Eating disorders and cognitive behavioural therapy


Ones behaviour often concerns how to deal with food, how to control the food intake, ones weight and shape. There are several types of eating disorders: binge eating disorder, anorexia nervosa, bulimia nervosa and other specified feeding or eating disorders (OSFED). In order to develop an eating disorder, one has to have a biological predisposition. When a predisposed person starves themselves, changes related to serotonin level and cerebral blood flow in the brain occurs. Eating disorders can often come together with anxiety and depression, and one often have difficulties with sleeping and focusing. In women, it is also normal to lose the periods as well.

Cognitive behavioural therapy (CBT), a therapy form that is very common to use for a range of mental conditions, such as addiction, depression and phobias.
It is also the primary evidence-based treatment for eating disorders through gain of self-control, avoid triggering factors and developing appropriate stress coping mechanisms. CBT is one of the most explored forms of therapy, as the treatment focuses on concrete goals and has easily measurable results.


What are the benefits of the CBT-method?

Cognitive behavioural therapy is a psychotherapeutic method. It used to teach people how to recognise and alter destructive and disturbing thought patterns that has an unfavourable influence on emotions and behaviour.

CBT-treatment aims to change the focus of the negative thoughts, that leads to difficulties, anxiety and depression. This also greatly impacts the mood negatively. The negative thoughts are identified, challenged and substituted by more realistic and objective thoughts. Different types of techniques used to overcome negative thoughts are journaling, role-playing, relaxation-methods and mental distractions. The CBT goes typically through different sub-subjects such as:

Benefits of the CBT-method
The patient learns to create a healthier thinking pattern.

One focuses on being conscious of the negative and unrealistic thoughts that affects your mood and emotions in negatively

The treatment is time-effective

One can notice improvement after five to 20 sessions

The treatment tends to be more affordable

It tends to be more affordable, compared to other psychological treatments methods

The method tend work well both for in-person consultations, as well as online consultations
It is a therapy form that is very helpful for people who does not use psychotropic medications
CBT and Eating Disorders

The cognitive model supposes that the main problem in an eating disorder concerns either body weight or body shape. Commonly this can lead to binge eating, purging, low weight or restrictive dieting. These behaviours can also go hand-in-hand e.g. restrictive dieting can lead to declined weight, which can further lead to binge eating.

The leading treatment for eating disorders is the cognitive-behavioural therapy helping to maintaining psychological distress. The sessions emphasise on the interaction and collaboration between the client/patient and the therapist.

The approach was developed in the 70s and has been successfully used for different types of eating disorders. An updated version called “Enhanced Cognitive Behavioural Therapy” covering a wider spectre including low self-esteem and perfectionism was published in 2008.

A 20-weeks program of 50 minutes per session can be very effectful in treating eating disorders . (In certain cases, one might need 40 weeks or more for treatment). Further, this type of method has proven to be cost effective for clients/patients having bulimia nervosa. During the sessions the patients are weighed, homeworks are evaluated, skills are taught to cope with hard situations and for problem-solving.


CBT-treatment for people with eating disorders could typically go through following scenarios:

  • Challenge dietary rules. Confront and identify dietary restrictions, such as eat after 20h or eat breakfast.

  • Write a food diary. Maintain a food diary, which includes sensations/emotions, thoughts and behaviour after the meal.

  • Change of behaviour. Develop a thinking technique to change the all-or-nothing attitude.

  • Change strategies. Develop strategies to avoid/delay binge eating or compensatory methods.

  • Fear of food. Expose the patient/client to the food despaired, after regular eating is established. They can then gradually introduce the foods they fear.

  • Meal planning. Plan meals in advance, thus the client/patient can know when and what one should eat. It is also a good idea to find some “safe foods” or “go-to foods” that one can choose, when feeling unsure or overwhelmed.

  • Behavioural experiment. If a person thinks that one will gain 3 kg by eating a piece of cake, challenge the person to eat the cake and observe if the weight gain will follow.

  • Prevent relapses. Go through the potential obstacles that the client/patient are likely to experience. Then, find techniques on how one can handle these challenges to avoid a relapse.

What are the challenges we might face through the CBT-approach?

  • Changing our behaviour can be difficult. Even though we can manage to identify and acknowledge certain negative thoughts, still can make it challenging and time consuming to change them.

  • It is a very structured approach. The therapy is more suitable for a structured audience and might therefore be more difficult for certain personalities to adapt to.

  • The motivation for change has to be present. It is essential that the patients/clients spend time and effort to evaluate their emotions and thoughts, even though they might find it challenging and hard. If the patient/client does not want or feel the need to change, the chances are higher that it will not be a sustainable behavioural change.

  • It is a gradual process that ultimately shows a great progress. The approach is based on a stepwise method towards behavioural changes, by starting with small changes that leads towards a bigger goal. It is less overwhelming for the patient/client, when we set smaller goals towards the end goal.
So, how do you get started?
  • Contact your doctor, can he/she refer you to someone that would suit you?
  • Would you prefer online or consultations in person?
  • Check with your health insurance, and find out if they cover this treatment
  • The initial consultation is often an opportunity to get to know one another
  • Come prepared and be ready to answer questions.

If you need more information or would like to speak to someone before you talk to you doctor, please feel free to contact our coaches on Our coaches are also able to advice you on your next steps and evaluate the right treatment for you.

written by Henriette Saevil – Clinical Nutritionist

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