Is Therapy an Effective Treatment for Eating Disorders?

There are many levels of care that are available for the treatment of eating disorders.

Intensive outpatient or outpatient

Outpatient means that you return home following a treatment session. This level of care is often used for individuals who:

• don’t need to be monitored on a daily basis
• are functioning well in school, work, or social settings
• are continuing to make progress in their recovery

Outpatient programs may vary in intensity depending on an individual’s needs. Some may have sessions once or twice per week, while more intensive programs often involve sessions that are longer and more frequent.

Partial hospitalization

You may also see these referred to as “day hospital” programs. They’re more intensive than an outpatient program and may be recommended for someone who:

• needs to be monitored on a daily basis
• has an eating disorder that impacts their ability to function, but not in a manner that poses an immediate risk
• performs activities like bingeing, purging, or fasting on a daily basis

A partial hospitalization program typically involves sessions that can last several hours and occur most days out of the week.

Residential

People in a residential treatment program temporarily live in a facility that’s specifically aimed at addressing eating disorders. These facilities offer their residents monitoring and care around the clock.

This type of program is often recommended for people that:

• need longer term care for their eating disorder
• require daily monitoring
• haven’t responded to outpatient or partial hospitalization treatment programs

The length of time that a person spends in a residential program depends on the severity of their condition as well as the individual facility.

Inpatient hospitalization

This level of care involves a stay at a hospital. It’s used for individuals with an eating disorder who are experiencing a medical emergency, such as:

• unstable vital signs
• symptoms that have worsened quickly
• complications due to their eating disorder or another underlying health condition
• suicidal ideation

Hospitalization aims to stabilize your condition. When you’re discharged, an outpatient, partial hospitalization, or residential program will be recommended based off your individual situation.

Various types of therapy can be used in the treatment of eating disorders. Below, we’ll explore each type of therapy in more detail.

Cognitive behavioral therapy (CBT) and enhanced cognitive behavioral therapy (CBT-E)

CBT aims to identify the thought patterns and beliefs that contribute to your eating disorder.

These could include thoughts or beliefs that are associated with things such as:

• food
• weight
• body shape
• appearance

Once these thoughts and beliefs are identified, you’re then taught strategies to modify them and to help manage them.

CBT is used for a variety of mental health conditions, and people receiving CBT for eating disorders experience improvements in other related symptoms like depression and anxiety.

CBT-E (enhanced) is a type of CBT that’s intended for use in all types of eating disorders.

Interpersonal psychotherapy (IPT)

IPT is a type of therapy that’s used to treat eating disorders like binge eating disorder or bulimia. In IPT, your eating disorder is explored in the context of social and interpersonal relationships.

Four different “problem areas” are used in IPT. These include:

• Interpersonal deficits: This often includes feelings of isolation or a lack of close, fulfilling relationships. The relationships in question don’t have to be romantic, but can also be related to those with friends or family.
• Role disputes: This often involves a difference in expectations between yourself and one or more important people in your life, such as parents, friends, or employers.
• Role transitions: This is typically concerned with big life changes, such as being on your own for the first time, starting a new job, or being in a new relationship.
• Grief: This can include feelings of loss due to the death of a loved one or the end of a relationship.

Your doctor will work with you to explore how issues in each of these problem areas contribute to your eating disorder. They’ll then help you develop strategies to improve your communication and interpersonal skills to help reduce your symptoms.

Family-based treatment (FBT)

You may also see this type of therapy referred to as the Maudsley Method. It’s often used for children or adolescents that have an eating disorder.

In FBT, your family members are vital parts of your recovery process. They’re involved in helping you do things like:

• maintaining healthy eating patterns
• restoring and maintaining a healthy weight
• interrupting unhealthy behaviors, such as binge eating or purging

Dialectal behavior therapy (DBT)

DBT focuses on managing difficult emotions. With DBT, you’ll learn skills to change the behaviors associated with your eating disorder.

Some specific skills that DBT aims to build include:

• interpersonal skills
• emotional expression
• flexibility and openness
• coping with feelings of distress
• encouraging mindfulness

DBT has been studied in the treatment of binge eating disorder, anorexia nervosa, and bulimia nervosa.

Acceptance and commitment therapy (ACT)

ACT asks you to focus on changing your actions as opposed to your thoughts or feelings.

A principle of ACT is that the behaviors associated with mental health conditions come from responses to unpleasant feelings like anxiety or pain.

People undergoing ACT are asked to examine for themselves what their core values are. They’re then asked to develop goals that help them better satisfy these values.

The aim is to accept all feelings — including the unpleasant ones — and to commit to changing your actions so they better align with your core values. Through this, it’s believed that you can lead a better life and begin to feel better.

ACT is a viable treatment for eating disorders, but more research is needed to see if it’s effective as a standalone therapy.

Cognitive remediation therapy (CRT)

CRT focuses on promoting big-picture thinking and mental flexibility. It’s currently used in the treatment of anorexia nervosa.

In CRT, a variety of exercises and tasks are used to help address the rigid thinking patterns that are often associated with anorexia nervosa. Some examples of such tasks include:

• drawing shapes or performing motions with your dominant and nondominant hand
• asking you to repeatedly switch your attention between two topics
• reading and summarizing increasingly difficult passages
• finding different ways to navigate a map
• asking you to come up with alternative ways to use everyday objects

Psychodynamic psychotherapy

The overall goal of psychodynamic psychotherapy is to help you understand the underlying cause of your eating disorder. This involves diving deep into things such as your internal conflicts and motives.

Providers of this type of therapy believe that your symptoms are the result of unresolved wants and needs. As such, understanding the root cause of your disorder can address your symptoms and reduce your risk of relapse.