There are numerous problems that are unique to binge eating disorder and make it different to treat, even with cognitive behavior therapy. One must also consider that there are many health related issues involved with this disorder and that it is, just like bulimia, a cycle that the patient will have difficulty escaping once the trigger has been set off. Low self-esteem is often an important factor to consider because the patient feels guilty about his or her actions and worse because their disease becomes apparent to those around them since the majority of people who suffer from Binge Eating Disorder are overweight because they do not purge following a binge.  Reasons for binge eating are very individualized.  During a binge a trace-like state takes over the individual.  During and also immediately after a binge a numb feeling is described.  No feelings are able to get through to the individual; they feel no emotions.  Unfortunately, this process is a very maladaptive coping skill that is extremely unhealthy for the individual.  Many people use binges as a way to hide from their emotions, to fill a void they feel inside, and to cope with daily stresses and problems in their lives. For the binge eater there is usually a vicious cycle that takes place.  This addictive cycle can be broken down into a series of steps.  Although a binge may seem to come out of nowhere or the causes of the binge may vary, the pattern is the same each time.  The reason why cognitive behavior therapy has been so much more successful than other treatments is because it recognizes the mental thought-cycle that is perpetuated and works on eliminating that emotional and thought response. The key for the cognitive behavior therapist is to isolate the trigger since it is the starting point for all that follows. In cases of binge eating, The trigger is usually an emotional feeling.  This feeling results from a given situation in life.  It can be a one-time experience or daily happening.  Common feelings that lead to binges are anger, loneliness, rejection, resentment, helplessness and depression.  The trigger than leads to the desire/decision stage.  The desire to eat and the follow through are the second phase of this process.  Many people make the decision to binge hours before they actually do it.  Some make an elaborate ritual out of shopping or preparing for the binge.  A binge can also be put into place just minutes after the decision is made but first there must be a decision and this makes the thought the process and the control of the initial trigger crucial to the success or failure of a cognitive behavior treatment regime. Even still there are other issues that must come into play in order for the illness to be completely treated and all of the symptoms and related problems for those suffering from it must be considered.

Despite the success rate with this eating disorder in particular, it is still not considered to be a “miracle cure” by any means. Just as is the case with other psychiatric illnesses, there are any number of factors that could help or impede progress and recovery. For instance, even though the treatment is very effective for bulimia nervosa, the patient must continue practicing the skills learned throughout his or her lifetime in order to remain healthy. This can be especially difficult, particularly since one of the features of cognitive behavior therapy is the counselor’s role as a “cheerleader” and instructor of sorts. After the course of treatment, patients could easily experience relapse and thus begin to get int the cycle of depression and old behaviors just as easily as they got out of them. Furthermore, treatment with medication should be considered in cases where the depression is possibly more than just a side effect of the illness. If a patient is still feeling depressed, there is obviously a much greater risk of relapse as well. Even though cognitive behavior therapy has been hugely successful in the treatment of this particular eating disorder, there are still patients who require help and want it, but do not gain any benefit from standard cognitive behavior treatment. In such cases, there are more integrative approaches that combine a number of side-branches of the treatment paradigm. Using other treatments and branches of cognitive therapy can be especially useful in the most difficult cases. One study suggests that the use of imagery gives access to direct “primitive” schemas in a way that verbal cognitive therapy treatments do not. “The failure of verbal forms of CBT in some cases may be a product of therapists attempting to access cognitive representations via an inappropriate channel. It is argued that imagery rescripting in such cases allows the affect associated with the schema to be evoked” (Ohanian 2002). This access makes it possible to help adults to restructure the meanings they attached as children to early negative experiences and to modify the conclusions they are likely to make about themselves and their worlds. This knowledge can also be applied to other eating disorders such as anorexia or binge eating since the concept is broad and integrative.

