Psychotherapy can help with eating disorders as well as the other psychiatric illnesses that frequently occur with them. Practitioners work with individuals and with groups, and deal directly with the disorders as well as potential underlying issues. Eating disorders frequently co-occur with other psychiatric disorders such as depression, substance abuse, and anxiety disorders.
In addition, people who suffer from eating disorders can experience a wide range of physical health complications, including serious heart conditions and kidney failure, which may lead to death. Recognition of eating disorders as real and treatable diseases, therefore, is critically important.
One commonly employed psychological approach to treating eating disorders is cognitive behavioral therapy, or CBT. When used with patients who want to change their eating patterns, CBT may prove sufficient by itself, but in many cases, at later stages of recovery, "insight therapies" may be used on a longer term basis. The initial aim is to improve eating patterns, so the therapist often works with dietitians and other medical professionals.
CBT is divided into three stages. In stage one, the main emphasis is on educating the patient about the mechanisms that maintain the illness, and steps are taken to replace disordered eating with more regular patterns. In stage two, further emphasis on eating regularly without dieting is combined with a focus on cognitive procedures, examining the thoughts, beliefs, and values that maintain the problem. Stage three considers relapse-prevention strategies.
CBT works by addressing emotional triggers and thinking patterns and helping the patient to identify, question, and modify relevant thoughts, beliefs, and attitudes. CBT is usually one-to-one therapy. Another form of individual psychotherapy that is proving effective with eating disorders: dialectical behavior therapy (DBT).
DBT may be especially appropriate for treating binge-eating disorder, because it helps patients regulate the emotional ups and downs that trigger this disordered eating pattern. One basic skill is learning to breathe with focus on the diaphragm, which encourages relaxation. It also includes education and practice in mindful eating, with a focus on awareness of emotional responses to food while eating.
For example, a common thought process might be, "I'm angry! What's wrong with me?" DBT helps to change this to, "I'm angry. I wonder why?" This ensures that anger and other "negative" emotions don't lead to shame and guilt. DBT is usually worked with a group, which can seem disturbing to people with eating disorders, but can be especially helpful.
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