Cognitive Behavioral Therapy, or “CBT” is a method of treatment therapy that focuses on examining the relationships between a patient’s thoughts, feelings, and behaviors. The key is to uncover the thoughts and feelings that lead to self-destructive or otherwise harmful behavior. In doing so, work in therapy can center on addressing these core beliefs so that the outcome, or end behavior, is modified. For example, if a person feels depressed and thinks “I am worthless” then he or she might engage in cutting, bingeing and purging, or isolative behavior as a result. Work in therapy will start with the feelings and thoughts instead of simply trying to put a stop to the harmful action. If the therapist and patient together can alter the thought from “I am worthless” to “I am worthwhile” then a chain reaction is created that encourages the patient to participate in positive, healing behaviors as opposed to self-destructive ones.
A person who seeks help from a CBT therapist can expect a very active experience both in and out of a session. This means being pushed to challenge the core thoughts and beliefs, or “automatic thoughts,” practicing acting based on alternative thought patterns, and completing homework assignments between appointments.
Cognitive behavioral therapy has been shown to be as effective as anti-depressants for some individuals, and even changes brain activity in people with mental illness. This suggests that the brain itself will actually improve as a result of participating in CBT. It is used to treat a wide range of issues, including depression, anxiety, and phobias.
Studies have shown CBT to be quite effective when used with eating disorder patients, particularly those with bulimia nervosa or binge eating disorder. In fact, cognitive behavioral therapy is said to be more effective for these disorders than any other form of talk therapy. In one study, 37% of people completely abstained from bingeing after receiving CBT that focused on the disorder. Other therapies show less promising results. One alternative, dubbed interpersonal therapy, did demonstrate similar results, but it took a much longer time to get there. Cynthia Bulik, PhD., director of the University of North Carolina Eating Disorder Program at Chapel Hill, said, “CBT is associated with the best outcome for bulimia nervosa.”
Because this type of therapy was initially formulated to treat depression, eating disorder patients who participate in CBT tend to experience a marked improvement in mood. This finding is especially important considering the number of patients who suffer from eating disorders and mood disorders, such as depression. Sometimes the eating disorder can cause problems in mood as well. It is not uncommon for people who binge and purge to feel guilty or anxious about the behavior, so the potential for CBT to improve these feelings is particularly helpful. CBT can also help the patient to implement positive actions that can help break the cycle of eating disordered behaviors, such as avoiding skipping meals or talking to others about triggering topics, such as weight or food.
One study measured outcomes among patients with either bulimia nervosa or eating disorder not otherwise specified (ED-NOS). Both groups showed clinically significant improvement at both the 20 week and 60 week follow up. Specifically, 39% of participants reported NO episodes of bingeing or purging over the previous 28 days, and at the 60 week follow up that number was 46%. Furthermore, an exploratory analysis showed a correlation between the psychopathology of the patient and the type of CBT employed. For patients with co-morbid disorders or more complex cases, a broader form of cognitive behavioral therapy that also addressed these other issues was more successful, while utilizing this broad method with patients who only had eating disorders had the opposite effect. For these patients, a more focused form of CBT was found to have the best results. For the therapist, the obvious recommendation is to understand the full extent of a patient’s profile before making a decision about how to execute the therapy. For patients, this means that regardless of complexity or psychiatric diagnosis, cognitive behavioral therapy can have promising results, more so than any other type of talk therapy.