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There is no “simple cure” for eating disorders; it’s not like prescribing medicine for an infection. Instead, treatment is a combination of medical, nutritional, and emotional therapy. If any of these components is missing, there is a strong chance that recovery will be harder to achieve. The medical aspect of treatment is essential of course, although it’s most intense at the beginning of treatment. The nutritional part is ongoing, with meal planning strategies designed for use long after treatment is over. Psychological treatment, in its many forms, is designed to process the emotions that drive a person to use disordered eating behaviors – and to address the behaviors themselves. By helping clients identify the way they think about food and eating, they can start to change those thoughts into healthier ones.

In the pursuit of eating disorder recovery, the experts at various eating disorder treatment centers have incorporated various techniques into treatment plans. In modern evidence-based programs, the results of these different methods are examined for effectiveness.The types of therapy most effective are then applied to future cases, with alterations to meet the individual’s unique medical and psychological needs.In the case ofeating disorder treatment, methods that help people change their repetitive behaviors by helping them change the way they think about food and meals are proving extremely effective.Here are some ways people in eating disorder treatment can learn to change the way they think about eating and food, and then change those behaviors.

Exposure Therapy

There is an old turn of phrase, “it’s better to show than to tell.”While talk therapy is one of the key components used ateating disorder treatment centers, in some ways, it is a theoretical exercise.That is, while lessons can be learned in aneating disorder recovery center or therapist’s office, they still need to be implemented in the real world to prove their long-term effectiveness.

That’s where exposure therapy comes into play.Frequently used in eating disorder treatment, exposure therapy consists of controlled exposure to the foods or behaviors that are being avoided.In the case ofeating disorder treatment, this can mean facing the stressors (for example, public speaking for someone with social anxiety) that cause urges to use disordered behaviors, then, under supervision, working to resist those urges. Exposure therapy has proven extremely successful in various mental health treatments including addiction treatment, OCD, and other forms of eating disorder treatment.

Exposure therapy should be begun early in eating disorder treatment, and it is best served when it becomes a daily occurrence. However, too much too soon can be traumatic. For example, a person with ARFID that compulsively avoids eating meat shouldn’t be presented with a steak on their first day of exposure therapy. A better option is to slowly incorporate small portions of the “fear food” day to day, taking time after each meal to consider and process how eating the food made the person feel. A similar exposure process can be useful for virtually any eating disorder such as anorexia nervosa, bulimia nervosa, or binge eating disorder.

Training Along the Hunger/Fullness Scale

One defining characteristic ofeating disorders is a feeling of losing control over how much /  little they eat. Disordered eating behaviors often result in great shame, self-disgust, or dissociation in the person engaging in these behaviors.This is often due to a sense of “losing control,” meaning the individual faces a compulsion to eat whether they want to or not. By training regarding mealtimes and controlled eating sessions, people ineating disorder treatment programs can employ a hunger/fullness scale to balance their meal times and sizes.

The scale is rooted in mindfulness, or the practice of being aware of one’s behavior, and teaches people in treatment to be aware of whether they are eating due to stress/compulsions or because they are actually hungry. It also puts a premium on being mindful as to how full the person is, helping them to eat regularlyat particular times and sizes, counteracting the disordered behaviors.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT), another empirically proven technique used for treatment among a wide variety of mental health disorders, is a client-therapist dynamic of guided thinking designed to isolate and negate negative thoughts and thinking patterns.For example, a person who turns tobinge-eating episodes when feeling especially depressed will work with their counselor at aneating disorder treatment center to “talk through” the feelings and thoughts of depression without engaging in a disordered behavior as a response to those feelings.CBT can be done in group settings, although it’s usually one-on-one between the client and therapist.

CBT is used across all kinds of mental health and behavioral health treatments, from substance abuse and addiction to eating disorders. As an example, a client with OCD that manifests as an eating disorder will engage in CBT, lessening the anxiety which leads to compulsive behavior likebinge eating or purging.The sessions are centered around objective self-awareness. To achieve this, the client works on mindfulness exercises that help them observe their thoughts and feelings without judging them, which is often called mindfulness training. The therapist will help them realize which thoughts are disordered by asking a series of questions and prompts to explain the feelings. Eventually, the client can come to realize that the behaviors driven by these negative emotions are causing them harm.

Sessions often continue through in-house treatment and into step-down programs. With time and practice, many individuals can perform these mindfulness practices alone, without a therapist present. Mindful mediation can help the individual objectively assess their thoughts and emotions and prevent disordered eating behaviors before they recur. CBT is effective both in the long-term and short-term, and the rational thinking lessons can be used for a lifetime.

Cognitive Processing Therapy

Developed in the late 1980s using the CBT method as its base, Cognitive Processing Therapy is a highly effective technique designed to help people process PTSD. Post-Traumatic Stress Disorder is a very potent trigger for various disordered behaviors, from substance abuse to eating disorders. This makes addressing PTSD an important foundation for continued recovery; promoting the ability to cope with negative emotions caused by PTSD helps prevent relapses after the individual has left the treatment center. The treatment consists of 12 sessions between a client and a trained therapist, usually once a week. It can be done in residential or outpatient treatment and can be done virtually, a boon in a time when in-person visits can be impossible.

CPT sessions begin with education about PTSD and trauma, aimed at helping the client understand that trauma can distort their thoughts and emotions. Moving on, the client will write about their trauma or discuss it. This can be difficult at times, but the pain will help them understand how trauma is affecting their decision-making and emotions. Later sessions include training on the part of the therapist on how to understand and react to the memories of trauma. Eventually, the new ways of thinking about past trauma replace the disordered ones, and trauma response becomes more manageable.

Dialectical Behavior Therapy

Another offshoot of CBT, Dialectical Behavior Therapy (DBT) was originally intended to help people with borderline personality disorder. DBT is useful for other behavioral health issues as well, especially eating disorders. It focuses on emotional regulation, interpersonal relationships, distress tolerance, and impulse control. DBT is useful in counteracting triggers for disordered eating behaviors. For example, a common method taught by DBT when a person is faced with an urge to restrict food is to do the opposite – in this case, have a snack. It’s often a long and arduous process to be able to accomplish this, but with support and practice, permanent behavior modification is possible.

Distress tolerance is also a central component of DBT. It helps people resist triggers for relapse. In practice, there are several techniques that can achieve this goal. These include distraction, improving the moment, self-soothing, and thinking of the pros and cons of not tolerating distress. By using one or more of these techniques when the urge to engage in disordered behaviors is strong, people can gradually replace their disorder coping mechanisms with healthier alternatives.

Interpersonal effectiveness is the last component of DBT. Many people with eating disorders feel stress in their personal relationships which can cause or be caused by their eating disorder. DBT teaches individuals how to improve their interpersonal skills to reduce that difficulty and lower relation-related stress. GIVE, an acronym for Gentle, Interest, Validate, Easy, is a prime example of this. By practicing keeping the principles of gentleness, expressing interest in what the other person is saying, validating their feelings, and keeping an easygoing, positive demeanor, individuals can reduce the stress in their relationships, removing a powerful trigger for disordered eating.

Getting Help Is Vital

Any eating disorder can lead to serious complications if it goes on without empatheticeating disorder treatment.These can include gastrointestinal problems, an increased risk of suicide and self-harm, and various other health concerns.The positive news is that there are eating disorder treatment centers available to provide positive thought/behavior training.If you or a loved one is experiencing eating disorder symptoms or simply wants to talk, reach out today and begin the path to a recovered lifestyle.


Melissa Spann, PhD, LMHC, CEDS-S

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.