Deciphering the alphabet soup of E.D. treatment options

Dear Readers,

 

         Those of you who have spent any time reading self-help books or treatment guides have probably come across mention of different psychological approaches used to treat eating disorders such as CBT, DBT, or ACT. We’d like to take some time to decipher this alphabet soup of options. Before we do, however, it’s important to remember that more important than techniques or methods is that you (or your loved one) develop a rapport and a working relationship with an experienced, competent psychotherapist. What matters most is that all involved feel confident the professional can be of help.

         Cognitive Behavioral Therapy (CBT) has been the most studied of the three forms of treatment we’ll discuss here. Many CBT techniques have become part of the standard repertoire of both psychotherapists and nutritionists treating eating disorders. CBT is based on the idea that you can change negative behaviors by changing your way of thinking. By examining your negative thought processes and correcting them, or changing the cognitive errors that give rise to those thoughts, you can alter or eliminate negative behaviors. A bulimic, for example, would learn how to recognize problematic thoughts such as “I am fat,” or “I feel fat.” She would work on changing her thoughts to more reasonable ones, such as “I can’t be fat since others see me as thin.” Seems so simple, but it works.

          Using food records or diaries to record what you eat and how you feel about it is classic CBT. If you never eat breakfast, a therapist using CBT might encourage you to have breakfast every morning while paying attention to how this affects your eating, energy, or mood later in the day. The book Overcoming Your Eating Disorder: A Cognitive-Behavioral Therapy Approach for Bulimia Nervosa and Binge-Eating Disorder by W. Stuart Agras and Robin Apple is one example of a workbook that is based on CBT techniques.

         Dialectical behavioral therapy (DBT) teaches healthier ways to handle painful emotions by recognizing and accepting feelings without judging them as “good” or “bad.” A therapist would teach you mindfulness skills to help you recognize when you are hungry or when you feel full. Your therapist might teach you to use breathing or relaxation exercises, to take an emotional timeout, or find a healthy distraction to keep you from engaging in eating-disordered behaviors. One DBT exercise is the “raisin mediation.” While slowly eating one raisin, the patient is asked to pay attention to the experience of eating the raisin, to any feelings of hunger or fullness, and to thoughts or emotions about eating. These guided food meditations move on to include foods like chocolate cake, cheese, crackers, then whole meals. The DBT workbooks on the market aren’t just focused on eating-disordered behaviors but can be helpful nevertheless. One example is Dialectical Behavior Therapy Workbook: Practical DBT Exercises for Learning Mindfulness, Interpersonal Effectiveness, Emotion Regulation, & Distress Tolerance by Matthew McKay, Jeffrey C. Wood, and Jeffrey Brantley.

         Acceptance and Commitment Therapy (ACT) is a newer approach to treating eating disorders but lacks the solid underpinning of research that anchors CBT and DBT. In ACT, a therapist might work with you on developing a deeper sense of “what really matters in life" for you, beyond just weight control. You would be challenged to take action so that you live in a way that is consistent with your core values. For example, if you value being a good student, then eating well and maintaining a healthy weight are both necessary for you to have the energy to study hard and retain information.

          One example of an ACT-focused book is The Anorexia Workbook: How to Accept Yourself, Heal Your Suffering, and Reclaim Your Life by Michelle Heffner, Georg H. Eifert, and Steven C. Hayes.

         You will notice that these approaches have much in common. They all require open and honest collaboration between you and your clinician.  Many therapists Marcia works with draw from all of these approaches, though you may notice that therapists who work at medical institutions are more likely to use one single approach.

            If nothing else, we hope this little primer has made the alphabet soup of treatment types a little less daunting.

 

Take care,

Marcia and Nancy

Comments

[Laura]

Thanks. This was interesting.