When was the last time that you genuinely enjoyed your food? For people with anorexia nervosa, bulimia nervosa, and binge-eating disorder, the answer might be an “I don’t know” with a look away from you. Interesting as it may sound, however, the reality is that suffering from any kind of eating disorder can get more demoralizing than it could ever be described. Many who do suffer from eating disorders feel the weight of anxiety upon them, piling on their shoulders as they carry the weight of their other anxieties every single day.
In some cases, these people react to their anxiousness and stressfulness by eating. They may find relief upon the consumption of food, any food, to the point that it starts to harm their health. Others abstain in the fear of gaining weight. Some would purge themselves of food, expelling what would have been “nasty” carbohydrates that they think would make them look fat.
And while it isn’t a perfect device on its own, cognitive-behavioral therapy (CBT) helps by relieving the thoughts of stressors and body shape as it strengthens the mind to better cope with emotional triggers. In fact, any kind of therapeutic technique could work in the same way. They all aim for one thing: to help the patient through when they have nothing left to do.
Thinking and Acting Are Linked
In CBT, the treatment focuses on how the patient perceives their feelings and how the way they think affects them. Hence the name, cognitive-behavioral. It’s the link between emotion and reason which influences each other. For instance, many people with anorexia nervosa believe that they are fat, even though the opposite is true. This makes eating unenjoyable to them because these people believe that they will gain more fat, and thus ugly, whenever they eat. The thought brings them into a downward spiral of eating and self-hate, which makes them want to avoid food more. However, this is just an over-simplistic explanation. The situation gets more complex in real life, and it’s the therapist’s job to unravel and analyze them.
CBT comes in two phases: behavioral and cognitive. At the first part of a CBT session, the patient goes through the behavioral phase, discussing their feelings and experiences with the therapist. This gives the therapist a good picture of how the patient feels. They may ask what the patient feels before a binge-eating session, for example. Then the patient would answer with as much detail as they possibly can.
The therapist may also ask for any recurring thoughts and deep emotions that the patient is aware of. Unlike most other therapeutic techniques, CBT only focuses on what the patient is aware of. This gives the patient the feeling that they are both working together for a common goal. The feeling makes them feel heard and it gives them the trust that the therapist needs for a good therapeutic outcome.
Of course, the therapist will still need to explain how their patient really feels. Sometimes, people know that they feel something, but they don’t really understand how each of their emotions is connected. Therapists do this by reframing, which is a way of looking at things from another angle. By doing this, the patient gains more insight into how they feel. They may also understand why they feel certain emotions, as is the case when they become burnt out from too much stress.
As the patient learns more of their emotions, the behavioral phase will eventually come to an end. Then the cognitive phase will begin. Here, the patient will learn how to use a variety of cognitive techniques to help them through their problems. Among these, mindfulness meditation helps with stress reduction to prevent burnout-related binge-eating episodes. The patient could also get assignments. These are usually simple techniques that they could try at home so they could speed up the therapeutic process.
Treating Eating Disorders
In effect, CBT works to treat most eating disorders. But even the other types of therapeutic techniques can work. Depending on the context, the following may even be used instead of CBT:
- Interpersonal psychotherapy.
- Dialectical behavior therapy for the management of strong emotions.
- Cognitive remediation therapy for big-picture thinking.
- Psychodynamic therapy helps patients find the cause of the emotions that cause eating disorders.
In most cases, however, CBT works best when combined with these other techniques. Usually, cognitive remediation therapy is combined with CBT to help people with anorexia and bulimia nervosas to think outside of exercise and losing weight. At other times, the therapist may decide to move up from CBT to dialectical behavior therapy, especially when the patient seems to need more help.
Some People Benefit More From CBT
CBT is most effective during the early phase of a disease. The same can be said with eating disorders. When done at the right moment, it could increase the chances of full remission in as short as five sessions.
However, the power of CBT lies in the patient’s willingness to change themselves. For people with eating disorders, this can be a tough problem. As a therapist, the main problem here would be getting them to stick to proper dietary patterns. Sometimes, the patient would just fail after an unexpected binge-eating session, causing them to give up and stop going back to therapy. As such, CBT can get frustrating at times especially when you find it hard to do your homework.
On the other hand, the patients who strive to follow the treatment plans and assignments most often finish sooner and with better success. For some people with anorexia, the discipline they use for abstaining from food sometimes helps them out during therapy. These people would strictly follow the meal plan and do their best to never falter.
What makes cognitive-behavioral therapy, or any other therapy, work to its very best is when the therapist uses the patient’s past experiences to build better habits. Oftentimes for people with eating disorders, they tend to learn a few tricks to keep their diets or maintain their weight. The point of therapy is not to remove all of these experiences altogether. They are a part of the person now, and it would only be counterproductive to throw these parts away. But by building better habits on them, any treatment strategy would work much better.
With that said, there also remains the patient’s social support. It could be with family or friends. A lot of times, support groups tend to work great by bringing people who go through the same journey in one place. These people can look out for each other and provide tips and tricks to make things easier for others. Or sometimes, they may just need a lending ear. Sometimes, you just need someone to listen to your problem even if they can’t offer a solution. Sure, they can’t fix it, but at least they helped you lift that heavy burden off your back.
At other times, you might just need a gentle push. Stenzel Clinical has counselors for both in-clinic and online consultation services for people eating disorders.