While there are many approaches to psychotherapy, it is best to select a treatment that is evidence-based. The term evidence-based or empirically-supported treatment refers to mental and behavioral health interventions for which research has provided scientific evidence as to the effectiveness of the treatment for a specific problem.
There are several different types of treatment that are considered evidence-based. These therapies include: cognitive-behavioral therapy, dialectical behavior therapy, interpersonal psychotherapy, and family-based treatment, also known as the Maudsley Approach.
Cognitive Behavioral Therapy (CBT) has the most research supporting its efficacy for the treatment of eating disorders – specifically bulimia nervosa. CBT is often used as the first line treatment (Hill, Craighead, & Safer, 2011). CBT is an active behavioral therapy that is based on the theory that emotions, behaviors and thoughts are all connected.
CBT techniques teach skills to alter inaccurate thinking patterns about one’s self, body, food and relationships. Outpatient CBT therapy occurs once a week and is highly structured. During the session, individuals are weighed and are asked to keep a diary of eating disorder symptoms. Homework is given and reviewed weekly. The goal of the treatment is for individuals to learn how to tolerate negative emotion, solve problems, manage stress and become more aware of themselves.
Dialectical Behavior Therapy (DBT) is a behavioral therapy that is based on an emotion regulation model of eating disorder symptoms. DBT has empirical data supporting its efficacy in the treatment eating disorders (Wisniewski, Safer, & Chen, 2007). DBT is a skill-based therapy that combines behavioral theories and techniques with Eastern philosophy.
DBT is comprised of four modules designed to help solve problems, tolerate distress, regulate emotions, and become interpersonally effective. Mindfulness is a core skill and helps increase one’s capacity to pay attention, non-judgmentally, to the present moment. DBT seeks a balance between opposites such as acceptance and change, and is effective in decreasing one’s anxious thoughts, feelings and eating disordered behaviors.
Interpersonal Psychotherapy (IPT) was developed to treat depression and is a brief, highly structured manual based therapy that addresses interpersonal issues. IPT is an outpatient weekly treatment that occurs over 12 to 16 one hour sessions. IPT has empirical data, demonstrating its effectiveness for patients with eating disorders, specifically those struggling with bulimia (Fairburn et al., 1993).
IPT posits that problems occurring within an interpersonal context are often interdependent of the illness process. IPT explores the relationship between interpersonal interactions and the individual’s eating disorder. IPT is designed to engage the individual in treatment, identify current interpersonal problems and establish a treatment contract. IPT seeks to change interpersonal behavior by encouraging adaptation to current interpersonal roles and situations.
Family-based Treatment - The Maudsley Approach (FBT) is an outpatient family therapy that is primarily used with adolescents. Multiple studies have demonstrated the efficacy of this treatment (Eisler, Dare, Russell, et al, 1997; Lock, LeGrange, Agras et al., 2010).
FBT is an intensive treatment where parents are empowered to take control over the child’s eating disorder. FBT’s philosophy is that the adolescent is imbedded in the family and the parent’s involvement in the treatment is essential for successful treatment (Lock, LeGrange, Agras, et al., 2001). There are three phases to the treatment, which usually occurs in 20 treatment sessions over the course of 6-12 months. Some families have used this treatment successfully with college age individuals (Chen et al., 2010).
College students who begin treatment for an eating disorder often feel quite overwhelmed by this therapeutic process. Explaining these treatment options in detail may help to alleviate some of the anxiety that will present itself during the initial counseling sessions.
Melissa Freizinger, Ph.D.
Laurel Hill Inn
1). Hill, D. M., Craighead L., & Safer, D. L. (2011). Appetite-focused dialectical behavior therapy for the treatment of binge eating with purging: A preliminary trial. International Journal of Eating Disorders, 44: 249–261.
2). Wisniewski, L., Safer, D., & Chen, E.Y. (2007). Dialectical Behavior Therapy for Eating Disorders. In L.A. Dimeff & K. Koerner (Eds.), Dialectical Behavior Therapy in Clinical Practice (pp. 174-221). New York, NY.
3). Fairburn, C.G., Jones, R., Peveler, R.C., Hope, R.A., & O'Connor, M. (1993). Psychotherapy and bulimia nervosa: the longer term effects of interpersonal psychotherapy, behaviour therapy and cognitive behaviour therapy. Archives of General Psychiatry 50: 419-428.
4). Eisler, I., Dare, C., Russell, G. F. M., Szmukler, G. I., Le Grange, D., & E. Dodge, (1997). Family and individual therapy in anorexia nervosa: A five-year follow-up. Archives of General Psychiatry, 54, 1025-1030.
5). Lock, J., Le Grange, D., Agras, W. S., C., & Dare, C. (2001). Treatment manual for anorexia nervosa: A family-based approach. New York: Guilford Publications, Inc.
6). Lock, J., Le Grange, D., Agras, W.S., Moye, A., Bryson, S.W., & Jo, B. (2010). Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Archives of General Psychiatry, Oct: 67 (10):1025-32.
7). Chen, E.Y., Le Grange, D., Doyle, A.C., Zaitsoff, S., Doyle, P., Roehrig, J.P. & Washington, B. (2010). A case series of family-based therapy for weight restoration in young adults with anorexia nervosa. Journal of Contemporary Psychotherapy, April (40):219-224.