Cognitive Behavioral Therapy for Bulimia Nervosa
Cognitive behavioral therapy (CBT) is widely considered the best psychological treatment for bulimia nervosa, with research indicating it to be significantly more effective than other approaches. Furthermore, CBT provides an accessible and cost-effective psychotherapeutic option for those with bulimia who cannot access hospital-based treatments.
According to transdiagnostic theory, the core psychopathology of bulimia nervosa is an excessive evaluation of body shape and weight combined with excessive concern about diet and exercise. Most clinical symptoms associated with this core psychopathology can be explained, including dietary restraint or restriction; preoccupation with thoughts about food/eating habits; checking one’s shape/weight or avoidance behaviors; as well as engaging in extreme methods like binge eating or purging for weight control purposes.
There is an urgent need for better insight into the psychopathology behind eating disorders, as well as treatment approaches which reduce relapse risk. Recent studies have highlighted the value of cognitive behavioral therapy (CBT) as the most successful form of therapy for bulimia nervosa and other eating disorders.
During the initial phase, patients are taught how to identify and challenge dietary rules as well as develop continuum thinking – replacing all-or-nothing thinking that can lead to binges. Furthermore, they learn to reframe negative feelings associated with food such as fear of failure or self-hatred by reframing negative emotions associated with food.
In the second phase, treatment aims to alter eating behavior through developing healthier choices and eliminating avoidance behaviors. Furthermore, strategies are created for avoiding binge-purge episodes as part of maintenance planning and relapse prevention.
Therapy of this kind is provided by a qualified professional who works with the patient to teach them skills and strategies to combat negative thoughts and behavior that fuel their disorder. Therapy may take place in various settings, such as individual sessions or group therapy.
Therapy utilizes a range of cognitive behavioral techniques, from weighing the patient and reviewing homework to teaching new coping skills and problem-solving approaches. The aim is to break the cycle of eating, binging and compensatory behaviors like vomiting or overexercising.
The therapist collaborates with the patient to create a plan of action that includes learning new skills, recognising triggers and pinpointing reasons for relapse. They also offer psychoeducation about eating disorders such as binge eating and purging, along with its detrimental effects on health.
Although CBT is the most studied and well-proven psychological treatment for bulimia nervosa, researchers are investigating the effectiveness of alternative therapies such as Internet-based therapy and psychoanalytic psychotherapy.
Recent randomized controlled trial (RCT) comparing internet-based cognitive behavioral therapy to face-to-face therapy for bulimia nervosa, or binge eating disorder (BED), revealed that the latter was more effective. Results indicated an earlier onset of improvement with internet-based therapy and it being cost effective too. Furthermore, the relapse rate was lower among those receiving internet-based therapy than those receiving face-to-face therapy.