Cognitive Behavioral Therapy for Bulimia Nervosa

Status: Strong Research Support


Cognitive Behavioral Therapy (CBT) for bulimia nervosa directly targets the core features of this disorder, namely binge eating, inappropriate compensatory behaviors, and excessive concern with body shape and weight. This treatment focuses on how these symptoms cycle to perpetuate themselves in the present, as opposed to why they originally developed in the past. CBT for bulimia nervosa is conducted in approximately twenty weekly sessions, which encompass three phases. The first phase includes psychoeducation regarding weight and the adverse physiological effects of binge eating, purging, and extreme dieting, and helps the patient establish a regular pattern of eating and an appropriate weight monitoring schedule. In the second phase, the focus shifts to reducing shape and weight concerns and dieting behavior, and identifying precipitants to any remaining binge-purge episodes. The third phase is devoted to maintenance planning and the prevention of relapse in the future. In CBT, the therapist works collaboratively with the patient to disrupt the factors maintaining the binge-purge cycle with the goal to achieve abstinence from these behaviors. This treatment is typically administered individually, but it can be delivered in group format. Therapists can also guide patients in a self-help version of CBT for bulimia nervosa. CBT has the strongest scientific evidence of all the tested psychological treatments for bulimia nervosa. An enhanced version of CBT has recently been developed and tested at Oxford University to treat the spectrum of eating disorders, including bulimia nervosa.

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