Stage three it is often helpful to explore the origins of a patient’s sensitivity to shape, weight, and eating. A historical review can help to make sense of how the problem developed and evolved, highlight how it might have served a useful function in its early stages, and the fact that it may no longer do so. If a specific event appears to have played a critical role in the development of the eating problem, the patient is helped to reappraise this from the vantage point of the present. This review helps patients distance themselves further from the eating disorder frame of mind or “mindset.”
Common maintaining factors in eating disorders
Perfectionism, low self esteem and problems with interpersonal relationships can all contribute negatively towards eating disorders developing.
The final stage in treatment, is concerned with ending treatment well. The focus is on maintaining the progress that has already been made and reducing the risk of relapse.
The goal is for patients themselves to decide to regain weight rather than this decision being imposed by the therapist. Eating disorders can be oversome with the right support and a hopeful brighter future can be achieved.
Fairburn C.G., Cooper Z., Shafran R. Enhanced cognitive behavior therapy for eating disorders: the core protocol. In: Fairburn C.G., editor. Cognitive behavior therapy and eating disorders. Guilford Press; New York: 2008. pp. 47–193.
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