Cognitive behavior therapy has also been applied in cases of anorexia nervosa and although the success rates are not as high as those associated with bulimia nervosa, there is promise in the future. There are several differences between the two eating disorders which makes treatment quite different, even if they are still disorders in the same area of classification. In the case of anorexia nervosa, the loss of weight is “primarily the result of a severe and selective restriction of food intake, with foods viewed as fattening being excluded. In some patients, the restriction over food intake is also motivated by other psychological processes, including asceticism, competitive behavior, and a wish to punish themselves” (Fairburn 2003). Unlike bulimia nervosa, this disease is one that takes rather constant vigilance and is associated with obsessive compulsive behavior. There are also many complex reasons and side issues associated with this particular illness which make it a different story treatment-wise than bulimia nervosa. Although these issues will be explored as we move along, it is still significant to note that cognitive behavior therapy is offering better success rates than many of the more traditional treatment paradigms for anorexia nervosa. As one study indicates, cognitive behavior therapy served patients much better after extended treatment when compared with the more standard approach of nutritional counseling. The study observed that, “After hospitalization, 33 patients with DSM-IV anorexia nervosa were randomly assigned to one year of outpatient cognitive behavior therapy or nutritional counseling. The group receiving nutritional counseling relapsed significantly earlier and at a higher rate than the group receiving cognitive behavior therapy (53% versus 22%). The overall treatment failure rate was significantly lower for cognitive behavior therapy (22%) than for nutritional counseling (73%)” (Pike 2003). While this might simply be proving that nutritional counseling was never the best option for post-hospitalization treatment, it would seem that at least cognitive behavioral therapy has shown itself to be an improvement on traditional treatment methods. It should be explored further, however, especially in the case of anorexia nervosa because there are any number of other issues that must be treated simultaneously in order for the model to be completely effective.

While the above study and related statements may have made it seem as though cognitive behavior therapy is one of the best solutions, especially for patients who are just leaving an extended hospital stay, there are some facts to be considered. One must recognize that although cognitive behavior therapy is quite promising, this is only in relative terms. We are looking at data that relates it to other traditional therapies and thus the success rate may seem higher than it is in “real life” simply because it is based on comparison. It is oddly difficult to find data that discusses cognitive behavior therapy as a stand-alone treatment (i.e. not being compared to other treatment methods) but what does exist does not bode particularly well for the treatment and shows that there are significant strides that must be made before it can be “officially” the best treatment available. While we all know it is the quickest treatment (since the average course of treatment is roughly 20 weeks) there are certainly flaws. For instance, in one study of anorexia patients who were assigned to one of three treatments: cognitive behavior therapy, interpersonal therapy, or a control treatment approach that combined clinical management and supportive psychotherapy. All patients were treated with 20 sessions over at least 20 weeks and were assessed after the 10th week of therapy and after the final session, “9% of the women had a very good outcome and 21% more had improved considerably; 70% made only small gains or no gains” (Rich 2005). Of these patients, those receiving interpersonal treatment had the highest failure rate and those with cognitive therapy were the most successful. The fact that only 9% of the patients with anorexia had a good result is quite frightening and shows that must be flaws inherent to the treatment itself. With such a wide margin of successes to failures, it hardly seems to fair to think that patients and their desire (or lack thereof) are the cause, thus we must consider what might be missing from the current form of cognitive behavior therapy treatments for anorexia patients in particular.

As with the other eating disorders discussed in this study, cognitive therapy alone might not be enough to achieve total success (which means no relapse). In addition to cognitive therapy, the counselor must remember that there are usually a host of other issues involved in anorexia cases and it is generally not a condition independent of certain variables such as long-running low self-esteem and other aspects. Treatment of anorexia calls for a specific program that involves three main phases: First and most importantly the individual needs to gain the weight lost to severe dieting and purging.  Psychological counseling to work with internal issues such as distortion of body image, low self-esteem, and interpersonal conflicts; and the long-term goal of remission and rehabilitation, or full recovery.  For an anorexic this treatment may need to be provided in an inpatient hospital setting, where feeding plans address medical and nutritional needs. In some cases, intravenous feeding is recommended to counteract malnutrition and help with weight gain.  Psychotherapy has been proven to be significant in treating anorexics, although even still, cognitive-behavioral therapy is thought to be the most successful.

