Psychotherapy Treatments for Eating Disorders

Often a part of a broader treatment plan, psychotherapy for eating disorders helps individuals address emotional and psychological factors behind disordered eating. Techniques and insights gained from cognitive behavioral therapy dialectical behavior therapy, exposure and response prevention and family-based treatment aim to improve body image, self-esteem and coping skills.

Psychotherapy in Eating Disorder Treatment

Eating disorders compromise the ability to get nutrition, negatively impacting eve ry single organ system. Eating disorders also have far-reaching emotional impacts, affecting all areas of life. Individuals with eating disorders often suffer from low self-esteem and distance themselves from their loved ones. Eating disorders also co-occur alongside many other psychiatric conditions (dual diagnosis), which can worsen symptoms and feelings of isolation.¹

Psychotherapy, also known as counseling or talk therapy, is a central treatment for those with eating disorders. Psychotherapy is a type of treatment that helps people identify and change thoughts and behaviors and has been shown to have value for patients across a spectrum of psychiatric disorders.²

Benefits of psychotherapy

Research continually shows that most people – about 75% – who receive psychotherapy experience some symptom relief and are better able to function in their lives.³ Psychotherapy has also been shown to improve emotional and psychological wellbeing.²

While psychotherapy is often used to treat psychiatric conditions, it can also help individuals in all areas of life, including coping with stressful life events, the impact of trauma, medical illness or grief.

Effective Eating Disorder Psychotherapies

There are numerous types of psychotherapy used to treat eating disorders, with some showing stronger clinical evidence than others. It’s common for therapists to use more than one form of psychotherapy throughout treatment, especially if a patient has been diagnosed with multiple conditions.

Cognitive behavioral therapy

Cognitive behavioral therapy (CBT) is a first-line treatment for eating disorders, such as:⁴

• Bulimia nervosa
• Binge eating disorder (BED
• Other specified feeding and eating disorders (OSFED)

CBT is a form of psychotherapy that focuses on challenging and changing cognitive distortions and their associated behaviors. CBT can help individuals:

• Improve emotional regulation
• Develop effective coping mechanisms
• Build awareness of inaccurate and/or negative patterns of thinking
• View challenging situations more clearly
• Respond to challenges in a more effective way
• Develop more realistic and positive thought processes
• Improve functioning and quality of life

While standard CBT is often utilized, other forms of cognitive and behavioral therapy are often employed, such as acceptance and commitment therapy (ACT) and dialectical behavior therapy (DBT).

Enhanced cognitive behavioral therapy (CBT-E)

Enhanced Cognitive Behavioral Therapy (CBT-E) is a form of CBT especially designed for eating problems and disorders. It differs from standard CBT because it is based on and aims to address psychological and behavioral mechanisms specific to eating disorders.

Dialectical behavioral therapy

Dialectical behavioral therapy (DBT) can be used to address eating disorders and other conditions. DBT is a form of psychotherapy that focuses on mindfulness, interpersonal relationships, distress tolerance and emotional regulation. It is especially helpful for those that feel emotions very intensely.

Dialectical behavioral therapy is also frequently used to treat common co-occurring conditions:

• Borderline personality disorder
• Substance use disorder

Radically open dialectical behavioral therapy

Radically open dialectical behavioral therapy (RO-DBT) is a form of DBT designed to address a spectrum of difficult-to-treat disorders with features associated with maladaptive over-control, like:⁴

• Anorexia nervosa
• Chronic depression
• Obsessive-compulsive personality disorder

Acceptance and commitment therapy

Acceptance and commitment therapy (ACT) is another effective, evidence-based form of psychotherapy.⁵ ACT aims to develop psychological flexibility instead of avoiding, eliminating or suppressing undesirable experiences like pain, grief, disappointment, illness and anxiety.

ACT encourages increased commitment to healthy, constructive activities that uphold your values or goals. It differs from other forms of psychotherapy, like CBT, whose goal is to reduce the frequency or severity of internal experiences.

ACT encourages detachment from emotions and learning that pain and anxiety are a normal part of living an authentic life. Through living authentically, many patients find they start to feel more confident in their recovery and can better resist eating disorders thoughts and behaviors.

Acceptance and commitment therapy can be used to treat a variety of other co-occurring conditions as well, including:

• Depression
• Anxiety disorders
• Substance use disorder

Family-based treatment

Family-based treatment (FBT) is one of the most successful treatments for eating disorders in children and teens.⁶ Also known as the Maudsley Method or Maudsley Approach, this home-based treatment approach places parents and caregivers at the center of eating disorder treatment.

FBT focuses on bringing the effective interventions used in higher-level care settings into the home, where parents can be agents of change. With love, care and knowledge, families are encouraged to shape these interventions in a way that works for them and respects the uniqueness of their family and child.

Treatment consists of re-establishing healthy eating, restoring weight, interrupting compensatory behaviors and returning control of eating back to the child.

Exposure and response prevention

ERP has been shown some efficacy with eating disorders and may be particularly useful for patients with avoidant restrictive food intake disorder (ARFID) who experience fear-based reactions to certain types of foods.⁷

ERP is a behavioral therapy originally designed to treat obsessive-compulsive disorder, that gradually exposes people to situations designed to provoke a person’s trigger in a safe environment.

