Cognitive Behavioral Therapy for Eating Disorders

Cognitive behavioral therapy, or CBT, is a relatively new psychotherapeutic weapon for counselors to aim at eating disorders. CBT has been around for a number of years, but its effectiveness at meeting the tremendous challenges eating disorders present has only recently been recognized. In relatively short order, CBT has become the gold standard treatment for bulimia nervosa and for adults with anorexia nervosa, and is considered effective for other types of eating disorders as well.

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy can almost be simplified as “the power of positive thinking.” It is a form of psychotherapy that focuses on replacing negative thoughts and attitudes about difficult situations with positive and productive thoughts. Unlike many other forms of psychotherapy, CBT generally involves very specific goals and a structured time frame. While individuals in treatment for eating disorders or other mental disorders may need or want general long-term counseling, CBT sessions are for a set duration. The average length of a CBT treatment program is 10 to 20 sessions. The early sessions of CBT program are focused on identifying the thoughts, emotions and attitudes that form the basis of their condition. With an eating disorder, these sessions seek to get the patient to recognize the irrational thoughts that motivate their disordered eating habits. This is the “cognitive” component of CBT. Later sessions are devoted to the implementation of specific behavioral changes that will help the patient to combat the negative and irrational thoughts. A system of goals and rewards is often used to promote positive behavior such as healthy eating.

Cognitive Behavioral Therapy for Bulimia

CBT is generally considered to be the best treatment for bulimia nervosa patients of all ages. While studies have shown positive results for those suffering from various eating disorders, the results for bulimia patients have shown the greatest number of positives. More than 20 controlled trials have examined the effectiveness of CBT for bulimia patients, and found equal or better initial results when compared to other treatments. These trials also found that most bulimia patients were able to maintain the improvements that they made during CBT—the longest such study found that two-thirds of patients had no eating disorder for years after their treatment.

Cognitive Behavioral Therapy for Anorexia

The results of CBT for anorexia nervosa patients is more mixed, however. Overall, the treatment was found to be very effective at helping patients overcome the mental and behavioral symptoms of their disorder. For adults suffering from anorexia, treatment programs that include CBT showed the best overall results. However, children and teenagers with anorexia were found to have a greater chance of recovery when their treatment emphasized family-based therapy (FBT.) FBT helps patients and their families to understand their dysfunctional role within the family structure, and how their eating disorder reinforces that role.

Enhanced Cognitive Behavioral Therapy

A newer variation on CBT called enhanced behavioral therapy has shown significant promise in recent small-scale studies. This form of CBT expands the standard CBT program for eating disorder patients to address more of the underlying thoughts and feelings that may be leading to the specific body-image and physical discomfort issues that motivate their disordered behaviors.

Multi-Treatment Programs

Eating disorders are complex illnesses, and concurrent diagnoses are very common. Patients may have serious physical complications as a result of their disordered eating, and many are found to be suffering from depression, anxiety or other simultaneous mental disorders. As a result, eating disorders often require more than one type of treatment. Some patients who have brought themselves almost to starvation may require emergency treatment in the form of intravenous fluids or tube feeding. Most eating-disordered individuals will benefit from the advice and supervision of a nutritionist who can instruct them in healthy eating. Concurrent diagnoses may require antidepressant medication or the like in order to ameliorate conditions that may be provoking the eating disorder. While cognitive behavioral therapy can produce positive results for eating disorder patients, it and other treatments are generally most effective over the long term when they are paired with other methods of treatment, education and support.

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