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Dysfunctional attitudes about physical appearance
- The cognitive theory of eating disorders posits that dysfunctional attitudes about physical appearance give rise to eating disorder risk factors such as dietary restriction, body dissatisfaction, and valuing of thinness.
www.sciencedirect.com/science/article/pii/S0005789402800077Testing the cognitive model of eating disorders: The role of ...
The theory is evaluated using a selected review of the eating disorder literature pertaining to cognitive biases, negative emotional reactions, binge eating, compensatory behaviors, and risk factors for eating disorders.
- Donald A. Williamson, Marney A. White, Emily York-Crowe, Tiffany M. Stewart
- 2004
- Overview
- History of CBT for Eating Disorders
- Cognitive Model of Eating Disorders
- Components of CBT for Eating Disorders
- How Effective Is CBT for Eating Disorders?
- When CBT Doesn't Work
Cognitive-behavioral therapy (CBT) is the leading evidence-based treatment for eating disorders. CBT is a psychotherapeutic approach that involves a variety of techniques. These approaches help an individual to understand the interaction between their thoughts, feelings, and behaviors. It also helps them to develop strategies to change unhelpful thoughts and behaviors to improve mood and functioning.
At a Glance
Cognitive behavioral therapy is a first-line treatment of eating disorders. CBT focuses on helping people identify and change the thought patterns that play a role in the onset and maintenance of their condition. It also addresses areas including coping skills, low self-esteem, interpersonal problems, and perfectionism that also make eating disorder recovery more complex.
CBT can be an effective treatment for adults with bulimia, binge eating disorder, and other specified eating disorder (OSFED). However, it is essential to note that eating disorders are complex, and each person's needs are different. Other treatments, including hospitalization and residential treatment, may also be necessary.
CBT was developed in the late 1950s and 1960s by psychiatrist Aaron Beck, who emphasized the role of thoughts in influencing feelings and behaviors. CBT was initially developed to treat depression, although today it is an evidence-based treatment for many mental health conditions and symptoms, including disordered eating.
Cognitive behavioral therapy itself is not a single distinct therapeutic technique, and there are many different forms of CBT that share a common theory about the factors maintaining psychological distress. Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT) are examples of specific CBT treatments.
The cognitive model of eating disorders posits that the core maintaining problem in all eating disorders is overconcern with shape and weight. The specific way this overconcern manifests can vary. It can drive any of the following:
•Binge eating
•Compensatory behaviors such as self-induced vomiting, laxatives, and excessive exercise
•Low weight
•Strict dieting
Further, these components can interact to create the symptoms of an eating disorder. Strict dieting—including skipping meals, eating small amounts of food, and avoiding forbidden foods—can lead to low weight and/or binge eating. Low weight can lead to malnutrition and also can lead to binge eating.
CBT is a structured treatment. In its most common form, it consists of 20 sessions. Goals are set. Sessions are spent weighing the patient, reviewing homework, reviewing the case formulation, teaching skills, and problem-solving.
Cognitive behavioral therapy for eating disorders typically includes the following components:
•Challenge of dietary rules. This involves identifying rules and challenging them behaviorally (such as eating after 8 p.m. or eating a sandwich for lunch).
•Completion of food records immediately after eating and noting thoughts and feelings as well as behaviors.
•Development of continuum thinking to replace all-or-nothing thinking.
•Development of strategies to prevent binges and compensatory behaviors, such as the use of delays and alternatives and problem-solving strategies.
Cognitive behavioral therapy is widely considered to be the most effective therapy for the treatment of bulimia nervosa and should, therefore, usually be the initial treatment offered at the outpatient level.
Research suggets CBT is effective for bulimia nervosa and binge-eating disorders, although there is less evidence of its efficacy for treating anorexia nervosa.
One study compared five months of CBT (20 sessions) for women with bulimia nervosa with 2 years of weekly psychoanalytic psychotherapy. Seventy patients were randomly assigned to one of these two groups.
After 5 months of therapy (the end of the CBT treatment), 42% of patients in the CBT group and 6% of the patients in the psychoanalytic therapy group had stopped binge-eating and purging. At the end of 2 years (completion of the psychoanalytic therapy), 44% of the CBT group and 15% of the psychoanalytic group were symptom-free.
Another study compared CBT-E with interpersonal therapy (IPT), an alternative leading treatment for adults with an eating disorder. In the study, 130 adult patients with an eating disorder were randomly assigned to receive either CBT-E or IPT. Both treatments involved 20 sessions over 20 weeks, followed by a 60-week follow-up period.
At post-treatment, 66% of the CBT-E participants met criteria for remission, compared with only 33% of the IPT participants. Over the follow-up period, the CBT-E remission rate remained higher (69% versus 49%).
CBT is often recommended as a first-line treatment. If a trial of CBT is not successful, individuals can be referred for DBT (a specific type of CBT with greater intensity) or to a higher level of care such as partial hospitalization or residential treatment program.
If you or a loved one are coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237.
For more mental health resources, see our National Helpline Database.
The Best Online Therapy and Support Services for Eating Disorders
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Dec 1, 2004 · The cognitive-behavioral theory of eating disorders addresses how cognition influences the emergence and maintenance of unhealthy eating and weight management behaviors. ...
This article presents an integrated cognitive-behavioral theory of eating disorders that is based on hypotheses developed over the past 30 years. The theory is evaluated using a selected review of the eating disorder literature pertaining to cognitive biases, negative emotional reactions, binge eating, compensatory behaviors, and risk factors ...
- Donald A. Williamson, Marney A. White, Emily York-Crowe, Tiffany M. Stewart
- 2004
Jan 1, 2022 · One of the prevailing theories of eating disorders (ED) is the transdiagnostic cognitive behavioural theory of eating disorders, which suggests that certain ED symptoms, such as over-valuation of eating, shape, and weight, may be more central than others.
- H.W. Mares Suzanne, Julian Burger, H.J.M. Lemmens Lotte, A. van Elburg Annemarie, S. Vroling Maartje
- 2021
Jan 1, 2017 · The transdiagnostic model builds on the original cognitive-behavioral model for bulimia nervosa, arguing that the dysfunctional system of self-evaluation based on the importance of weight, shape, and/or eating provides the core psychopathology for all eating disorders.
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They identify a dysfunctional system for evaluating self-worth as central to the model: individuals with eating disorders evaluate themselves according to a relatively narrow range of domains including their eating habits, shape and weight, and their ability to control them.
