Our therapists provide cognitive behavioral therapy (CBT) for adults and some older adolescents with anorexia, bulimia, binge eating disorder, and other eating disorders. Our therapists also incorporate elements from other models consistent with CBT into our work, including intuitive eating, mindful eating, mindfulness, and appetite awareness training. A course of CBT for bulimia is usually about 20 sessions.
Cognitive behavioral therapy for eating disorders was first described by Christopher Fairburn, MD in 1981 and has been updated several times, including a revision in 1993 co-authored by Dr. Muhlheim’s mentor, Dr. Terence Wilson (Fairburn, C. G., Marcus, M.D., & Wilson, G. T. (1993). The most recent revision is an “enhanced” (CBT-E) protocol (Fairburn, Christopher G., 2008).
A core problem in most eating disorders is overconcern with shape and weight. Cognitive behavioral therapy, which focuses on addressing the various behaviors, thoughts, and feelings that are components of this core overconcern, is ideally suited to treat eating disorders. Cognitive behavioral therapy also addresses general personality characteristics, such as perfectionism, that maintain eating disorders.
Cognitive behavioral therapy has become the leading evidence-based treatment for adults with eating disorders. It has been tested in numerous clinical trials and proven successful. Research studies indicate that about two-thirds of the patients who complete treatment have an excellent response. It can also be successfully employed with older adolescents with bulimia nervosa.
In cognitive behavioral therapy the treatment focuses primarily on factors in the present that are keeping the eating disorder going. The therapist and client work together as a team to understand the client’s problem and develop strategies to overcome it. Some of the cognitive behavioral strategies employed for eating disorders include:
- Replacing strict dieting with regular meals
- Meal planning
- Regular weighing
- Introduction of forbidden foods
- The use of delays and alternatives to prevent bingeing and purging
- Strategies to manage negative mood states
- Cognitive restructuring
- Relapse prevention
- Strategies to address negative body image, perfectionism, and self-esteem issues
- Fairburn, C. G., Marcus, M.D., & Wilson, G. T. (1993). Cognitive-behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment and treatment. New York: Guilford Press
- Fairburn, Christopher G.(2008), Cognitive Behavioral Therapy and Eating Disorders. The Guilford Press: New York