Don’t Lose Sight of What Works in Eating Disorder Treatment: Part I

All the changes in the eating disorder treatment field distract clinicians from the basic, most effective ways to help people with eating disorders. While access to care and outcomes matter, all those in the field still need to rely on therapy approaches that work.

With that in mind, I think it’s worth revisiting the tried and true ways to treat people with eating disorders lest we forget what types of therapy really help people get well.

Any type of binge eating disorder, including Bulimia Nervosa, Binge Eating Disorder, Compulsive Overeating and Night Eating, responds best to Cognitive Behavioral Therapy (CBT). The first studies that proved how effective CBT is for these disorders were in the 90’s, and nothing developed since is more helpful.

CBT entails writing a detailed log each day of what one eats, whether or not the eating is disordered and, most importantly, the thoughts and feelings around each time one eats.

The log is the centerpiece of the treatment. Assessing the log each session unearths a multitude of critical information about the eating disorder and charts a path to recovery.

First, looking in detail through a day can reveal what thoughts, behaviors and feelings foreshadow a binge. The most likely causes are undereating through the day, emotional triggers or situational triggers. Even though patterns of eating that lead to binges are often similar, each person learns how their individual eating disorder works.

All this new information makes clear the options to circumvent binges. Adding food at certain times of day or acting on feelings in advance are the most common examples of what can change the course of the day. Each step forward empowers the person to see they are not trapped in the binge cycle indefinitely.

Once the eating pattern normalizes, CBT gradually transitions towards the working in new thoughts and feelings around each meal as binging subsides and in everyday life. The therapy can both curtail binging while assessing what someone needs to face other parts of life without returning to the eating disorder. Awareness of thoughts and feelings enables people to learn about themselves and how to cope in new ways.

The path of recovery may seem straightforward from the above summary, but there are always ups and downs in eating disorder recovery. CBT gives a direct route to getting well and makes clear the steps to get there.

All clinicians in the eating disorder field need to remember that CBT works for any binge or overeating disorder and not get distracted by all the new programs. The focus needs to be on helping people get well.