While we have seen that there are many benefits to cognitive behavior therapy, it is crucial to recognize that there are still several aspects that are important to keep in mind. Even though there appears to be a high success rate, the treatment is far from perfect. One of the most often cited problems with cognitive behavior therapy is that after the course of treatment the rate of relapse is rather high. As one researcher notes, “Existing research evidence suggest the benefits of cognitive behavior therapy last for up to a year following the end of a course of treatment. A new trial has found that more than half of a group of people who had undergone cognitive behavior therapy and were followed up for 2-14 years were still diagnosed with some form of mental illness and very few had mild or no symptoms” (Ennis 2005). This poses one of the greatest problems in the entire field of treatment options. If the typical course of treatment for cognitive behavior therapy is 20 weeks, how do ensure that patients are continuing to feel the benefits without their “cheerleader” and instructor there to guide them? Furthermore, what good is a treatment that is highly effective in the first year after treatment but whose message and benefits become obsolete within a relatively short time frame? The only that seems reasonable is that cognitive behavioral therapy should act as a “kick start” in the case of an eating disorder. During that course of the initial 20 weeks, the patient can identify and begin to control his or her thoughts in order to achieve temporary success. If the mental health professionals see that this is not a permanent solution, then there will be better long-term plans laid. Although cognitive behavior therapy will be the most important step, patients must be informed to keep coming back, albeit at a less frequent rate. They should also be given access to traditional treatment options to supplement and hopefully extend the benefits and learning that took place during the cognitive behavioral sessions. The results of several studies suggest “a need to focus treatment directly on factors such as hopelessness and depression in addition to standard eating disorder procedures to ensure clients are able to engage in therapy” (Steel 2000). Furthermore, the patients need to be able to hold on to what they’ve learned during their cognitive behavior sessions and traditional treatments such as medications and standard psychotherapy might be the best way to extend what they’ve learned.

While in the end there are no infallible treatment options for eating disorders, cognitive behavioral therapy offers patients a potential solution that will help them identify and change thought patterns. With enough follow-up care and determination, this could, in select cases, truly be the “miracle cure” for such a complex and often devastating illness.

Related Articles

Borderline Personality Disorder: An Analysis

Works Cited

Andersson, Gerhard. (2005). Is CBT already the Dominant Paradigm in Psychotherapy Research and Practice? Cognitive Behaviour Therapy, 34(1), 1

Coker, Sian. (1993). Patients with Bulimia Nervosa Who Fail to Engage in Cognitive Behavior Therapy.International Journal of Eating Disorders, 13(1), 35

De Zwaan, M. (2001). Binge eating disorder and obesity. International Journal of Obesity, 25(5), S51

Ennis, B. (2005). Effects of CBT eroded over time. Practice Nurse, 30(10), 6

Fairburn, Christopher G. (2003). Eating disorders. Lancet, 361(9355), 407

Grave. (2005). A multi-step cognitive behaviour therapy for eating disorders. European Eating Disorders Review, 13(6), 373

Greeson, Janet, PH.D.  It’s Not What You’re Eating, It’s What’s Eating You.  New York, NY:  Simon & Schuster Inc., 1999

Hutchinson-Phillips. (2005). Differing roles of imagniation and hypnosis in the self-regulation of eating behavior. Contemporary Hypnosis, 22(4), 171

Ohanian, Vartouhi. (2002). Imagery Rescripting Within Cognitive Behavior Therapy for Bulimia Nervosa: An Illustrative Case Report. International Journal of Eating Disorders, 31(3), 353

Pike, K.M. (2003). Cognitive behavior in the posthospitalization treatment of anorexia nervosa. American Journal of Psychiatry. 160(11).

Openshaw. (2004). Group cognitive-behavior therapy for bulimia nervosa: Statistical versus clinical significance of changes in symptoms across treatment. International Journal of Eating Disorders,36(4), 363

Rich, B.R. (2005). Evaluating Three Psychotherapeutic Approaches for Anorexia Nervosa. Eating Disorders Review, 16(3), 4.

Steel, Zachary. (2000). Why the High Rate of Dropout from Individualized Cognitive-Behavior Therapy for Bulimia Nervosa? International Journal of Eating Disorders, 28(2), 209