Eating Disorder Psychotherapy and Treatment Options
Cognitive Behavioral Therapy for Eating Disorders (CBT-E) is a form of psychotherapy that focuses on the relationship between thoughts, feelings, and behaviors.
CBT focuses on the present: Unlike other forms of therapy, CBT focuses on current issues and concerns, rather than past experiences.
CBT aims to change negative patterns of thought and behavior. The goal of CBT is to help individuals identify and challenge negative or inaccurate thoughts, and to replace them with more realistic and positive ones. Emotions also shift and change when we challenge our thoughts and behavior patterns that can influence our emotions.
CBT is goal-oriented: CBT sessions are structured, with specific goals and objectives that are reviewed and discussed throughout the course of therapy. You take an active role in defining your goals, and contributing to the structure of each session based on what you want to get out of therapy.
CBT emphasizes the importance of homework. For example individuals in CBT-E therapy are often asked to complete homework assignments, such as keeping a thought diary or practicing specific exercises, in order to reinforce the skills learned in therapy. In eating disorder treatment this can
CBT is often used to treat a wide range of mental health conditions, and CBT-E is an expanded form of CBT that focuses on specific eating disorder behavior changes. Some of the most common conditions that CBT has been used to treat include depression, anxiety disorders, and post-traumatic stress disorder (PTSD). CBT-E is a newer modality that is specific for eating disorder treatment.
Dialectical Behavior Therapy (DBT) is a form of therapy that emphasizes the dialectic between acceptance and change. It is developed by Marsha Linehan . Here are some basic aspects of DBT:
DBT is heavily focused on acceptance and also is considered an experiential therapy. DBT focuses on the balance of both acceptance of one's thoughts, feelings, and behaviors without judgment, as a necessary step for making changes with skillfulness.
DBT is a skill-based therapy that is experiential in a way that skills can be taught, learned, and practiced in sessions directly. DBT teaches individuals a set of skills, including areas of mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness, which can be used to manage emotional dysregulation with difficult emotions, tolerating distress when changes are attempted, to improve relationships by shifting the ways that social cues are expressed, and expanding communication skills.
The full comprehensive model of DBT includes individual and group therapy. DBT typically includes both individual therapy sessions with a therapist and group therapy sessions, where individuals can practice the skills they have learned with others. Individual only therapy can be DBT informed, meaning the skills are taught, practiced, and the components of DBT individual sessions are also integrated. In adolescents, parents can be involved in the DBT focused therapy as well. MED-DBT is a newer model that has been created and focuses on the multiple symptoms that co-occur with eating disorder symptoms and therefore the traditional model of DBT has been modified to incorporate the more specific eating disorder specific needs.
DBT has primarily been used to treat individuals with Borderline Personality Disorder (BPD) and other disorders involving intense emotions and impulsive behaviors that can be considered life threatening or high risk. DBT is also used for other mental health condition that involve unstable emotions, such as depression and post-traumatic stress disorder (PTSD) which can be connected to difficulty with tolerating distress, strained interpersonal relationships, hopelessness, helplessness, emotional dysregulation, and feeling out of control with life. DBT has also been utilized to treat eating disorders that are inclusive of ARFID, Anorexia, Bulimia, and Binge Eating Disorder.
What is Exposure Therapy?
According to the American Psychological Association (APA), exposure therapy is a form of psychological treatment that helps you overcome fears by exposing you to them in a safe and controlled environment. Over time, those fears are reduced as you relearn how to interact with the object or situation you are afraid of.
The transformation can happen in a variety of ways, including the following:
Habituation – the gradual reduction of negative reactions to feared objects or situations
Extinction – the weakening of learned associations between feared objects or situations and bad outcomes
Self-efficacy – the realisation that you are capable of confronting your fears and managing the feelings of anxiety that come with them
Emotional processing – the ability to attach new, more realistic beliefs about feared objects or situations, and to process the feelings that come up in those situations
Aspects of exposure therapy can be incorporated into the CBT models of therapy noted above
Exposure Therapy is typically included and recommended with the treatment of ARFID-Avoidant Restrictive Food Intake Disorder
4 Focus Areas of Eating Disorder Treatment and Psychotherapy as a Process
Eating disorder treatment is often presented in a focus of 4 areas.
Assessing the presenting concerns, the history and presentation of the eating disorder, as well as noting other co-occuring mental health conditions such as anxiety, OCD, perfectionism, depression, emotional dysregulation, personality coping style, thinking style, and previous treatments provided. Part of the assessment process is also inclusive of getting a thorough medical evaluation to determine if there is medical stability or if there are medical issues that will change the course of treatment. This could include things like getting a full evaluation by a healthcare provider. A part of assessment is providing informed consent about treatment options, what’s expected, what is involved, and helping you to understand the risks of not engaging in treatment for you to be able to make a decision. Assessment is also working on enhancing your commitment and motivation to make changes.
Treatment focused on medical stabilization and weight restoration is an initial focus where applicable. We know from research that when someone is actively engaging in an eating disorder that results in being malnourished, nutrient deficient, or underweight for their own individual body’s needs, it can definitely lead to increased anxiety and depression presenting, more rigid thinking patterns, and extreme difficulty to interrupt behaviors of an eating disorder inclusive of compulsive/over exercising, restricting food intake, and other things. It’s a priority to work on interrupting the eating disorder specific patterns of behavior. While this is happening it’s common to focus on building coping strategies, connecting to supports, receiving meal support, building distress tolerance skills, and exploring emotional regulation strategies to help you with this aspect of change.
3. Once you are further along into treatment and even in recovery, you can shift your focus to healing relationships that became strained during your eating disorder being so active. This is a time to explore what you value, what is meaningful in your life, and moving yourself towards living beyond your challenges with an eating disorder.
4. There is an opportunity to work on building a relapse prevention plan so that you are more likely to recognize when you are starting to experience difficulty before you are in a crisis need for support, which can help you to make a change sooner. Terminating therapy is also a time where you can reflect on the progress made, ways that you were able to make changes, and outlining these steps to com back to if you need help in the future. A reminder that it’s always an option to return for support even after you have fully recovered, or you have finished therapy.
Got further questions about therapy process, or how therapy works in treating an eating disorder, then reach out to Shelley to inquire with your questions HERE.
