CBT Snapshot: Using Cognitive Behavior Therapy for Eating Disorders

Teenage girl talking to a therapist


Posted in: Parenting Concerns, Teenagers, Young Adults

Topics: Mental Illness + Psychiatric Disorders

Cognitive Behavioral Therapy is a special kind of talk therapy that can be used to help with mental health challenges. In this CBT Snapshot series, Dr. Ellen Braaten gives a glimpse of what it looks like to use CBT for a range of mental and behavioral health disorders. 

The most effective treatment for bulimia is Cognitive Behavior Therapy (CBT), delivered either individually, in family therapy, or in combination. Although anorexia is a more difficult disorder to treat, CBT forms the basis for much of the treatment for anorexia, as well. CBT therapists change eating behaviors by rewarding and modeling appropriate eating habits while helping the patient change their distorted or rigid thinking patterns. Many patients hold themselves to perfectionist standards that, because they cannot be met, cause them to be self-critical (e.g., “I’m so fat that anyone would think I am disgusting,” or “Everyone is looking at me because I look like a pig.”). Treatment that uses CBT includes the following:

  • Establishing an appropriate eating plan that includes 3 meals a day, plus snacks.
  • Keeping a diary of what the patient is eating, including the frequency and amount, as well as thoughts and emotions connected with eating (and purging, if that is an issue).
  • Using response delays, such as waiting for a certain amount of time before engaging in purging or binging. While waiting, the patient engages in an alternative activity, such as calling a friend, reading a book, or listening to music.
  • Cognitively monitoring thoughts, such as “My stomach is so fat.”  Once the adolescent is aware of these thoughts – and their frequency – they can work to evaluate and change them in therapy.
  • Relaxation training and positive body imagery (i.e., imagining the positive aspects of a healthy body).
  • Training in problem-solving skills, such as assertiveness and communication skills.

Using CBT as part of treatment for eating disorders can help to change behavior by challenging negative, eating-disordered thoughts and increasing self-esteem.

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Ellen Braaten, PhD

Ellen Braaten, PhD

Ellen Braaten, PhD, is executive director of the Learning and Emotional Assessment Program (LEAP) at  Massachusetts General Hospital (MGH), an associate professor of psychology at Harvard Medical School, and former co-director for the MGH Clay Cente...

To read full bio click here.