Blog post written by Natalie Doan, BAH, MSc candidate in Public Health and Health Systems, University of Waterloo
Due to the complex nature of eating disorders, approaches toward treating eating disorders often involve a multidisciplinary team of doctors, psychiatrists, psychologists, dieticians, social worker, nurses, etc. Treatment also addresses different components of eating disorders, such as the physical, psychological, and interpersonal factors that contribute to and maintain eating disorders. This article will briefly describe five empirically-based psychotherapy approaches to treating eating disorders. Please note, this is not an exhaustive list.
Cognitive Behavioural Therapy- Enhanced (CBT-E)
Cognitive Behavioural Therapy (CBT) is a popular psychotherapy used to treat many mental disorders. Cognitive Behavioural Therapy-Enhanced is a version of CBT that is modified for individuals with eating disorder pathology and is considered the gold standard in treating eating disorders. This type of therapy rests on the theory that disordered eating pathology is rooted in cognitive factors such as over-evaluation of the body, perfectionistic standards, and the need for control. The behavioural component of CBT-E focuses on reducing problematic eating disorder behaviours such as restriction, bingeing, purging, and body checking. Common activities in CBT-E include self-monitoring, cognitive restructuring, and behavioural chain analyses.
Dialectical Behavioural Therapy (DBT)
Dialectical Behavioural Therapy (DBT) was originally developed for people struggling with Borderline Personality Disorders, but has now been applied to treat a range of mental disorders, including eating disorders. This type of therapy is based on the affect regulation model which assumes that impulsive and self-destructive behaviours are caused by the inability to regulate and manage emotions. DBT is grounded in the concept of dialectics- the coexistence of seemingly opposite truths- and incorporates cognitive behavioural, meditative, and acceptance-based strategies to do so. The main modules of DBT include: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. DBT is used to treat eating disorders based on the assumptions that many individuals with eating disorders have difficult describing, tolerating, and expressing their emotions and that negative emotions are one of the most common triggers for symptomatic behaviours. This type of therapy is particularly effective for treating impulsive and problematic eating disorder symptoms where emotion dysregulation is a key culprit.
Cognitive Remediation Therapy (CRT)
Cognitive Remediation Therapy (CRT) targets weakness in cognitive processes underlying eating disorder symptoms. This therapy rests on the assumption that many Individuals with eating disorders often have cognitive styles characterized by inflexibility and excessive attention to detailed information. Cognitive inflexibility can manifest as persistent, rigid, conforming and obsessional thoughts or behaviours around food, weight, and routines. CRT helps individuals become aware of inflexible thinking patterns by reflecting on the process of completing simple cognitive games, reflecting, and then applying it to eating behaviour symptoms. Ultimately, these exercises help individuals see how thinking styles influences their eating disorder symptoms and overall quality of life. CRT also encourages practicing psychological flexibility outside of therapy sessions to strengthen neural connections, with simple (but challenging) behaviours such as taking a different route to destinations.
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy (ACT) contrasts some cognitive therapies (i.e., CBT) in that it focuses on changing actions rather than thoughts, feelings, sensations, or memories. To do so, individuals are encouraged to: accept reactions and be present; choose a valued direction; and take action. In the beginning of ACT, individuals identify core values and commit to creating goals to fulfill their values. In the process, ACT enables individuals to open up to unpleasant emotions and learn that they are a normal part of living an authentic life. In the end, this therapy should lead to reductions in avoidant coping styles that may enable eating disorder behaviours.
Cognitive Remediation and Emotion Skills Training (CREST)
As mentioned above, individuals with eating disorders often struggle with emotions. Therefore, Cognitive Remediation and Emotion Skills Training (CREST) was developed to help individuals with eating disorders to improve their emotional processing, the ability to process stress and other emotionally charged events. CREST aims to improve emotional processing by using simple experiential exercises to normalize emotions. The use of simple, concrete, and engaging exercises allow individuals to develop a more accessible range of vocabulary and skillfully manage their emotions. This adjunctive treatment for eating disorders covers themes such as thinking about feelings, recognizing your emotions, thinking positively, and expressing your emotions.