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Looking at the Various Kinds of Therapy Used in Eating Disorder Treatment

There’s no simple panacea for treating eating disorders. To make a complete recovery, several disciplines and types of treatment are needed.  This can include a combination of therapy, in some rare cases, medication, and education. Because of the variety of various treatments available, the types are used will depend on the eating disorder a person has and each person’s specific needs and goals. Eating disorder treatment centers perform an assessment when their client first comes into the facility, and plan their treatment program accordingly. The following are several types of the most prominent therapies used to treat eating disorders.

Psychotherapy and Interpersonal Education

In traditional talk therapy, a person works with a therapist to target problems in the individual’s life such as significant life changes, addressing negative or distorted emotions, or conflicts with other people. Troubled relationships and the emotions that surround them are frequent triggers for disordered eating behaviors, so interpersonal therapy is often a part of a comprehensive program, and traditional talk therapy is a given at any eating disorder treatment center.

Intensive talk therapy usually will last three or four months. It can last much longer, however, depending on the person’s needs. Although talk therapy has various uses, it can be a bit generalized, and specific types of therapy may be needed that can focus on a specific area of improvement.The focus on building and repairing healthy relationships fostered by interpersonal therapy can help the client learn skills for relating to other people and improve communication. These changes, in turn, help a person successfully recover from an eating disorder.

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) was originally developed for treating mental health disorders like depression and bipolar disorder, and it has been proven to be equally effective for the treatment of eating disorders. In simplest terms, CBT is a kind of talk therapy that promotes mindfulness and objectivity through a Socratic dialectic process. This type of therapy is often used because it can help people quickly identify and learn to cope with challenges in their lives. According to the American Psychological Association, here are the core principles of CBT:

  • Problems or conditions are based, at least in part, on unhelpful or negative thinking patterns. Identifying and sharing thoughts about an individual’s problems is a major part of CBT.
  • Problems or conditions are based, at least in part, on patterns of negative behavior. It’s necessary to reshape ways of thinking that will eventually change behavior.
  • CBT provides better ways of thinking, and ultimately of coping. This can lead to the successful treatment of everything from depression and anxiety to a variety of eating disorders.

The core of CBT is helping an individual identify which of their thought patterns are disordered or distorted, remaining objective and non-judgmental about them. Eventually, these thoughts can be replaced with more positive ones. CBTexperts will work with individuals to help them discover ways to treat their condition that is catered to their specific needs. CBT is effective for people with a wide variety of mental health disorders, and there is generally no risk involved, although the process, even with a gentle therapist can be difficult at first.

Dialectical Behavioral Therapy

This type of therapy is a modified form of CBT that is helpful in a talk therapy milieu as well as being an effective improvement tool for socialization. Dialectical Behavioral Therapy (DBT) builds on the principles practiced in CBT. DBT is especially useful for people with especially strong emotions or who are prone to extreme mood swings. It’s one of the few therapies found to be useful with borderline personality disorder. There are four specific areas of emphasis in DBT.

  • Mindfulness – Observation, description, and participation are all aspects of mindfulness. St. Catherine University describes mindfulness strategies as purposeful observation, paced breathing, and self-soothing.
  • Interpersonal Effectiveness – This part of therapy emphasizes personal relationships and interactions with other people.
  • Distress Tolerance – This is a unique approach to stress in that it focuses on accepting and learning to tolerate stressful situations.
  • Emotion Regulation – Identifying and controlling emotions is a key component of DBT.

Dialectical Behavioral Therapy also differs from CBT in one important way; DBT usually requires both individual and group therapy every week. During group therapy, the clients can benefit from the catharsis of discussing shared experiences. The skills fostered by DBT include distress tolerance, interpersonal effectiveness, mindfulness skills, and emotion regulation. Group therapy provides a supportive and safe environment to practice these types of skills, making DBT an increasingly effective tool for the treatment of eating disorders.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) is less clinical than CBT and DBT but is equally as effective when it comes to mindfulness and self-acceptance. One of the key components of this type of therapy is for an individual to learn how to cease self-denial and self-judgment about their disordered or negative emotions. People learn to accept that their feelings are, in some circumstances, appropriate responses. The goal is for individuals to accept that these feelings are valid, and to hold space for that validity – without resorting to destructive behaviors to compensate for them. According to Good Therapy, there are several core processes involved in ACT:

  • Acceptance – This means allowing unpleasant thoughts and experiences to exist without trying to alter or change them.
  • Being Present – This means living in the moment without trying to change the experience or predict what will happen next.
  • Self as Context – This means that people can find themselves outside of the current experience.
  • Values – Individuals will try to work toward and live out the values that are important to them.
  • Committed Action – The person will commit to living their values daily.

