Anorexia nervosa is an eating disorder, characterised by a preoccupation with body image, shape and weight; excessive weighing and body measuring; distorted eating and weight loss behaviours; and a lack of regard for the consequences of being underweight. The National Institute for Health and Care Excellence (NICE) recommends that Cognitive Behavioural Therapy (CBT) is one of the most effective psychological treatments for anorexia. We asked RSCPP therapist and eating disorder expert Beverley Marais to explain what CBT is, and how it can be used to treat anorexia nervosa.
CBT explores the distorted or maladaptive meanings and interpretations you make of the various situations in your life, which lead you to experience negative emotions and then engage in unhelpful behaviours. It helps you to identify this cycle and the function of the unhelpful behaviours, and formulate an understanding of how these emerged throughout your life. CBT involves identifying and challenging negative thoughts, and experimenting with changing disruptive behaviours, whilst learning to tolerate, at times, uncomfortable feelings. The outcome can be an increased self-efficacy and control within situations, events or relationships.
CBT, when applied to anorexia, views the eating disorder symptoms maintaining your anorexia as the result of an overvaluation of the importance of controlling shape, weight and eating. There is a relationship between how you think about your body, weight and shape, and how you behave, which controls your eating and your weight. Low self esteem, amongst other personality traits and characteristics, can predispose you to become more easily influenced by social media and societal ideals about being thin. A belief is formed, which associates thinness with positive regard and success. This dysfunctional belief is what prompts you to severely restrict your eating in order to control your weight. The psychological impact of starvation reinforces these cognitive disturbances and, over time, you become almost completely preoccupied with eating, weight and shape. CBT for anorexia would include psychoeducation about the physical and biological factors that may be contributing to your vulnerability. Therapeutic focus would lie on the core features perpetuating the disorder, such as emotional regulation, interpersonal relationships, dysfunctional beliefs, and addressing motivation to change, in addition to addressing disturbances in your thoughts and behaviours.
The NICE guidelines recommend outpatient treatment up to approximately 6 months. This is variable, depending on your levels of motivation to change, the severity of the illness, as well as whether you have other, complex mental health needs.
CBT is suitable for you if you are either contemplating change or ready to make changes to your eating and preoccupation with body, shape and weight.
There is limited evidence for CBT in the treatment of low weight anorexics. More encouraging research outcomes have been noted in individuals who have restored their weight, and these results view CBT as effective in preventing relapse and improving rates of recovery.
All therapists on rscpp.co.uk are accredited, registered or chartered by a UK professional body. Therapists who offer Cognitive Behavioural Therapy will in addition have completed training in cognitive behavioural practice.