Cognitive-behavioural therapy, or CBT, is the leading evidence-based treatment for adults with eating disorders and is also adapted for use with younger patients. It is based on the theory that a person’s thoughts, emotions, and behaviours are interconnected and can be restructured to support new, healthier thoughts and actions.

Cognitive behavioural therapy provides the foundation for individual and group therapies throughout all levels of care at Dreams To Realities (DTR) Eating Disorders Clinics. DTR provide structured treatment that focuses on the present and the future.

The cognitive-behavioural model emphasises the important role that both thoughts (cognitive) and actions (behavioural) can play in maintaining an eating disorder.

Examples of maintaining factors include:

Cognitive Factors: Over-evaluation of weight and shape, negative body image, core beliefs about self-worth, negative self-evaluation, perfectionism.

Behavioural Factors: Weight-control behaviours including dietary restraint, restriction, binge-eating, purging behaviours, self-harm, body checking and body avoidance.

Individuals with eating disorders often hold a negative or distorted view of themselves and their bodies. These highly critical thoughts can result in feelings of shame, anxiety or disgust that often trigger weight control behaviours and fuel a cycle of negative self-evaluation.

Guided by a DTR trained therapist, CBT helps the individual to examine which specific factors are maintaining their disorder and to set personalised goals that are addressed throughout the various phases of CBT.

The phases of cognitive behaviour therapy:

CBT stresses education and skills training that help the patient gain a thorough understanding of themselves and their eating disorder so that healing can occur.

1. Behavioural Phase: The patient and therapist work together to formulate a plan for stabilising eating and eliminating symptoms. Because emotions often intensify during this phase of treatment, tools (coping strategies) for managing these feelings are developed and become an important part of the work. CBT includes in-session activities as well as “homework” so that new behaviours can be practised.

2. Cognitive Phase: As treatment progresses, cognitive restructuring techniques e.g. techniques aimed at recognising and changing problem thinking patterns are introduced. Thoughts and beliefs that perpetuate the problems (“I will only be happy if I can lose this weight”) are identified and work aimed at developing new perspectives and ideas (“my self-worth doesn’t depend on my size or shape”) begins. Additionally, during this stage of treatment, broader concerns such as relationship problems, body image, self-esteem problems, and emotion regulation are addressed.

3. Maintenance & Relapse Prevention Phase: The final stage of CBT concentrates on reducing triggers, preventing relapse and maintaining the progress that’s been made. Even though CBT is focused on the elimination of symptoms, the overall goal of the treatment is to assist the patient in making their return to a healthy and fulfilling life.

So, very often, once symptoms are stabilised, treatment will expand to include other areas of concern and conflict that can help individuals move towards holistic healing and emotional well-being.

CBT is an important part of the recovery process. As stated before, CBT provides the therapeutic foundation upon which each individual’s treatment is then personalised and tailored to meet specific needs. As the preferred first line of treatment for eating disorders, CBT is incorporated into all treatment modalities and levels of care with DTR.

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