Being able to relate to different events and ideas is a primary concept in Acceptance and Commitment Therapy. ACT is used to treat, depression and anxiety as well as eating disorders.

Nutritional Therapy

Nothing is more central to a successful long-term recovery from eating disorders than nutritional education and training. Nutritional therapy is almost always used in conjunction with other types of psychotherapy in eating disorder treatment centers. Most eating disorder treatment centers keep a staff of nutritionists and dieticians on hand to teach their clients about the importance of proper nutrition and how to achieve it. These professionals can help individuals rebuild their relationships with food and eating. The National Eating Disorders Association (NEDA) states that treatment goals for both Anorexia Nervosa and Bulimia Nervosa include developing a positive, or at least neutral relationship with food.

Occasionally, when someone enters a residential eating disorder facility there are medical and physical issues that need nutritional attention as well. These could include establishing correct blood-sugar levels and regulating blood phosphate levels. These measures are usually taken immediately if the client needs medical stabilization, and continue throughout treatment. Dietary recommendations can help initiate a positive relationship with food both physically and psychologically, and also carry the advantage of being useful for years and decades following treatment – knowing how to prepare and enjoy nutritious meals is a skill that lasts a lifetime. When looking for eating disorder treatment centers, it’s important to find one that provides adequate nutritional counseling.

Family Therapy

Incorporating family members into therapy can help individuals identify problems related to their closest relationships and address them. It’s not only useful for the individual in treatment because most centers will include the family members themselves in joint sessions. While this is especially true for adolescents working toward becoming fully recovered, family therapy can help people of all ages. According to the National Institutes of Health, outcomes for people with anorexia nervosa are significantly better when the families are included in therapy.

There are several different approaches a therapist can take when bringing the entire family into therapy. There is often training provided to the family without the client present that teaches them how to best provide support after their loved one graduates from treatment. Some methods have included the family bringing a meal into therapy so the therapist can observe and instruct the family. Family members, spouses, and close friends are a constant presence in people’s lives; they’re the most important and effective support system possible with training.

Art and Music Therapy

These types of alternative treatment combine creative arts and psychology therapy to promote healing and growth. Creativity can come in many forms when used in therapy, including music, dance, painting, or even journaling and other kinds of writing. Expressing themselves through a form of creative art can bring new perspectives, especially if the person has not been particularly artistic beforehand. A therapist will observe an individual’s impulses during the time of artistic expression since they provide new avenues of discussion in later therapy sessions.

Please note that the point of creative therapy is not to make a masterpiece; no one expects a person using these therapeutic methods to become the next Michelangelo or Toni Morrison. The therapeutic benefit isn’t necessarily based on the final result, but on the creative process itself. Artistic expression can unleash certain truths about the self that many people could not otherwise express. Creativity becomes the path to understanding and self-discovery.

Look for These Kinds of Therapy at Your Eating Disorder Treatment Center

Any proper eating disorder recovery process must be customized to meet each individual’s personal needs. Before deciding which type of therapy or a combination of therapy is the best treatment option, individuals will need to find a program that can accommodate their needs through a wide range of available treatments. Reach out to a program that can meet these needs today if you or a loved one is struggling with an eating disorder – it’s never too late to get started on a happier, healthier life in recovery.

Melissa Orshan Spann, PhD, LMHC, RTY 200, is Chief Clinical Officer at Monte Nido & Affiliates, overseeing the clinical operations and programming for over 50 programs across the U.S. Dr. Spann is a Certified Eating Disorder Specialist and clinical supervisor as well as an accomplished presenter and passionate clinician who has spent her career working in the eating disorder field in higher levels of care. She is a member of the Academy for Eating Disorders and the International Association of Eating Disorder Professionals where she serves on the national certification committee, supervision faculty, and is on the board of her local chapter. She received her doctoral degree from Drexel University, master’s degree from the University of Miami, and bachelor’s degree from the University of Florida.