Cognitive Behavioural Therapy

What is CBT?

Cognitive behavioural therapy (CBT) is a talking therapy that focuses on your thinking (cognitions), your behaviours (what you do in response to certain thoughts), and your emotions (how you feel in response to certain thoughts). The premise behind CBT is that these negative thoughts, emotions and unhelpful behaviours all feed into each other, and can leave you trapped in a downward spiral. CBT is designed to give you the skills to break out of this vicious cycle.

There are two main types of cognitive behavioural therapy for eating disorders: cognitive behavioural therapy-enhanced (CBT-E) and cognitive behavioural therapy for avoidant/restrictive food intake disorder (CBT-AR). CBT-E is the current leading treatment for adults with eating disorders.

How does CBT work?

People often fall into unhelpful patterns in their thinking (e.g. “I am not good enough” or “If I were thinner I’d be more successful”). These thoughts can feed into negative emotions (feeling low, anxious or frustrated) or into unhelpful behaviours (e.g. cancelling plans with friends, over-working, or trying to restrict food intake). CBT helps people to recognise their unhelpful or negative thinking, see the patterns in their behaviours, and develop healthy strategies and skills to challenge or cope with their unhelpful thoughts.

What does CBT-E involve?

CBT-E isn’t a “one-size-fits-all” treatment but a  highly individualised treatment. The therapist and client will collaboratively develop a joint understanding of a person’s eating difficulties and what treatment will need to focus on in order to resolve these difficulties and to maintain recovery post treatment. There are a wide number of strategies and techniques used within CBT-E and it is considered a structured, skills-based, here-and-now approach; providing people with education, skills and strategies to enable them to maintain recovery without the need for ongoing support.

CBT-E is different from generic CBT as there is an increased focus on thoughts and feelings about eating, weight and shape, and a lot of education targeted at changing a person’s beliefs about food and the body. Additional tools might include completing food diaries, doing therapeutic weigh-ins to challenge beliefs about weight, and working on body image.

Whilst CBT typically focusses on the here-and-now, it is possible to explore how and where difficulties arose and to work on underlying issues using a longitudinal CBT approach.