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Common Types of Therapy Involved in Eating Disorder Treatment

An effective treatment program for eating disorders usually involves a variety of treatment methods. While this may involve medication, most often a combination of talk therapy and cognitive retraining are the focal points. There are several specific types of therapies that can be used for treating eating disorders.

The specific types of therapy vary depending on the individual’s specific needs and goals as well as the severity and type of eating disorder. While the details will vary from client to client, some commonly used therapies make it into almost every program. The following are several types of the most prominent therapies used to treat eating disorders.

Levels of Care

Not every eating disorder looks the same, even if they use some of the same techniques. Programs are usually offered on several levels of care, matched to the individual’s medical and psychiatric needs. Many individuals will begin at one level of care, then transition to a less intensive level as they progress in their recovery. Here are the major levels of care in which eating disorder treatment can be found:

  • Residential–The most intensive level of care. Residential treatment is recommended for severe cases and those with a medical or psychiatric risk factor present in the individual. Residential care provides round-the-clock care for individuals, with medical, nutrition, and nursing staff on hand. Residential treatment often begins at 30 days, but there is no set limit of time.
  • Intensive Outpatient (IOP) – Often used as a step-down level of care for graduates f a residential program, IOP allows the individual to receive intensive psychiatric care and still return home at the end of the day. It’s usually not every day, but rather weekly or twice a week. IOP programs can also be conducted in virtual settings, further freeing up the individual’s time.
  • Partial Hospitalization Programs (PHP) –Bridging the gap between residential and IOP levels of care, PHP programs provide more intensive treatment than IOP, but still allow the individual in treatment the freedom to return home and continue work or school. PHP is the ideal option for a person who has relatively severe needs for treatment but cannot commit to a full residential program.

At each level of care, eating disorder treatment focuses on both individual and group therapy sessions. There is almost always a nutrition education and meal planning component as well. Among these therapeutic techniques, there are several effective methods that are commonplace at every level of care. Here are some therapy types to be expected during an eating disorder recovery program:

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy (CBT) has been proven useful in treating other forms of mental health illness such as addiction and depression and has become a central component of many eating disorder recovery programs. CBT can be understood as a type of talk therapy that also serves as cognitive retraining. CBT helps individuals identify and challenge disordered thoughts and behaviors via objective self-reflection and help from a therapist. According to the American Psychological Association, there are several basic principles involved in CBT:

  • Unhelpful or negative thinking patterns are the cause of many disordered behaviors. Identifying and sharing the client’s thought patterns act as a first step to repairing the negative thoughts.
  • Negative thoughts and disordered emotions can influence patterns of negative behavior. It’s necessary to reshape ways of thinking that will eventually change behavior.
  • CBT gradually teaches a more objective way of thinking and allows clients to identify when their thought patterns and coping mechanism are disordered. This can lead to the successful treatment of everything from depression and anxiety to a variety of eating disorders.

There are several strategies CBT will use to help individuals change their thinking patterns and eventually their negative behavior. The most central one of these is embracing mindfulness, which allows them to step back from themselves and objectively identify their emotions. CBT therapy also helps individuals understand the motivation and behavior of other people.

Acceptance and Commitment Therapy

Acceptance and Commitment Therapy (ACT) is similar to CBT in that it involves identifying certain negative emotions, however, it is less focused on altering negative emotions. One of the key components of this type of therapy is for an individual to stop denying and avoiding their inner emotions. Individuals will learn that negative emotions are, at times, appropriate responses to some situations. The goal is for individuals to accept the difficulties and issues in their lives and then commit to making changes in their current behavior. According to Good Therapy, ACT involves a few major tenets:

  • Acceptance–Acknowledging unpleasant thoughts and experiences to exist without trying to deny or change them.
  • Being Present –Another term for mindfulness, this means being aware of emotions without trying to “do something” about them.
  • Self as Context – This means that a person exists outside the current experience; the self is a constant and the circumstances change.
  • Values – Individuals will try to codify and live by the values that are important to them.
  • Committed Action – The person will commit to living their values consistently.

Being able to relate to different events and ideas is a primary concept in Acceptance and Commitment Therapy. This type of therapy is useful in treating anxiety disorders as well as EDs like anorexia nervosa and bulimia nervosa.

Dialectical Behavioral Therapy

This type of therapy is a slightly altered form of CBT that puts its focus on dealing with difficult situations in a positive fashion. Dialectical Behavioral Therapy (DBT) builds on the principles previously outlined in CBT. DBT focuses on the ways one person’s emotions can be roused more quickly or intensely than another’s, and how to harness or allay the intense negative emotions. There are four specific areas of emphasis in DBT.

  • Mindfulness–As with all these treatments, mindfulness is key. St. Catherine University lists the tenet of mindfulness as purposeful observation, paced breathing, and self-soothing.
  • Interpersonal Effectiveness–Using a mindful approach can apply to person-to-person interactions as well as self-examination. DBT uses dialogue to increase interpersonal effectiveness.
  • Distress Tolerance – This method of coping teaches ways to tolerate rather than avoid stressful situations.

Dialectical Behavioral Therapy differs from the other two categories of treatment above in that it includes both individual and group therapy regularly. During group therapy, individuals will learn skills from one of the following methods: distress tolerance, interpersonal effectiveness, mindfulness skills, and emotion regulation. Group therapy is an ideal setting for putting these concepts into practice.

Exposure Therapy

Fear is often a part of having an eating disorder; fear of gaining weight, fear of being judged, fear of a specific food, etc. – any and all of these fears surrounding food and eating can have a great effect on psychosocial and physical health. Along with increasing mindfulness and self-awareness through CBT and other related therapies, many programs also include exposure therapy to help individuals confront and overcome these fears. Exposure therapy is widespread int h treating ARFID, orthorexia nervosa, anorexia nervosa, and other eating disorders that are at least partially predicated on a fear of something food-related. It’s useful in normalizing intuitive eating practices as well.

Originally developed to treat phobias, exposure therapy gradually exposes a person to the thing or situation they are afraid of, in a controlled and safe environment. This is not a sink-or-swim situation; individuals will not be asked to face an overwhelming barrage of their fear foods and there will always be a way to end the session at a moment’s notice if they are being too disturbed. An example of exposure therapy in an eating disorder treatment context might be a person with ARFID, who won’t eat any kind of meat or protein to the point that it’s hurting their health, being asked to first simply be in the presence of some meat. Then, they might smell it, or take a tiny bite, and s on until they have reached a place where they can tolerate being around that food. It’s a difficult process, but highly effective for long-term recovery.

Seeking Treatment for Eating Disorders

These treatments are proven effective for virtually all forms of eating disorders; they are indeed used across a wide spectrum of mental health treatments from depression to substance use disorder. As with any form of mental health treatment, eating disorder recovery is most effective with early intervention; it’s easier to recover the sooner you start. If you or a loved one is struggling with an eating disorder, reach out as soon as you can. Recovery is possible.

Melissa Spann, PhD, LMHC, CEDS-S

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.
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