Cognitive Behavioural Therapy (CBT) is now a widely recognised and accepted approach to recovery from a whole host of different mental health conditions. More recently there has been an increasing interest in how CBT skills may aid recovery from eating disorders. Below is a list of four key CBT tools used to promoting healthy recovery.
- challenging negative thoughts
- challenging core beliefs
- behavioral experiments
- Socratic enquiry
Challenging Negative Thoughts for Anorexia Recovery
Challenging "ANTS" or Automatic Negative Thoughts is a crucial component of CBT. Firstly, one has to be aware of the forms such thoughts take in order to recognise them. Common thinking errors include: overgeneralising (one person rejected me so the whole world will too), black and white thinking (all or nothing), catastrophizing, mind reading and personalisation.
Once one is able to recognise thinking errors, they may begin to challenge them primarily through using thought records. Thought records require the patient to write down when a ANT pops up, what they are feeling, what the triggering situation is and what thoughts were going through their mind immediately prior to feeling that way. This tool may be used to challenge the anorexic's body image disturbances as well as their distorted ideas surrounding food and weight.
Core Beliefs: Getting to the Core of the Problem for Anorexia Recovery
Challenging core beliefs is critical to help the sufferer move away from old, unhelpful beliefs and work towards creating healthier ones. Core beliefs, usually learned in childhood impact the client’s current behaviour and thinking distortions. These are basic, solid beliefs that can sometimes be misinterpreted as facts and truths.
An example of this is when a relationship fails this may confirm an ‘I’m unlovable" core belief developed in childhood through having over-critical parents. Techniques used to challenge beliefs include: pros/cons list (advantages/disadvantages of holding on to old beliefs). Also, using a continuum (where you place yourself and others relating to belief) and recording evidence to support new beliefs through the use of a "positive data log."
Behavioural Experiments: Action for Anorexia Recovery
Behavioural experiments may be used to test the validity of the anorexic's thought and beliefs. They may be used to challenge distorted ideas about exercise, diet and perfectionistic attitudes. For example, if a patient believes that by missing an exercise session they will gain weight or that failure to check body areas for fat will cause weight gain these can be challenged by working through a behavioural experiment with a therapist or coach to test whether the feared prediction is true or false.
Socratic Enquiry: Learning to Question for Anorexia Recovery
Socratic enquiry, often referred to as using "open questions" is a valuable means of getting the patient to think about their illness (especially previously dismissed issues) in a more in-depth way. For example it it is well-documented that relapse is common to eating disorder recovery. Therefore Socratic questioning could be used to help the patient comprehend why relapse awareness is vital for recovery. Beliefs common to eating disorder sufferers, such as "if I'm fat, I'm worthless" can be challenged by getting the patient to ask what evidence exists that such a belief is true and how such a belief helps or hinders recovery.
To conclude, there is strong evidence that CBT skills can certainly aid eating disorder sufferers in their recovery. These skills can be learnt through reading self-help books (there are several books available which specifically focus on CBT & eating disorders) or working with a therapist. The primary goal is that the patient eventually becomes his or her own therapist and thus continues to daily apply CBT skills to maintain a healthy recovery.
Sources:
Abraham, S. & Llewellyn-Jones, D. Eating Disorders: The Facts Oxford University Press 1997
Fairburn, C. CBT and Eating Disorders New York: Guilford Press 2008
Waller et al. CBT for Eating Disorders Cambridge Medicine 2007
Kate Le Page - Kate Henning-Le Page writes about eating disorders, body image and recovery issues. She specializes in anorexia recovery.
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