CBT-E for Binge Eating
Enhanced Cognitive Behavioral Therapy (CBT-E) is the first line treatment for binge eating. You may have heard of CBT—it is a thoroughly researched and proven treatment for many behavioral health conditions. The form of CBT used for binge eating (CBT-E) differs slightly from traditional CBT. In this blog post, I’ll break down CBT-E for binge eating and explain the first (of four) stages of treatment.
CBT-E for binge eating typically extends over about 20 weeks with one-on-one sessions with a therapist.
Stage One: Getting started and building momentum.
You and your therapist will get to know how your binge eating works. When does it happen? What are your triggers? How do your feelings about your weight impact your eating? What do you like about binge eating… and what do you dislike? Together, you will then create an easy-to-understand diagram—a “formulation”—that maps out the processes maintaining your binge eating. This really helps to lay the groundwork for making changes. A formulation might look something like this:
You will begin monitoring. First, you’ll start a food diary. Sharpen those pencils, because you need to write down everything you are eating and drinking, as well as where you were, what you were feeling, whether there were any triggers if you had a binge, and any additional commentary. Logging is certainly not easy but it is an extraordinarily useful tool. It’s like giving you and your therapist the keys to the castle—the binge eating can no longer hide if it’s out in plain sight!
Second, you and your therapist will start to track your weight. This will mean a weekly weight at the beginning of each session Knowledge of weight is an important part of treatment, since it helps us to understand how your body is responding. It’s also important to work with your therapist to tackle the intense feelings that can come up around weight. People with binge eating tend to be especially tied to “the number;” an attachment that – you’ll see – fuels the problem further.
Finally, in this first stage you will establish regular eating patterns. You will create a structure for meals and snacks so that you are eating at regular intervals throughout the day. And you’ll work with strategies to avoid eating during the gaps in between. Just creating structure like this often reduces binge eating significantly.
As you can see, CBT-E for binge eating is very collaborative. You are constantly observing and assessing your progress together with your therapist. Together you will ask: What do we believe is working? What isn’t? How can we create effective change together?
In future posts, I’ll move on to the other stages of CBT-E treatment!