Science has come a long way over the last few decades and in the process, has produced effective interventions for eating disorders, particular as it relates to short-term treatment options. While there is still much we don’t know, we have learned a lot about how and why eating disorders evolve and how to treat them effectively.
Short-Term Treatment for Eating Disorders
The most current, short-term treatment for eating disorders lasts 20 to 40 weeks, is structured, and focuses on what is happening today. So when people present for treatment and ask “what caused my eating disorder?” I tend to respond by explaining why it doesn’t actually matter; the more important question is “what’s keeping your eating disorder going now?”
Think about cancer: once a diagnosis is confirmed, there are immediate interventions like surgery, chemotherapy, radiation – implemented even though it’s unclear what caused the cancer in the first place. Treatment is prompt and aggressive because we know that the longer the cancer festers, the worse it gets, the more it spreads and unfortunately, the more lethal it becomes.
Well, the same can be said for eating disorders. An article in the November 2015 issue of The International Journal of Eating Disorders highlights factors that predict good treatment outcomes both at end of treatment and follow up:
“Greater symptom change early during treatment… [is] the most robust predictor of outcome…”
This confirms what we see in practice: patients who implement behavioral changes early in treatment (in the first six to eight weeks) tend to do better overall. A rapid response to treatment increases feelings of efficacy, boosts confidence and over all increases optimism about recovery. Significant early change simply does not happen in longer-term, non-behaviorally oriented treatments where the focus is on exploring, processing and increasing insight over time.
Early intervention leads to better outcome.
Yes, addressing behaviors before they have habituated is a potent predictor of a good result; hence the importance of using a treatment that encourages change (over “processing”) from the start. Treatments that are change-oriented and that incorporate manageable behavioral exposures early on, will guide the patient forward right from the start of treatment.
Talk Therapy: A Time and A Place
More open-ended treatment – those that focus in on exploring early experiences, unconscious drives, processing feelings day-to-day – are wonderful! But they will not help you change your eating behavior, at least not very quickly. More concrete and practical strategies that focus on what is happening now – with each and every eating experience (of which there are many!) – will be the best course for change. My strong recommendation – for any ED sufferer (regardless of the condition) – would be to save a longer-term talk-therapy for once your eating and weight have normalized and stabilized and you are in an ideal position to do some deeper emotional work.
CBT-E (Enhanced Cognitive Behavioral Therapy) is the gold standard, first-line treatment for eating disorders in adults. It is a short-term, practical treatment that emphasizes early change; we expect to see a 50 to 60 percent reduction in symptoms within the first eight weeks of treatment. CBT-E, a highly customizable approach, involves one-on-one sessions with a therapist focused on uncovering the factors that keep your eating problem going. Once those factors are clarified, you can systematically tackle them.
In bulimia and binge eating disorder, the treatment consists of 20 treatment sessions over 20 weeks. For people who are underweight, the treatment tends to be longer (typically 40-sessions over 40 weeks for Anorexia).
CBT-E will not be the treatment of choice for every eating disorder sufferer; of course, a full assessment of the individual’s struggles by an experienced specialist would be necessary in order to establish the right level of care and therapeutic intervention… but for medically stable, motivated individuals who have not received a full CBT-E treatment, it most likely would be in their interest to pursue.
For More Information
If you are motivated and ready to conquer your eating struggles, it is important to consider treatment options structured to modify behavior and decrease symptoms from the start. The Centre for Research on Eating Disorders at Oxford is a reputable resource for learning more about CBT-E and evidenced-based treatment for eating disorders in general.
Vall E, Wade T. Predictors of Treatment Outcome in Individuals with Eating Disorders: A Systematic Review and Meta-Analysis. International Journal of Eating Disorders 2015; 48: 946-971.