In the past decade, cognitive behavior therapy has become leading treatment for all varieties of eating disorders. Through its thought-centered approach, it has proven that eating disorders can be treated and although there are still some hurdles to overcome in the area, the future of cognitive therapy in the treatment of a range of eating disorders (as well as other psychological disorders) is promising. It is stunning to note that “cognitive behavior therapy is represented for almost all psychiatric conditions as well as numerous somatic conditions. In fact, it is difficult to find a major condition for which psychosocial interventions are implicated where cognitive behavior therapy has not been tested or, in many cases, has become the treatment paradigm of choice” (Anderson 2005). Generally speaking, the world should recognize the power of this treatment in dealing with eating disorders since it is being proven to work.
Throughout its history, cognitive behavioral therapy has gained credence after several statistical and clinical trials carried out by hundreds of research teams internationally. Instead of focusing on weekly sessions geared towards speaking alone, cognitive therapy is able to quickly treat eating disorders because it aims to focus on the negative thoughts associated with day to day activities and this therapy is reinforced through the use of daily activities by the client that are part of their lives outside of traditional therapy. This can include “homework” assignments that include reading and recording thoughts and ideas.
Cognitive therapy is a proactive solution, but the patient must be willing to receive treatment in order for it to work best. The following report will detail many of the successes as well as some of the failures associated with this treatment and will discuss its application and rate of success in treating individual eating disorders in women such as bulimia nervosa, anorexia nervosa, and binge eating disorder. Although each case warrants its own description, it is fair to suggest that overall, cognitive behavior therapy offers patients new hope and will allow them to live normal lives. That said, there are still some issues, particularly with the longevity of success as well as aspects related to caring for issues that are the result of or part-cause of the disorder itself. Just as in the case of any disorder and treatment paradigm, there is no perfect solution and nothing will offer a 100 percent success rate simply because all patients are individual and have unique ways of responding to treatment. That said, the general consensus of this report and of the research of several scholar is that this is one of the most effective treatments available.
Interestingly, the success of cognitive behavior therapy is remarkable because of how basic the guiding principles behind it are. Instead of involving murky theoretical principles that have little use for the patient in an interactive way, cognitive behavioral therapy is straightforward and is designed to be integrated into the daily life of the patient. Cognitive behavioral therapy is by no means a complex idea within itself and for the most part, the theory is quite simple and although there are a variety of interpretations and ways of conducting the counseling itself, its basis is grounded and easy to understand. “In a nutshell, the cognitive model proposes that distorted or dysfunctional thinking (which influences the patient’s mood and behavior) is common to all psychological disturbances.
Enduring improvement results from modification of the patient’s underlying dysfunctional beliefs” (Beck 1995). For example, according to this succinct definition, when applied to the area of eating disorders, a patient likely has an emotional or mental process that lead inexorably to their disordered actions such as binging or purging. According to the cognitive behavior therapy paradigm, with modification of these thought processes, the patient can be pulled out of the unwanted behavior simply by recognizing the triggers and then replacing the harmful thought with one that is revised and hopefully, more rational and healthy. In essence, this is what the whole of cognitive behavior therapy revolves around. Ideally, the patient and the counselor would look at the patterns of thought and throughout the course of treatment, no matter how long or short, these behaviors would be slowly dissolves and replaced by those that the counselor assists in placing. In other words, “The core of cognitive behavioral therapy lies in the enhancement of effective self-regulation of behavior” (Hutchinson-Phillips 2005). The key word is “self” in this paradigm of treatment as much of the emphasis is removed from the professional and put into the hands of the client.
While thus far cognitive behavior therapy has been described as being an almost magically simple way of “curing” eating disorders, it is far from perfect. There are still a large number of issues to consider and after looking at all of the facts, we see that while it is an effective treatment, this is a relative classification. The success rates are high but that is only in comparison to other methods. There are still large numbers of cases of eating disorders that are unfazed by treatment, no matter what variety. While cognitive behavior therapy may work well in comparison, there are other issues that must be considered in addition to this treatment for it to be truly effective.
Although cognitive behavioral treatment is the treatment of choice in bulimia nervosa, anorexia nervosa, and binge eating disorders, patients’ response is variable. As one scholar notes, “A minority of patients do not respond at all and some never engage in treatment. Many of these patients were more likely to have been diagnosed as having borderline personality disorder and were more likely to have abused psychoactive substances and engaged in episodes of self-harm” (Coker 1993). This signals that there are inherent problems when discussing the vast success of this treatment. For example, what about these issues such as other addictions, depression, and other disorders that interfere with the potential success of cognitive behavioral therapy? Many researchers who seem quick to tout the benefits of the treatment ignore the fact that medication is also a necessary component in many cases, especially in the case of eating disorders. Patients who suffer from an eating disorder are likely to have other personality problems as well as these must be treated along with the actual symptoms of the eating disorder itself. Through an approach that balances traditional pharmaceutical lines with the newer cognitive behavior therapy, the success rates might be higher and more people will benefit from this new form of treatment.
One of the most promising findings in the last ten years in the field of cognitive behavior therapy and eating disorders has been in the case of bulimia nervosa. Cognitive behavior therapy for bulimia nervosa has demonstrated the largest success rate by far. “The results of over 20 randomized trials indicate that CBT-BN produces in completers (typically between 80-85%) an abstinence from binge eating and purge eating between 40-50%. CBT-BN is more effective than delayed treatment and pharmacotherapy, and as effective as, or more effective than delayed treatment, all the other psychotherapies evaluated” (Grave 2005). While scholars have yet to hypothesis any widely agreed upon reason for the higher success rate for this branch of eating disorder in particular, one must admit that the statistics are quite astounding. One potential hypothesis is that the problems associated with this disease are a bit easier to treat because many of the side issues such as depression can be the result of the disorder itself—not simply a foregone symptom that one must figure was present before the onset of symptoms. Something generally acts as a trigger to cause the behavior and such behavior is not quite as sustained as that which is associated with anorexia nervosa.
