What Kinds of Therapy Are Involved in Eating Disorder Treatment?

An effective treatment program for eating disorders usually involves a variety of treatment methods. While this may involve medication, most often a combination of talk therapy and cognitive retraining are the focal points. There are several specific types of therapies that can be used for treating eating disorders, and here we’ll outline some of the most commonplace and successful ones.

What Kinds of Eating Disorder Require Treatment?

Any eating disorder should be considered a severe psychiatric disorder and the individual suffering from it should receive specialized, professional help. There are many kinds of eating disorders, and some individuals may experience several of them, at the same time, or alternating. Here are some of the most common eating disorders (all definitions are from the DSM-V):

Binge Eating Disorder:

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating, in a discrete period (e.g., within any 2-hour period), an amount of food that is larger than most people would eat in a similar period under similar circumstances
  • The sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating)

Anorexia Nervosa:

• Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health (less than minimally normal/expected).
  • Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain.
  • Disturbed by one’s body weight or shape, self-worth influenced by body weight or shape, or persistent lack of recognition of the seriousness of low body weight.

Bulimia Nervosa:

• Recurrent episodes of binge eating, as characterized by both:
  • Eating, within any 2-hour period, an amount of food that is definitively larger than what most individuals would eat in a similar period under similar circumstances.
  •  A feeling that one cannot stop eating or control what or how much one is eating.
  • Recurrent inappropriate compensatory behaviors to prevent weight gain such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting or excessive exercise.
  • Self-evaluation is unjustifiability influenced by body shape and weight.

Pica:

• Persistent eating of non-nutritive, non-food substances for at least one month.
• The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual.
• The eating behavior is not part of a culturally supported or socially normative practice.
• If occurring with another mental disorder, or during a medical condition, it is severe enough to warrant independent clinical attention.
• Treatment Techniques for Eating Disorders

The specific types of therapy vary depending on the individual’s specific needs and goals as well as the severity and type of eating disorder. While the details will vary from client to client, some commonly used therapies make it into almost every program. The following are several types of the most prominent therapies used to treat eating disorders.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) has been proven useful in treating other forms of mental health illness such as addiction and depression and has become a central component of many ED recovery programs. CBT can be understood as a type of talk therapy that also serves as cognitive retraining. CBT helps individuals identify and challenge disordered thoughts and behaviors via objective self-reflection and help from a therapist. According to the American Psychological Association, there are several basic principles involved in CBT:

• Unhelpful or negative thinking patterns are the cause of many disordered behaviors. Identifying and sharing the client’s thought patterns act as a first step to repairing the negative thoughts.
• Negative thoughts and disordered emotions can influence patterns of negative behavior. It’s necessary to reshape ways of thinking that will eventually change behavior.
• CBT gradually teaches a more objective way of thinking and allows clients to identify when their thought patterns and coping mechanism are disordered. This can lead to the successful treatment of everything from depression and anxiety to a variety of eating disorders.

There are several strategies CBT will use to help individuals change their thinking patterns and eventually their negative behavior. The most central one of these is embracing mindfulness, which allows them to step back from themselves and objectively identify their emotions. CBT therapy also helps individuals understand the motivation and behavior of other people.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) is similar to CBT in that it involves identifying certain negative emotions, however, it is less focused on altering negative emotions. One of the key components of this type of therapy is for an individual to stop denying and avoiding their inner emotions. Individuals will learn that negative emotions are, at times, appropriate responses to some situations. The goal is for individuals to accept the difficulties and issues in their lives and then commit to making changes in their current behavior. According to Good Therapy, ACT involves a few major tenets:

• Acceptance–Acknowledging unpleasant thoughts and experiences to exist without trying to deny or change them.
• Being Present –Another term for mindfulness, this means being aware of emotions without trying to “do something” about them.
• Self as Context – This means that a person exists outside the current experience; the self is a constant and the circumstances change.
• Values – Individuals will try to codify and live by the values that are important to them.
• Committed Action – The person will commit to living their values consistently.

