When a person goes into eating disorder treatment for the first time, they might not know what to expect. Most people assume there will be sessions with psychologists and lots of meal planning and nutritional education, but there is often much more to it than that. Whether the eating disorder treatment is on a residential or an outpatient basis, they feature multiple therapy types. Cognitive therapy is chief among them.
Unlike the stereotypical talk therapy that most people imagine, with a client and the therapist sitting on a couch and discussing emotions and past experiences or the popular image of a cathartic group session, cognitive therapy is not as well-known in the general public. These forms of therapy are focused on identifying and then eventually replacing disordered thoughts and emotions through an established pattern developed evidentially by the therapist over decades. Each of the cognitive therapy types we’ll discuss follows a distinct pattern that is more hyper-focused on a cognitive retraining goal than traditional talk therapy.
The three main types of cognitive training therapies are Cognitive Behavioral Therapy (CBT), Dialectic Behavioral Therapy (DBT), and Cognitive Processing Therapy (CPT).Each has been proven effective in treating a wide range of severe mental health disorders from OCD to anorexia nervosa. Crucially, they are all especially useful in treating the causes and symptoms of PTSD; past trauma is one of the most common contributing factors in the development of eating disorders. Effectively addressing trauma is central to any eating disorder treatment program.
Cognitive Behavioral Therapy (CBT)
CBT is the original form of cognitive therapy. It was initially created in the 1960s, primarily by the psychiatrist Aaron Beck, and has been further developed by countless practitioners since. This form of therapy is based on the philosophy that a person’s thoughts and feelings influence their behavior. For example, a person with an unreasonable fear of drowning will avoid swimming or being around water. These feelings are often caused by a traumatic experience that influences their thoughts and feelings – in the previous example, they may have had a bad first swimming experience as a child.
CBT aims to identify which thoughts and feelings are causing disordered behaviors, objectively understand them, and eventually replace them with more rational ones that do not cause negative behaviors. As the client progresses through CBT sessions in an eating disorder treatment context, they will begin to replace the disordered coping mechanisms (such as binging and purging in the case of bulimia nervosa) with healthier ones, such as journaling or practicing a hobby. CBT is a gradual process, in which the client and therapist incrementally make progress in repairing the negative thoughts and feelings involved in their disorder.
Dialectical Behavioral Therapy (DBT)
An offshoot of CBT, Dialectical Behavioral Therapy was originally designed to treat Borderline Personality Disorder, a mental health condition in which a person has difficulty regulating emotion and building relationships. DBT is focused on mindfulness, or the ability to observe feelings and thoughts without acting on them or judging them. It’s useful for eating disorders as well as BPD because it directly impacts a person’s ability to regulate their actions irrespective of what negative or distorted emotions they are feeling.
The term “dialectical” refers to the Socratic method of discussing an idea from two opposite points of view to reach a synthesis. Applied to eating disorders, the therapist will discuss with the client the emotions that are triggering disordered eating behaviors and take the opposite position until the client can easily identify which of their emotions are disordered. This can lead to impartiality when self-assessing, allowing the client to avoid disordered behaviors without the help of the therapist. DBT can be an emotionally distressing process, but it has proven an extremely effective way to overcome disordered eating behaviors.
Cognitive Processing Therapy
CPT is another evolution of CBT that was designed specifically to address PTSD or other forms of trauma and the coping behaviors that can arise from them. CPT is clearly outlined in 12 sessions between a client and a single therapist. It’s hyper-focused on addressing trauma, the event that caused it, and its emotional consequences. Like CBT and DBT, cognitive processing therapy begins with objectively identifying emotional disturbances without acting on them or judging them.
Unlike the other forms of cognitive training we’ve discussed, CPT focuses specifically on the trauma a person has suffered and retraining their attitudes about that trauma. As an example, a person who had been abused as a child may turn to the feelings of control that restrictive eating behaviors associated with anorexia nervosa provide to cope with the pain of their trauma. CPT, throughout 12 sessions helps the client identify that this is an unhealthy response to the trauma, and replace it with more healthful options.
ABOUT THE AUTHOR: CARRIE HUNNICUTT
With 20 years of behavioural health business development experience, Carrie combines world-class marketing, media, public relations, outreach and business development with a deep understanding of client care and treatment. Her contributions to the world of behavioural health business development – and particularly eating disorder treatment – go beyond simple marketing; she has actively developed leaders for her organizations and for the industry at la