Cognitive Behavioral Therapy (CBT) is an evidence-based treatment model focused on the premise that an individual’s thoughts, feelings and behaviors are intertwined and can ultimately be re-structured to support more productive actions. Historically routed in the treatment of depression and anxiety, CBT is becoming more prevalent in eating disorder treatment settings, particularly more recently, with Binge Eating Disorder (BED).
CBT focuses on three phases of treatment – the behavioral phase, cognitive phase and maintenance and relapse phase. Below is an overview of each stage, with critical treatment components specific to the Binge Eating Disorder population:
Behavioral Phase: In this phase, the patient and the clinician/therapist build rapport. The patient identifies negative emotions and behaviors, and with the support of the clinician/therapist, a plan for normalizing eating behaviors is developed.
This requires:
1. Addressing & minimizing negative behaviors associated with BED such as episodic binge eating and subsequent behaviors derived from guilt and shame.
2. Providing education and awareness about balanced eating, meal planning and nutrition.
3. Developing coping strategies for managing negative emotions that provoke episodic binge behaviors. Distraction, prolonging urges and thought stopping are some of the skills taught to cope with overwhelming urges.
Cognitive Phase: In this phase, “cognitive restructuring” techniques are introduced. Patients are encouraged to challenge their thought process and learn to identify unhealthy, treatment-interfering thoughts. They are supported in reshaping their thoughts by developing new perspectives.
This requires:
4. Conquering concrete & distorted thoughts about negative body image or self-worth as it applies to an unrealistic level of perfectionism.
5. Improving interpersonal relationships begins here. Patients identify unhealthy thought patterns, looking introspectively into the impact of their thoughts on relationships and patterns of communication with others.
6. Providing increased hopefulness, as patients gain insight into how their thoughts affect their behavior and begin to embrace positive change.
Maintenance & Relapse Prevention Phase: This final phase focuses on maintaining the skills learned in the previous stages of treatment. A comprehensive relapse and recovery plan is developed by the patient, with the clinician/therapist’s support, to assist the patient in managing the negative thoughts and behaviors associated with BED.
This requires:
7. Improving self-confidence as patients become more comfortable using the acquired skills and can identify triggers before they manifest into negative thoughts and behaviors. Patients should be positively reinforced by the noticeable progress that is visible to themselves and others.
8. Achieving holistic healing as the BED symptoms are improved and stabilized. Patients should be able to focus on the root cause and subsequent areas of mental and physical health that will assist in transitioning them into a life of recovery.
CBT isn’t easy – and certainly requires patience. But using these steps, clinicians can truly make a difference in re-shaping the mindset and providing invaluable skills for binge eating disorder patients in their journey forward.
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