Being able to relate to different events and ideas is a primary concept in Acceptance and Commitment Therapy. This type of therapy is useful in treating anxiety disorders as well as EDs like anorexia nervosa and bulimia nervosa.

Dialectical Behavioral Therapy

This type of therapy is a slightly altered form of CBT that puts its focus on dealing with difficult situations in a positive fashion. Dialectical Behavioral Therapy (DBT) builds on the principles previously outlined in CBT. DBT focuses on the ways one person’s emotions can be roused more quickly or intensely than another’s, and how to harness or allay the intense negative emotions. There are four specific areas of emphasis in DBT.

• Mindfulness–As with all these treatments, mindfulness is key. St. Catherine University lists the tenet of mindfulness as purposeful observation, paced breathing, and self-soothing.
• Interpersonal Effectiveness–Using a mindful approach can apply to person-to-person interactions as well as self-examination. DBT uses dialogue to increase interpersonal effectiveness.
• Distress Tolerance – This method of coping teaches ways to tolerate rather than avoid stressful situations.

Dialectical Behavioral Therapy differs from the other two categories of treatment in that it includes both individual and group therapy regularly. During group therapy, individuals will learn skills from one of the following methods: distress tolerance, interpersonal effectiveness, mindfulness skills, and emotion regulation. Group therapy is an ideal setting for putting these concepts into practice.

Cognitive Processing Therapy

Another permutation of CBT, Cognitive Processing Therapy (CPT) is a regimented process between a therapist and a client that’s designed specifically to help with PTSD. Past trauma is a key contributing factor in many cases of eating disorders. When a person experiences trauma, which can range from a violent experience to emotional distress, they naturally put up defenses to deal with the stress of their experience. This often takes the form of coping mechanisms that temporarily ease the negative emotions caused by the stress; unfortunately, these mechanisms can take the form of harmful behavior, such as substance abuse or disordered eating patterns.

Unlike CBT or ACT, which focus on generally negative emotions or behavioral patterns, CPT specifically works to help the client address their past trauma. It’s performed in a specific series of 12 steps, with each step consisting of a single session. These sessions can be done in both residential and day treatment settings. Some of the individual sessions consist of:

• Education About Trauma – The therapist goes over how trauma affects emotion and behavior, using both the client’s experiences and general psychological education. This sets the stage for a better understanding that the client’s thinking has been distorted by the traumatic experience.
• Self-examination – With a basis of understanding how trauma affects emotion, the client and therapist then focus on the client’s specific trauma. They may be asked to write about the experience and read it back to the therapist, or engage in an honest, objective conversation about it. This may be an emotionally difficult step; it is similar to exposure therapy in many ways.
• Building New Skills for Coping–Now that a baseline of understanding trauma has been set, the pair move on to learning new ways to cope with the emotional distress caused by PTSD. These may include mindful mediation, journaling, or any other process of self-care that sidesteps the destructive coping mechanisms.
• Challenging Your Beliefs About Trauma – Finally, the last sessions deal with balancing the client’s previous emotions and beliefs about the traumatic experience. They will help the client realign their beliefs about intimacy, trust, safety, control, and self-esteem.

Cognitive Processing Therapy has become a standard part of treatment plans at most eating disorder treatment facilities since PTSD is so common in people with eating disorders. Trauma-informed therapy can also become part of other aspects of treatment, such as mindful movement (a great example is trauma-informed yoga) and meal planning that’s sensitive to a client’s individual phobias.

Getting Help for Eating Disorders Is an Achievable Goal

In the throes of an eating disorder, regaining a positive relationship with food, eating, and one’s body seems a million miles away. However, the past few decades have seen an expansion of the quality and availability of specialized care. Both individual therapists and eating disorder treatment facilities have become more capable of applying specialized treatments like the ones above to their clients. Often, getting started on the recovery process is just a phone call away.