Over the last few decades, science has come a long way. As a result, we’ve seen advances in effective interventions for eating disorders. While there is still much we don’t know, we’ve learned a lot about how and why eating disorders develop and how to treat them most effectively.
The most current, evidence-based outpatient eating disorder treatments are relatively short-term (20-40 weeks) and highly structured. These treatments are present-focused; in other words, in lieu of talking about one’s history, family life, early years, we tune in to what’s happening in the present day with your eating… We want to understand your thoughts and feelings about food in the present moment and what drives your decision-making process in relation to eating. The factors that might have caused your eating disorder are less important than the factors that are keeping it going now.
If you 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. A review in The International Journal of Eating Disorders[i] 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 6-8 weeks) tend to do better over all. 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, focused 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.
If you want to address disordered eating – restricted eating, bingeing, purging – without a doubt, it’s best not to get too caught up in the past. Consider a present-focused, change-oriented treatment like CBT-E (Enhanced Cognitive Behavioral Therapy), the leading evidence-based treatment for bulimia, binge eating disorder and anorexia.
[i] 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.