Binge eating followed by self-induced vomiting or laxative abuse is the chief symptom of the eating disorder called bulimia nervosa. Many men and women with this disorder know and accept that they have a problem that requires medical help, and are willing to seek treatment. The most effective treatment for bulimia nervosa to date has been cognitive behavioral therapy. Let's have a brief look at CBT for bulimia nervosa.
What is CBT?
First, let us understand what exactly CBT is. Cognitive behavioral therapy is a combination of behavioral techniques and cognitive therapy. It is based on the belief that the individual's cognitions are based on attitudes that have developed from previous experiences and his or her thoughts, beliefs, and values are interrelated. These, in turn, influence the affect and behavior of the individual. Behavioral techniques are used in this approach to bring out these cognitions of the individuals and change the associated behaviors.
There are three stages of CBT as it is used for treating bulimia nervosa as follows:
The Cognitive View on the Maintenance of Bulimia Nervosa
During the first stage of the treatment, the therapist attempts to establish a good rapport with the patient and also provides details about what is going to happen during the course of the therapy. The history is taken and the rationale behind the approach is also explained. The therapist will also provide the client with a review monitoring sheet to note down what he or she is eating. He or she is also asked to stop checking their weight on a daily basis and instead begin weighing themselves on a weekly basis.
This is also the time when the identification of the various cognitions surrounding the eating problem will be tested and the individual will be asked to test these as a homework assignment. The therapist will also teach the individual about how behaviors such as binge eating, purging, extreme dieting, and laxative use can harm the body of the individual. The individual is given a regular eating pattern and he or she is also taught alternative behaviors.
A joint session is also generally organized with friends and relatives so that the problem can be brought out in the open. The patient is also asked to explain the rationale behind the treatment which can help the therapist ascertain whether the individual has understood the therapeutic principles.
Establishment of Healthy Eating Habits
The objective of stage two of cognitive-behavioral therapy for bulimia nervosa is to establish healthy eating habits and especially to eliminate the strict dieting which these individuals often follow. Therefore, the review monitoring sheets and homework assignments that were started in stage one will continue. Besides these, the problem-solving skills of the individual and his or her concerns about shape and weight are worked on. This is the stage where the cognitive distortions are extensively covered and the therapist will examine the thoughts, beliefs, and values of the individual in detail to identify which ones are responsible for maintaining this eating problem.
Maintenance of Gains Achieved
The final stage of this treatment aims at maintaining the gains that have been achieved during the previous stages. Since this is the final stage and the therapy would have been ongoing for 20 weeks, this is typically the time that the treatment will be terminated. However, it is necessary that learned skills are continually practiced and the individual does not have a relapse of the binge and purge cycle.
CBT for bulimia nervosa is considered to be the most effective treatment option available. It helps in reducing the frequency of binge eating and purging among others, which are used by these individuals to control their weight. The gains achieved during treatment are also found to be effectively maintained over time. So, if you are thinking about getting treatment for your bulimia or suggesting treatment to someone you love, consider cognitive-behavioral therapy.
Vanderbilt University: Cognitive-Behavioral Therapy For Bulimia Nervosa
Cognitive behavioral treatment of bulimia nervosa. The Clinical Psychologist, 50(2), 10-12.