Can CBT Help with an Eating Disorder?

Yes. CBT can help with an eating disorder.

Cognitive behavioral therapy (CBT) is a form of therapy that can be used in eating disorder recovery to challenge and change problematic thoughts and behaviors. During CBT, patients work with their therapist to learn practical techniques to change these patterns of thinking and behaving.

CBT was first applied to treating eating disorders in the early 1980s. Since that time, there have been numerous studies supporting its efficacy in treating all types of eating disorders, including binge eating disorder, anorexia nervosa, and bulimia nervosa. Today, it is the most commonly used treatment for most mental health disorders, including for those recovering from an eating disorder.

How does CBT work?

While some forms of therapy explore the origins of feelings, thoughts, and behaviors, cognitive behavioral therapy focuses more on what is going on for you now. It is a problem-focused, action-oriented approach.

It starts with identifying maladaptive core beliefs. What ideas do you have about your body, eating habits, and self worth? Your therapist may encourage you to write down self-critical thoughts and any resulting behaviors. Getting more familiar with the internal critic begins the process of de-emphasizing core beliefs that are unhelpful or destructive.

Once you identify your core beliefs about yourself, you and your therapist will focus on cultivating healthier beliefs that will help move you in the direction of eating disorder recovery. For example, if you have a perfectionist view of yourself (e.g. “I have to look perfect or I’m worthless”), one CBT goal might be to celebrate failures when they happen. Start to notice any silver linings, too.

Another exercise might be to conduct a realistic written self-assessment, where you take a global look at yourself and not only make note of areas for potential improvement, but also highlight your strengths. You and your therapist may then explore the difference between constructive self assessment and destructive self criticism—which may be accompanied by feelings of shame and guilt. By confronting and discussing your self evaluation, it may start to disrupt an engrained negative behavior pattern of fear and avoidance.

Then the focus shifts to modifying problematic behaviors and/or introducing more constructive actions.

Possible CBT exercises your therapist (or dietitian) may have you try:

  • Monitor your eating habits. In a journal, record the food you eat and your thoughts, feelings, and associated behaviors.
  • Eat at regular intervals during the day. This avoids “delayed eating,” a common behavior we see in people with eating disorders.
  • Plan your meals in advance.
  • Regular weighing (usually once per week).
  • Challenge your dietary rules. Are there are certain times of day or “fear foods” you don’t normally eat? Your therapist may gradually ask you to let go of these once you’ve gotten on a regular eating schedule.
  • Practice the continuum technique for perfectionist behaviors.
  • Role playing. This allows you to rehearse new approaches when you encounter situations or people who tend to trigger your problematic behavior.
  • Behavior experiments.
  • Learn to calm and relax your mind.
  • Introduce self compassion. This helps you turn toward yourself in times of distress or perceived failure, rather than allowing the inner critic to take over.

Cognitive behavioral therapy is a structured and time-constrained approach to eating disorder recovery. Toward the end of your treatment, your therapist will work with you to develop a relapse prevention plan in order to maintain your eating disorder recovery.

Do you want to improve your relationship with yourself and your body?

Evolve Wellness Group has a team of dedicated therapists and dietitians who are experienced in helping people recover from eating disorders. Cognitive behavioral therapy is just one of the tools we use to help clients on the road to recovery. 

Your first step: Contact us for a 15-minute intake call. It’s free, and we can answer any questions you might have.