Cognitive Behavioral Therapy

Eating Disorders and Coping Skills

By Jeanne Rust, Phd

One of the most striking characteristics of anorexia nervosa is the intensity and importance of the patient's dysfunctional beliefs and values concerning her weight and shape. The patient's beliefs and values can be viewed and understood in cognitive terms.

Anorexia nervosa may be seen as a behavioral coping skill. Like all coping skills, it develops out of attempts to deal with life events. The poor coping skills that develop may include:

A few of the cognitive distortions a patient may develop are:

· fears of growing up and fears of being on one's own
· feelings of ineffectiveness, helplessness, and poor self-esteem
· disturbed or dysfunctional relationships with people close to the person

The anorexic becomes preoccupied with food and weight to distract herself from overwhelming feelings of anxiety, fear, and depression, triggered by these events. Then, the habit of food restriction and rituals become so entrenched that this set of behaviors can become split off from their original causes and exist by themselves, maintaining themselves as functionally autonomous behaviors.

The distorted beliefs, values, and behaviors or cognitive distortions of the patient are more than just symptoms and can assume primary importance in the maintenance of the eating disorder. A requirement for full recovery is to change these cognitive distortions. For this reason, Christopher Fairburn in 1981 developed a cognitive-behavioral model of treatment for anorexia nervosa and bulimia nervosa. This model utilizes behavioral interventions and formal cognitive restructuring.

A few of the cognitive distortions a patient may develop are:

• I do not need treatment. If I see a therapist or go to treatment, I will get fat.
• I am fat (even though I weigh 90 pounds).
• I am not allowed to eat anything until after 9:00PM. If I do, I will be out of control.
• Once I begin to eat normal foods, I will lose control and not be able to stop.
• If I eat any fat, it will go right to my thighs.
• I love to wear tank tops to the mall because people stare at me. I know that they are just jealous because I look so good.
• I feel more powerful when I do not eat.
• I like the way I feel when I am thin.
• I can keep people at a distance.
• I am more confident and capable when I am thin.

Many researchers have elaborated on the cognitive-behavioral model and suggested their own extensions of the cognitive-behavioral model that integrates sociocultural and biological influences which may lead to the initiation and maintenance of the habits of the anorexic. They proposed that predisposing factors were genetic and nutritional. Affective disorders such as anxiety and depression were prominent etiological factors along with family dysfunction and personality variables. Their models include obesity and binge eating. In their model, the weight gain from binge eating leads to the perception of being fat, and anorexia may develop out of extreme weight control behaviors in response to the fat perception. One prediction from the model is that anorexia is a weight phobia.

Cognitive-behavioral therapy has been thought of as the gold standard in the treatment of anorexia. It is still extremely effective but the addition of experiential and physiological therapies dramatically increases its effectiveness.

Jeanne Rust, PhD is the CEO and Founder of Mirasol, a treatment program for women with anorexia, bulimia, obesity, and binge eating disorder. Her treatment philosophy is integrative combining the best of the medical model of treatment with the most effective alternative ones.