Patients gradually confront situations, images, objects and thoughts that cause anxiety or trigger obsessions and challenge themselves not to perform compulsions in response. In the context of eating disorders, this may mean not restricting, purging or exercising when being confronted with or doing something that triggers disordered eating thoughts.

Over time, these incremental exposures help individuals confront their fears and to develop more helpful responses.

Cognitive remediation therapy

Cognitive remediation therapy (CRT) is a behavioral intervention targeting problems with cognition to ultimately improve day-to-day function. For individuals with eating disorders, this may involve improving cognitive flexibility and central coherence.

While CRT can help patients modify their thought processes, it is not as well studied as other psychotherapeutic interventions for eating disorders. It has only been studied in patients with anorexia nervosa and is considered a supplement to other forms of psychotherapy.^8,9

Cognitive remediation therapy can also be used to help those with other frequently co-occurring conditions, including:

• Bipolar disorder
• Depression
• Autism
• ADHD
• Anxiety disorders

Integrated cognitive affective therapy

Integrated cognitive affective therapy (ICAT) is associated with significant improvements in bulimic and associated symptoms.^10,11

ICAT is a psychotherapy therapy treatment for those with bulimia nervosa and binge eating disorder (BED). ICAT combines a focus on the cognitive issues addressed in CBT-E and a variety of emotional and interpersonal factors.

ICAT helps patients identify and understand the emotional reactions that elicit binging, purging and compensatory behaviors. It encourages individuals to develop alternative coping mechanisms and ultimately help reduce disordered eating behaviors.

Interpersonal psychotherapy

Interpersonal psychotherapy (IPT) is an evidence-based treatment that focuses on improving relationships to relieve mental health symptoms. IPT explores how interpersonal dynamics play a key role in mediating different psychiatric conditions.

For eating disorders, traumatic or adverse experiences, family values and dynamics and peer feedback can all be interpersonal contributors to the development and maintenance of an eating disorder.

Interpersonal psychotherapy helps patients work on their interpersonal effectiveness skills and improve relationship dynamics so they can be a force to uplift their recovery rather than work against it.

Getting Therapy for an Eating Disorder

Getting therapy for an eating disorder is important no matter how long you’ve been struggling; healing is possible at every stage. Compassionate psychological support can help you untangle deeply rooted patterns, rebuild trust in yourself and move toward a more peaceful relationship with food and your body.

References

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2. American Psychological Association. (2013). Recognition of psychotherapy effectiveness. Psychotherapy, 50(1), 102–109. https://doi.org/10.1037/a0030276
3. Ching, J., Londoño-McConnell, A., Ducharme, E., Gock, T., Lonning, B., Molitor, N., Polowczyk, D., & Ritz, M. (2023, December). Understanding psychotherapy and how it works. apa.org. https://www.apa.org/topics/psychotherapy/understanding
4. Kaidesoja, M., Cooper, Z., & Fordham, B. (2023). Cognitive behavioral therapy for eating disorders: A map of the systematic review evidence base. The International journal of eating disorders, 56(2), 295–313. https://doi.org/10.1002/eat.23831
5. Gloster, A. T., Walder, N., Levin, M. E., Twohig, M. P., & Karekla, M. (2020). The empirical status of acceptance and commitment therapy: A review of meta-analyses. Journal of Contextual Behavioral Science, 18, 181–192. https://doi.org/10.1016/j.jcbs.2020.09.009
6. Gorrell, S., Loeb, K. L., & Le Grange, D. (2019). Family-based Treatment of Eating Disorders: A Narrative Review. The Psychiatric clinics of North America, 42(2), 193–204. https://doi.org/10.1016/j.psc.2019.01.004
7. Butler, R. M., & Heimberg, R. G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical psychology review, 78, 101851. https://doi.org/10.1016/j.cpr.2020.101851
8. Tchanturia, K., Giombini, L., Leppanen, J., & Kinnaird, E. (2017). Evidence for Cognitive Remediation Therapy in Young People with Anorexia Nervosa: Systematic Review and Meta-analysis of the Literature. European eating disorders review: the journal of the Eating Disorders Association, 25(4), 227–236. https://doi.org/10.1002/erv.2522
9. Rhind, C., Mahdi, M., Simic, M., Espie, J., & Tchanturia, K. (2022). Group cognitive remediation therapy for children and adolescents in intensive day-patient treatment for anorexia nervosa: a feasibility study. Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Osterreichischer Nervenarzte und Psychiater, 36(3), 125–135. https://doi.org/10.1007/s40211-022-00420-5
10. Wonderlich, S. A., Peterson, C. B., Crosby, R. D., Smith, T. L., Klein, M. H., Mitchell, J. E., & Crow, S. J. (2014). A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa. Psychological medicine, 44(3), 543–553. https://doi.org/10.1017/S0033291713001098
11. Lebow, J., Sim, L., Wonderlich, S., & Peterson, C. B. (2023). Adapting integrative cognitive-affective therapy for adolescents with full and subthreshold bulimia nervosa: A feasibility study. European eating disorders review: the journal of the Eating Disorders Association, 31(1), 178–187. https://doi.org/10.1002/erv.2946