1. A model of eating disorders
Biological
Stress vulnerability
Psychological
Anxiety about appearance
Social
Cultural & family pressures
Restriction of eating
Bulimia
Bingeing
Purging
Maintain weight
Anorexia
Continued restriction
Reduced anxiety
Excessive weight loss
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Based on Barlow & Durand (1995)

2. Treatments for EDs Behaviour therapy Cognitive behaviour therapy
Weight restoration (anorexia only)
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3. CBT Treatment based around:
Identifying dysfunctional thinking processes that cause & maintain disordered eating
Use of behavioural exercises to test and modify maladaptive beliefs
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4. CBT with bulimia nervosa
Four stages (Fairburn, 1985):
Education about effects of bingeing, purging, dieting
Modified eating patterns – small meals 5-6 times a day
Altering dysfunctional attitudes about food, eating & the body
Teaching coping strategies to avoid bingeing & purging
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5. CBT with bulimia nervosa
Fairburn et al (1993); comparison of three treatments:
CBT (all four parts)
BT (just the eating habits part)
IPT (interpersonal therapy)
Outcome measures: cessation of bingeing/purging; attitudes to body/eating
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6. CBT with bulimia nervosa
Start End mo mo Mo
Cessation rate
CBT
IPT BT
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7. CBT with bulimia nervosa
CBT works fast & is more effective than BT
Not a panacea – only 36% had no symptoms at 1 year follow-up
Early treatment gains may be lost; IPT more effective long term
Drugs may boost effectiveness (Agras et al, 1992)
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8. CBT with anorexia nervosa
Anorexia involves several cognitive distortions:
Irrational beliefs about food & weight gain
Inaccurate perception of body
CBT aims to change these thinking patterns, which are assumed to maintain anorexia behaviour
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9. CBT with anorexia nervosa
Treatment goals (Yager, 1994):
Educate & inform about anorexia
Identify & focus on unhelpful thoughts & beliefs
Replace these with more adaptive ways of thinking
Identify problems & develop problem solving strategies
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10. CBT with anorexia nervosa
Improved body image, eating habits at 7-year follow up (24 patients; Yager, 1994)
Can be effective in helping maintain weight but many continue to have distorted body image (Davison & Neale, 1994)
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11. CBT with anorexia nervosa
Highly structured treatments (BT, CBT) most effective during initial treatment (<1 year)
In longer term, patients may benefit more from psychotherapy/IP/family therapy
Addressing underlying problems? Compare bulimia treatment data.
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