What is CBT?
CBT is a present-focused, active, and collaborative treatment. Let’s consider each component in turn. A present-focus separates CBT from a variety of insight-oriented treatments that devote major attention to the historical roots of problems. In contrast, CBT may attend to what was learned at earlier stages of life (with attention to strategies that people learned to use in order to cope with life challenges), but will focus primary attention on the current (and often self-perpetuating) patterns that serve to maintain disorders. This is an important distinction, because the way in which you got a disorder may differ substantially from what keeps you stuck in that disorder. Understanding what maintains a disorder and applying specific strategies to overcome these patterns is at the core of CBT.
This brings us to active. In CBT you will be asked to DO things differently. Doing includes working to make changes in your thoughts, your actions, and in resulting emotions. CBT keeps a focus on helping you meet your goals and values – to not be derailed by the emotional strategies that do not serve you well.
Collaborative refers to the way in which the therapist and patient come to work together to further the patient’s goals and values. The role of the therapist is to help teach patients about their disorder, while guiding them toward new patterns that help. In other words, the CBT therapist helps the patient become their own agent of change – getting these actions in line with their broader goals and values (instead of the over-focused world of weight concern).
How does CBT help you get better?
- Education about the nature of one's eating disorder and self-perpetuating patterns of over concern regarding weight, shape, and control over eating. (It is not unusual for therapists to diagram a patient's particular patterns within their eating disorder, filling in the specific situations, thoughts, feelings, and responses that characterize their experience with these problems).
- Self-monitoring of thoughts, feelings, and behaviors as a first step to understanding a person’s relationship with food and their body.
- Training in regular and healthy eating patterns.
- Regular attention to the thinking and action patterns that lead to: (1) Over-evaluation of shape and weight as crucial determinants of self-esteem and worth, (2) Under-evaluation of other areas of life that should receive attention, and (3) Perfectionism, low-self esteem, and interpersonal difficulties.
- Develops alternatives to repeated body checking (i.e., mirror use)
- Developing and rehearsing strategies to deal more directly with mood challenges. This includes addressing “feeling fat” by understanding the triggers for negative feeling states and attending directly to those feelings (feeling sad, bored, or anxious has nothing to do with fat - fat is not a feeling state).
- Correction of the use of extreme and overly-perfectionistic standards for self-evaluation. Such standards maintain shame while impairing goal attainment.
- Systematic re-introduction of avoided foods (to undermine the presumed power these foods have over an individual)
- Reorient problem solving (so that the thing to do when stressed is no longer to exercise, restrict, or binge.) The over-focus on food insulates individuals from life experiences that might otherwise help place eating and body image concerns in proper perspective.
- Help for disorders that go along with eating disorders. That is, CBT is known to be among the most effective treatments for anxiety issues, depression, anger, insomnia, and a host of other conditions that may co-occur with eating disorders.
CBT is Research Supported!
Rather than relying on theory alone, CBT for eating disorders has been shaped and validated by clinical study. That is, hundreds of patients with eating disorders have contributed to testing this treatment approach. With CBT, you will get an approach that is known to benefit the majority of individuals. In fact, based on one of the foremost guidelines for clinical treatment, the National Institute for Health and Clinical Excellence in the United Kingdom concluded that CBT is the clear leading treatment for bulimia nervosa. Just under half make a full and lasting recovery from treatments in the range of 20 sessions over a five-month period.
Top 10 reasons to consider CBT:
- Actively teaches you to become your own therapist
- Is richly collaborative
- Provides a step-by-step model for change
- Is focused on the timely achievement of results
- Provides training in problem solving and emotional regulation
- Attends to interpersonal challenges
- Uses “feeling fat” as a cue for problem solving
- Has abundant research support
- Offers protection from relapse
- Is also one of the most effective treatment approaches for disorders that co-occur with eating disorders (namely, depression, anxiety, anger, and substance abuse)
Dr. Michael Otto
Professor, Department of Psychology