The Psychology of Eating: From Healthy to Disordered Behavior

Treating Eating Disorders 261

• Breaking the cycle: A discussion will be held concerning the cycle of
  dieting and bingeing, the psychological triggers to bingeing, the importance
  of eating regularly and frequently, and the cycle of purging and bingeing.


• Principles of normal eating: This involves a discussion of the nature of
  healthy eating, the importance of regular meals, the role of eating in
  company, planning meals, reducing weighing, and using distraction.


• Diary keeping: Diary keeping and self-monitoring is central to the CBT
  approach. This can be used to record food eaten and the time and place
  of any binges, and to monitor mood and feelings of control.

Stage 3: Cognitive restructuring techniques

Central to a cognitive behavioral approach to eating disorders is the role
of dysfunctional cognitions. These take the form of automatic thoughts and
automatic schemata. Cognitive restructuring addresses these cognitions. This
involves the following:

• Explaining that “automatic thoughts” are automatic, frequent, and
  believed to be true by the patient, and can influence mood and behavior.
  An example is “If I cannot stick to my diet, I am a complete failure.”


• Helping the patient to catch and record her thoughts in her diary.


• Challenging these thoughts and replacing them with more helpful
  ones. This involves the therapist asking “Socratic questions” such as “What
  evidence do you have to support your thoughts?” and “How would
  someone else view this situation?” The therapist can use role play and
  role reversal.


• Introducing the concept of automatic schemata, which refers to deeper
  layers of thinking around themes such as control, perfectionism, self-
  indulgence, and guilt.


• Challenging the basic automatic schemata using role play and Socratic
  questions.

Stage 4: Relapse prevention

This stage involves emphasizing that the skills learned during therapy can
be used when therapy has finished, and that if relapse should happen the
patient now has new skills to manage it. Further, in line with Marlatt and
Gordon’s model of relapse prevention (1985), the patients are taught to
expect relapse and to plan for it by developing effective coping strategies.