The Psychology of Eating: From Healthy to Disordered Behavior

Treating Eating Disorders 263

had fewer relapses, had fewer readmissions, showed a more stable weight
pattern, and reported better social functioning. This could indicate the
effectiveness of CBT for anorexia. However, Freeman (1995) argued that
“so many other factors were involved in the treatment packages that formal
CBT may have been irrelevant” (p. 329). Bulik et al. (2007) carried out a
systematic review of the evidence for the treatment of AN using a number
of different treatment approaches, including CBT and medication. They
searched the databases for RCTs from 1980 to 2005 and identified 32 studies
that met their inclusion criteria. The conclusions from this review were not
as clear as those from the review for BN described above. In particular,
although they reported that CBT may reduce weight loss after weight restora-
tion, the evidence for its use for those patients with AN who are still under-
weight remains unknown. Overall, they concluded that sample sizes are too
small, outcome measures are not standardized, and dropout rates are high,
making clear conclusions about the effectiveness of CBT for AN impossible
to make.

Problems with CBT for eating disorders

The problems with CBT for eating disorders are as follows:

• Although it works well for bulimia, it requires major changes before it
  can be applied to anorexia nervosa.


• CBT requires patients to be motivated to change and to engage actively
  in therapy by keeping diaries and providing feedback. Anorexic patients
  may be being treated against their will and may be poorly motivated.


• For anorexics, their emaciation is seen as the solution to their problems.
  A therapist who is attempting to facilitate eating and weight gain can
  be seen as another problem, not a solution.


• Anorexics have the automatic schemata addressed by CBT, but they may
  be so entrenched that the use of Socratic questions may not shift them.


• CBT does not address the role of family relationships and the impact
  of such relationships on current functioning to the same extent as
  psychoanalytic psychotherapy.

In summary, cognitive behavioral therapy addresses both the patient’s
cognitions through cognitive restructuring, and their behavior through the
use of self-monitoring and information. It is assumed that changed cogni-
tions will result in a subsequent change in behavior. It is also believed that