How Is CBT Used to Treat Bulimia?
Though initially developed to help people with borderline personality disorder (BPD), cognitive behavioral therapy has since been adapted to treat a number of different conditions, including bulimia nervosa. In fact, CBT is now the leading evidence-based treatment for BN, and it is often the initial treatment tried for people struggling with this eating disorder. [1]
Recognize Unhelpful Thought Patterns
For the treatment of bulimia nervosa, a course of CBT will focus on helping people recognize the unhelpful thought patterns that lead to behaviors related to the condition, such as binge eating and inappropriate compensatory behaviors, such as self-induced vomiting or excessive exercise.
Learning Healthy Techniques
Patients are taught to address these thoughts with new, more healthy techniques. The goal is something called cognitive restructuring, which is when a patient eventually eliminates these unhelpful thoughts altogether and replaces their disordered eating behavior with healthier coping mechanisms.
Still, mental health represents only one aspect of treating an eating disorder. CBT is usually combined with nutritional counseling and the possible use of medication to help with other symptoms associated with the condition.
This is a long-term treatment process. Eating disorders are complex conditions that take time to recover from. At the same time, recovery is a spectrum, and people may begin experiencing some of the benefits of cognitive behavioral therapy shortly after beginning treatment.
How Does CBT Bulimia Treatment Work?
Cognitive behavioral therapy operates on the idea that unhelpful behaviors are borne of unhelpful thoughts. The purpose of the work done in CBT treatment is to eliminate these unhelpful behaviors by training someone to recognize and purposely change their unhelpful thoughts.
Cognitive behavioral therapy is a highly-structured form of therapy, often lasting a predetermined number of sessions. These sessions are further broken into different focuses:
- Recognizing unhelpful thoughts
- Practicing new skills and coping techniques
- Setting recovery goals
- Working on future problem-solving strategies (which help a patient maintain long-term recovery)
This approach is a highly evidence-based psychological treatment and is used to help with a variety of mental health issues. [2]
What to Expect from CBT
CBT is a highly-structured form of therapy. Rather than sitting on a couch and having a free-form conversation, you’ll work with a therapist to specifically identify unhelpful thought and behavioral patterns, then work through ways to change them.
Talk About Your Feelings
You will likely spend time talking and thinking about how you feel about body shape, body image, food, and eating. You might discuss the feelings or events that trigger binge eating episodes, self-induced vomiting, laxative abuse, or other unhelpful behaviors. You may also discuss the things that cause you anxiety generally or past traumas that may be affecting your mental health.
This is a process designed around your needs. While the topics can be difficult, you won’t be forced to discuss topics you don’t feel ready to discuss.
Homework
Once you reach the phase of learning new skills and coping mechanisms, it’s not uncommon to receive “homework assignments” from your therapist. These can include games, puzzles, or other techniques which are designed to help break your brain out of following entrenched and unhelpful neurological pathways.
Cognitive behavioral therapy is usually practiced with a trained mental health professional, though its highly-structured nature has made it a good option for self-help therapies. This can include workbooks or other online programs which help introduce the same ideas and teach the same techniques, allowing a patient to work through the course in their own time.
How Effective Is CBT?
According to an analysis of available data, CBT is one of the most successful psychological treatments for reducing the behaviors associated with adult cases of bulimia nervosa, binge eating disorder (BED), and night eating syndrome. [3]
CBT is the most effective therapy for treating depression, which commonly co-occurs with bulimia nervosa.
Compared to a variety of other treatments as well as no treatment, CBT was also shown to generally be the most effective option for reducing symptoms associated with depression. [3] As depression commonly co-occurs with BN and, in many ways, works to sustain the condition, this added benefit of CBT can be huge for achieving successful treatment and recovery.
In fact, CBT was the top psychoanalytic psychotherapy for achieving BN remission across a number of different studies. [3]
As bulimia nervosa has no true “cure,” similar to anorexia nervosa (AN) and a number of other mental health conditions, achieving remission is essentially considered the most successful outcome of therapy and other treatments.
What Other Therapies Are Used to Treat Bulimia?
While there are many advantages of using cognitive behavioral therapy to treat BN, the method isn’t the only available technique that can help.
Interpersonal psychotherapy (IPT) is another popular type of bulimia nervosa treatment.
Rather than focus on how the inner workings of the mind may influence someone’s behavior, IPT examines how someone’s personal relationships may impact their stress levels or other factors that could trigger unhelpful behavior.
The treatment duration of this method is also short and structured, with a program generally lasting between 12-16 weeks. In the long term, though, IPT may be about as effective as cognitive behavioral therapy for reducing bulimia symptoms. [4]
For younger patients dealing with BN, family-based treatment (FBT) is one of the most popular therapeutic methods.
Also called the Maudsley Method, this type of treatment involves a child’s guardians and possibly other family members in the treatment process. Together, the group will work with a mental health professional to develop the skills needed to better help their child and aid in recovery.
FBT also utilizes different phases of treatment to focus on different priorities. During the first phase, the focus remains on helping a child recover their weight and get their biological needs met. The second phase is focused on returning some of their autonomy and helping them eat in healthier ways with less input from their parents or therapist. The third and final phase centers on helping the child develop a healthier body image and become more comfortable with accepting who they are.
Finding Help for Bulimia Nervosa
If you or a loved one are struggling with bulimia nervosa, it’s important to seek out help.
Cognitive behavioral therapy is a great option to start with, but finding any type of help is important to help slow down disordered eating behaviors before they become dangerous to your health.
You can speak with a trusted mental health professional, such as your therapist or physician, for help finding an appropriate treatment center. Or you can call your insurance company to be pointed in the direction of programs that may accept their coverage.
Online treatment for bulimia and other eating disorders is available and may be the best option for you.
The most important thing is to act. Recovery from bulimia nervosa is possible, and it can help lead you to a healthier and happier future.
Resources
- Bulimia: Symptoms, Diagnosis and Treatments. (2014, December 19). Harvard Health Publishing. Retrieved December 11, 2022.
- What Is Cognitive Behavioral Therapy? (2017, July). American Psychological Association. Retrieved December 11, 2022.
- Costa, M. B., & Melnik, T. (2016). Effectiveness of psychosocial interventions in eating disorders: an overview of Cochrane systematic reviews. Einstein; 14(2):235–277.
- Kass, A. E., Kolko, R. P., & Wilfley, D. E. (2013). Psychological treatments for eating disorders. Current opinion in psychiatry; 26(6):549–555.