There is an important distinction between the two eating disorders that must be made in order to realize this more fully. “The main feature that distinguishes bulimia nervosa from anorexia nervosa is that attempts to restrict food intake are punctuated by repeated binges (episodes of eating during which there is an aversive sense of loss of control and an unusually large amount of food is eaten)” (Fairburn 2003). In most cases, the binge eating is followed up with self-induced vomiting or abuse of laxatives, although there is a classification for those who do not purge. Oftentimes, depression accompanies this illness as the feelings of lost control grow more prominent. When a patient being treated for bulimia nervosa enters cognitive behavior therapy, one of the first elements the counselor must begin with is that actual trigger for the behavior. After there is progress made in this area the depression will be treated, almost by proxy since the patient’s depression can often stem from the feelings of helplessness and lack of control associated with bulimia nervosa. Bulimia typically starts in teenage years; teens seeing it as a way of getting the pleasure of eating while not gaining weight as a result. This behavior that begins in the teenage years, often time, the teen realizes the danger and stop this behavior. It is at this crucial point where an individual may chose to continue this harmful behavior eventually it becomes an addiction. Over time this cycle will continue until it encompasses an individuals every thought. At this point the previous pleasure that was derived from this behavior has now been replaced with an obsession. The conflict that this eating disorder creates is that a bulimic wants to be thin and have the ability to overeat. It is this conflict that is the most difficult for a bulimic to overcome. They are unable to give up; their behavior has taken over rational thought. Although the behaviors are out of their control the individual is actually uncontrolled. They feel that they have control because they determine what food enters their body and the act of purging is a decision. That by just thinking of vomiting they are often able to do so, reinforcing their thinking of complete control over their behaviors. This cycle begins with an episode of binge eating. Purging; using laxatives, syrup of ipecac or diuretics; or excessive exercise or starving themselves compensates the individuals’ intake of food. It is common for individuals to develop a tremendous fear of gaining weight if they stop purging; however, the majority of bulimics have average weights. They see gaining weight as a worse option then the binge/purge behavior they are currently in. By stopping bingeing behavior they feel they will not be able to eat healthy for fear that they will not have enough food. To maintain a thin body the only option they can see is dieting throughout their life. They see this as self-depravation. These emotions and fears are what fuel this cycle of bulimia. In the field of cognitive behavior therapy, this cycle can only be halted by helping the patient understand that he or she is merely caught in the cycle of thoughts, not actions and that these thoughts can be changed. While this certainly takes a great deal of effort on both the part of the patient and the counselor, results can be seen and cognitive behavior has been the standard in the past decade for treating this disorder simply because it restructures these old thought patterns that were likely begun when a person was much younger.
Cognitive behavioral therapy alone might not be enough in many cases. Although it is a promising field with excellent results (particularly with this disorder) traditional methods of treatment cannot be foregone in favor of the cognitive end or else danger of relapse may be heightened. The primary goal of treatment for bulimia is to reduce or eliminate binge eating and purging behavior. Nutritional information and guidelines to follow are needed; psychological intervention and medication management strategies are often successful. Helping the bulimic establish a pattern of regular, non-binge meals and a regular exercise plan that is not excessive is extremely important. Individual counseling, cognitive-behavioral therapy is recommended, group therapy that uses a cognitive-behavioral approach, and family or marital therapy have been reported to be effective. Psychotropic medications, primarily antidepressants such as the selective serotonin reuptake inhibitors (SSRIs), have been found helpful for people with bulimia, particularly those with significant symptoms of depression or anxiety, or those who have not responded adequately to psychosocial treatment alone. These medications also may help prevent relapse (Greeson 1993). This is an issue that must be remembered throughout this report because it seems that there are usually other serious issues to contend with including, but not limited to, personality disorders, depression (not necessarily as a result of the guilt and helplessness associated with the eating disorder) and other mood disorders. While cognitive therapy can be an effective way to manage and rehabilitate thought patterns, in serious cases there are many other issues that must not be ignored.
Another related eating disorder, binge eating, has also been shown to be highly compatible with cognitive behavior therapy. Much like bulimia nervosa, many of the same symptoms are present, particularly in terms of the feelings of depression that come as a result of feeling out of control and helpless. There are, however, important distinctions to be made between bulimia nervosa and binge eating. As one definition states, “Binge eating disorder is characterized by recurrent episodes of binge eating in the absence of regular compensatory behavior such as vomiting or laxative abuse. “Related features include eating until uncomfortably full, eating when not physically hungry, eating alone, and feelings of depression and guilt. Binge eating disorder is also associated with increased psychopathology, including depression and personality disorders…. Eating disorder treatments such as cognitive behavior therapy improve binge eating with abstinence rates of about 50%” (De Zwaan 2001). Although 50% may not sound as successful as one may wish, this is still quite high, especially when one considers that the success rates through traditional therapies was only between 35-40%. It is also important to note that these are two similar eating disorders with very similar causes and effects and these similarities can tell researchers quite a bit about how different therapies work for particular aspects of a condition (such as in terms of anxiety, depression, etc). Even still, the numbers seem as though they should be higher and it is clear that there must be more to discover about eating disorders and cognitive behavior therapies.