The Psychology of Eating: From Healthy to Disordered Behavior

260 Treating Eating Disorders

reflected in the patient’s behavior, and the second is the formation of
dysfunctional cognitions about body weight and self-esteem. Cognitive behav-
ioral therapy (CBT) is used extensively with bulimia nervosa and addresses
the two central themes of behavior and thoughts. It has been used less widely
with anorexia nervosa. Freeman (1995) described CBT for eating disorders
in terms of a series of stages which apply to both group and individual
therapy. These are parallel to those developed by Fairburn (1985) and
Fairburn et al. (1986), and are synthesized below.

Stage 1: Assessment

The assessment stage involves taking a full history, making any physical
investigations, and excluding patients who have a marked suicidal intent
or severe physical illness. Extreme emaciation will also preclude a patient
from CBT, which may be offered once weight gain has started.

Stage 2: Introducing the cognitive and behavioral approaches

This stage addresses both the cognitive and behavioral components of
eating disorders.

The cognitive model
The therapist will describe the basics of the cognitive component of CBT.
Freeman (1995) described this in terms of the following:

• The link between thoughts and feelings


• Therapy as a collaboration between patient and therapist


• The patient as scientist and the role of experimentation


• The importance of self-monitoring


• The importance of regular measurement


• The idea of an agenda for each session set by both patient and therapist


• The idea that treatment is about learning a set of skills


• The idea that the therapist is not the expert who will teach the patient
  how to get better


• The importance of regular feedback by both patient and therapist.

The behavioral model
The therapist will describe the basics of the behavioral model in terms of
three factors: