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Connecting feelings, thoughts and deeds: Cognitive Behavior Therapy and eating disorders

Cognitive-behavioral therapy, or CBT, is the leading evidence-based treatment for adults with eating disorders and is also adapted for use with younger patients. It is based on the theory that a person’s thoughts, emotions, and behaviors are interconnected and can be restructured to support new, healthier thoughts and actions. Cognitive behavior therapy provides the foundation for individual and group therapies throughout all levels of care at the Center for Eating Disorders.

Structured treatment that focuses on the present and the future.

The cognitive-behavioral model emphasizes the important role that both thoughts (cognitive) and actions (behavioral) can play in maintaining an eating disorder. Examples of maintaining factors include:

  • Cognitive Factors ~ over-evaluation of weight and shape, negative body image, core beliefs about self-worth, negative self-evaluation, perfectionism
  • Behavioral Factors ~ weight-control behaviors including dietary restraint, restriction, binge-eating, purging behaviors, self-harm, body checking and body avoidance

Individuals with eating disorders often hold a negative or distorted view of themselves and their bodies. These highly critical thoughts can result in feelings of shame, anxiety or disgust that often trigger weight control behaviors and fuel a cycle of negative self-evaluation. Guided by a therapist, CBT helps the individual to examine which specific factors are maintaining their disorder and to set personalized goals that are addressed throughout the various phases of CBT. 

The phases of cognitive behavior therapy

CBT stresses education and skills training that help the patient gain a thorough understanding of themselves and their eating disorder so that healing can occur. Three phases of CBT may unfold over the course of the inpatient, partial hospital and IOP programs, and some or all of them may take place during outpatient therapy.

  1. Behavioral Phase: The patient and therapist work together to formulate a plan for stabilizing eating and eliminating symptoms.  Because emotions often intensify during this phase of treatment, tools (coping strategies) for managing these feelings are developed and become an important part of the work.  CBT includes in-session activities as well as “homework” so that new behaviors can be practiced.
  2. Cognitive Phase: As treatment progresses, cognitive restructuring techniques (e.g., techniques aimed at recognizing and changing problem thinking patterns) are introduced.  Thoughts and beliefs that perpetuate the problems (“I will only be happy if I can lose this weight”) are identified and work aimed at developing new perspectives and ideas (“my self-worth doesn’t depend on my size or shape”) begins.  Additionally, during this stage of treatment, broader concerns such as relationship problems, body image, self-esteem problems, and emotion regulation are addressed.
  3. Maintenance & Relapse Prevention Phase: The final stage of CBT concentrates on reducing triggers, preventing relapse and maintaining the progress that’s been made. Even though CBT is focused on the elimination of symptoms, the overall goal of the treatment is to assist the patient in making their return to a healthy and fulfilling life.  So, very often, once symptoms are stabilized, treatment will expand to include other areas of concern and conflict that can help individuals move towards holistic healing and emotional well-being. 

CBT is an important part of the recovery process

As stated before, CBT provides the therapeutic foundation upon which each individual’s treatment is then personalized and tailored to meet specific needs.  As the preferred first line of treatment for eating disorders, CBT is incorporated into all treatment modalities and levels of care at the Center. Additional personalized goals and specific therapy tracks are integrated based on specific input from the patient and informed feedback from his or her treatment team.  

If you’re interested in reading about other evidence-based treatment approaches provided at The Center for Eating Disorders, please click on the links below:

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