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Cognitive Behavioral Therapy (CBT) for Eating Disorders

Cognitive Behavioral Therapy (CBT) is used by psychologists worldwide for many disorders. Similarly, CBT is the leading treatment option for eating disorders such as binge eating, anorexia nervosa, bulimia nervosa, and avoidant restrictive food intake disorder (ARFID). Cognitive behavioral therapy can be used in both outpatient and inpatient settings. The following section will explore what CBT is and the ways CBT helps aid individuals affected by these eating disorders.

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy is a form of psychotherapy in which patients meet with their therapist to talk about their issues. Their therapists help guide them in becoming more aware of their negative thought processes and help them develop healthy coping mechanisms to better combat their negative thoughts and tackle their issues in a more coherent and effective way. It is the most preferred type of psychotherapy and can be used to treat a wide range of issues with fewer sessions. 

It emphasizes an active partnership between the patient and the therapist, often involving homework outside of the sessions. In some cases, CBT is paired with medications to better support the treatment process. Due to CBT’s exploratory nature into the patient’s emotional well being, it can be uncomfortable at times. It forces the individual to face themselves and their problems head on, and for most people that thought can be extremely intimidating and painful. However with an open mindset, it is proven to be very effective and long lasting.

How does CBT Help Combat Eating Disorders?

Because cognitive behavioral therapy involves the patient working with a therapist to develop techniques to combat negative and distorted thoughts about oneselves or situations, it has been found to be highly effective when treating eating disorders. Eating disorders such as binge eating, anorexia, bulimia, and ARFID often have the people affected by them to become highly critical of their behaviors and body image. 

Treatment involving CBT for eating disorders typically involves a whole team of professionals:

  • Nutritionist
  • Therapist
  • Psychiatrist
  • Healthcare physician

Depending on the stage the individual is at on their journey to recovery, all or only some of the aforementioned are necessary. Similarly, outpatient versus inpatient care is determined by the individual’s stage of recovery. The aim of CBT with eating disorders is to normalize healthy eating behaviors and how the patient responds to food. 

Cognitive Behavioral Therapy for Binge Eating

Binge eating is characterized by an individual who experiences recurrent episodes of eating large amounts of food to the point of discomfort. They often feel out of control during the episodes followed by feelings of shame and guilt. Usually, they do not engage in purging or rigorous workouts to compensate for their episodes. The following section will outline the steps taken to combat binge eating through the use of cognitive behavioral therapy:

  • Patients will meet with their therapist to begin addressing their negative behaviors and thoughts associated with binge eating disorder. 
  • Therapists will educate their patients on the benefits of balanced eating and nutrition.
  • Healthy coping strategies will be developed to combat negative emotions that trigger binge eating episodes.
  • Implementation of the healthy coping strategies will allow the patient to improve their self esteem and combat the disorder.

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Cognitive Behavioral Therapy for Anorexia

Anorexia is characterized by a severely restrictive diet and/or avoidance of food. People suffering from this disorder will go to extreme measures to control their weight. Excessive exercising, controlling their caloric intake, and misusing laxatives, diuretics, and diet aids are some examples of the measures they use. CBT has proven to be effective however, the best results are achieved through in-patient care. Anorexia has the highest mortality rate making it dangerous and a difficult eating disorder to overcome. 

Enhanced Cognitive Behavioral Therapy (CBT-E)

Patients suffering with anorexia nervosa go through enhanced CBT on their journey to recovery. The primary reason for this is CBT-E is the ideal form of treatment for people who are at a minimal body weight range or higher. The process can take up to  20 sessions over 20 weeks; if the individual is severely underweight sessions can last 40 plus weeks. The following will outline the steps taken between the patient and therapist throughout the CBT-E process:

  • Step 1 – Educate the patient on anorexia, and focus on stabilizing eating patterns, and understanding/combating negative emotions surrounding the disorder. 
  • Step 2: Progress check and goals are set. A continuation of healthy coping mechanisms are practiced. 
  • Step 3: Weekly sessions are focused on behaviors and symptoms. Homework is focused on improving daily function and moods. 
  • Step 4: Relapse prevention is focused on through managing setbacks and focusing on the future of the patient’s recovery.

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Cognitive Behavioral Therapy for Bulimia

Bulimia is characterized by the individuals’ obsessive need to control their weight through extreme dietary measures following a binge eating episode to make up for their sense of loss of control. Although purging bulimia is more prevalent among people suffering, there are two types – purging and nonpurging. The misuse of diuretics and laxatives are also common. While bulimia and anorexia can have similar criteria for diagnosis, the main difference is that food restriction practices with people suffering from bulimia are interrupted by an episode of binge eating. Evidence shows, CBT is the number one combative practice for adults with bulimia. The following section will outline the process patients will undergo:

  • Engage in 20 sessions in which they will identify their negative thoughts and feelings toward their eating habits with their therapist.
  • Become educated on the disorder and healthy practices for eating as well as retraining their thoughts.
  • Engage in outside homework focused on improving their self esteem and their relationship with food.

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Cognitive Behavioral Therapy for ARFID

Avoidant restrictive food intake disorder is characterized by the avoidance of food due to the individuals eating or feeding disturbance based on sensory characteristics of food and/or the lack of interest in eating. Most people with ARFID started out as a typical picky eater in early childhood. This disorder can lead to malnutrition and low energy levels. 

While ARFID is a fairly new recognized eating disorder, cognitive behavioral therapy for ARFID (CBT-AR) has shown to be highly effective for ages 10 and up. The following section will outline the steps taken to help individuals suffering with ARFID:

  • Consists of 20 to 30 sessions between the therapist and patient.
  • Therapists will incorporate parent/family involvement for younger patients.
  • Step 1: Education on ARFID and zoning in on the patients avoidant patterns paired with psychotherapy. 
  • Step 2: Goals are set through exploratory collaboration between the therapist and patient on how to overcome barriers for treatment.
  • Step 3: Patient actively works through their food aversions and fears. Exposure of food and volume increase is encouraged.
  • Step 4: Prevention plan for relapse is discussed by encouraging patients to use the tools obtained through treatment to ensure their long term success after treatment is complete.

Each session is structured with clear goals in mind and continued practice through outside homework helps patients stay on track. Patients’ nutritional deficiencies should decline, and they should be able to eat several foods from each food group by the end of treatment. 

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If you or a loved one suffer from an eating disorder, it may seem like a hopeless journey full of pain and disappointments. But there is hope! Find a mental health professional that treats eating disorders.




Anthony Bart
Author: Anthony Bart

Anthony Bart is a huge mental health advocate. He has primarily positioned his marketing expertise to work with mental health professionals so that they can help as many patients as possible. He is currently the owner of BartX, TherapistX, and TherapyByPro.

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