Eating disorders - Cognitive-behavioural treatments

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a “time-limited and focused approach” which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

CBT-Enhanced
A common form of CBT that is used to treat eating disorders is called CBT-Enhanced (CBT-E) and was developed by Christopher G. Fairburn throughout the 1970s and 1980s. Originally intended for bulimia nervosa specifically, it was eventually extended to all eating disorders. Within Fairburn’s enhanced CBT is CBT-Ef, designed to deal particularly with eating habits, and CBT-Eb for other issues that don’t directly involve eating.

Bulimia nervosa
A study conducted by the UK National Institute for Health and Clinical Excellence has found that CBT is the best treatment for bulimia nervosa. Enhanced CBT is delivered on an individual basis and usually in an outpatient situation and is meant to help with the psychopathology of the eating disorder rather than the diagnosis itself. Research demonstrates that antidepressants may be an effective alternative to CBT for treatment of eating disorders; however, CBT continues to prove more effective than antidepressants specifically for the treatment of bulimia nervosa. A small study on patients with bulimia combined CBT with text-messaging a therapist about the frequency of binge-purge behaviours and the strength of the patient's desires to binge and purge. The number of binge eating and purging episodes decreased significantly from base-line to post-treatment and followup.

Anorexia nervosa
Less research has been conducted on the effectiveness of CBT for those with anorexia nervosa, but a recent study demonstrated that CBT was effective for 60% of the subjects tested – 60% of those for whom CBT was effective were improved upon receiving the treatment. In addition, the US National Guideline Clearinghouse reported that CBT can alleviate symptoms of depression and compulsivity that are associated with anorexia nervosa.

Binge-eating disorder
The same type of CBT used for bulimia nervosa has demonstrated that it can be helpful in the treatment of binge-eating disorder. However, one of the problems with administering CBT to those suffering from this disorder is that it does not traditionally encourage weight loss. This can be problematic for binge-eaters who are overweight or obese. As a result of issues like these CBT has not yet been established as the most effective treatment for binge-eating disorder. A commonly used alternative is behavioral weight loss because it prioritizes physical health by maintaining a healthy weight.

Other eating disorders
Eating disorders not otherwise specified (NOS) have been given less attention than anorexia nervosa and bulimia nervosa which are given their own categories in the DSM-IV-TR. That said, a recent study has shown that CBT is just as effective for treating eating disorders NOS as it is for bulimia nervosa.