I provide cognitive-behavioral therapy (CBT) to adults and older adolescents with eating disorders and family based therapy (Maudsley model) to adolescents with eating disorders. A course of CBT for bulimia is usually about 20 sessions. Family based therapy (FBT) usually consists of 20 treatment sessions over a course of 6 to 12 months.  I also incorporate elements from some other models consistent with CBT into my work,  including intuitive eating, mindful eating, mindfulness, and appetite awareness training.

Eating Disorders are serious disorders that are associated with numerous medical problems. If you see me for an eating disorder you also should be seeing a physician. The Academy for Eating Disorders has published guidelines for medical doctors treating eating disorders. You can download these guidelines and bring them to your medical doctor if he/she is not an eating disorder specialist. If additional services are needed I can provide some referrals for psychiatrists and nutritionists.

Sometimes clients need more support for their eating disorder than can be provided through individual outpatient therapy. If I feel that higher level of care is warranted I will provide referrals. I have connections to many different treatment centers locally as well as nationwide.

Adult Treatment

Cognitive behavioral therapy for eating disorders was first described by Christopher Fairburn, MD in 1981 and has been updated several times, including a revision in 1993 co-authored by my mentor, Dr. Terence Wilson (Fairburn, C. G., Marcus, M.D., & Wilson, G. T. (1993). The most recent revision is an “enhanced” (CBT-E) protocol (Fairburn, Christopher G., 2008).

A core problem in all eating disorders is overconcern with shape and weight. Cognitive behavioral therapy, which focuses on addressing the various behaviors, thoughts, and feelings that are components of this core overconcern, is ideally suited to treat eating disorders. Cognitive behavioral therapy also addresses general personality characteristics that maintain eating disorders. 

Cognitive behavioral therapy has become the leading evidence-based treatment for adults with eating disorders. It has been tested in numerous clinical trials and proven successful. Research studies indicate that about two-thirds of the patients who complete treatment have an excellent response. It can also be successfully employed with older adolescents with bulimia nervosa.

In cognitive behavioral therapy the treatment focuses primarily on factors in the present that are keeping the eating disorder going. The therapist and client work together as a team to understand the client’s problem and develop strategies to overcome it. Some of the cognitive behavioral strategies employed for eating disorders include:

• Self-monitoring
• Replacing strict dieting with regular meals
• Meal planning
• Regular weighing
• Introduction of forbidden foods
• The use of delays and alternatives to prevent bingeing and purging
• Strategies to manage negative mood states
• Problem-solving
• Cognitive restructuring
• Relapse prevention
• Strategies to address negative body image and self-esteem issues

Adolescent Treatment

For adolescents with anorexia, one of the most successful and empirically validated treatments is Family-Based Treatment (FBT or Maudsley Approach).  This treatment was developed at the Maudsley Hospital in London, England in the late 1970s and early 1980s by Drs. Christopher Dare, Ivan Eisler, Gerald Russell, and George Szmukler. Dr. Daniel le Grange and Dr. James Lock brought the treatment approach to the US and published the first treatment manual in 2002 (Lock, J., Le Grange, D., Agras, W.S., Dare, C. (2002).

In the Maudsley approach, no one is blamed for the development of the eating disorder. The symptoms are seen as outside of the child’s control and taking on a life of their own.

In contrast to traditional therapies, Maudlsey Family-Based Therapy enlists the support of the entire family as a resource in helping the adolescent battle the eating disorder. Treatment initially focuses on weight restoration, with the parents given the task of providing adequate nutrition for their adolescent during family meals. The therapist supports the parents in this difficult task and also models an uncritical stance that views the eating disorder as an external force that must be fought off by the entire family working together. In the second phase of treatment once progress has been made in weight gain, the child is gradually given back more control over their own eating. In the final phase of treatment issues of adolescent identity are addressed within the family context.

Maudsley is a promising alternative model to costly inpatient or day hospital programs Research out of the University of Chicago and Stanford University shows that at the end of a course of FBT, two-thirds of adolescents with anorexia nervosa are recovered and 75 to 90% are weight-recovered at five year follow-up. It has also been successfully employed with adolescents with bulimia nervosa and with college students with anorexia nervosa.

References:

• 1. Fairburn, C. G., Marcus, M.D., & Wilson, G. T. (1993). Cognitive-behavioral therapy for binge eating and bulimia nervosa: A comprehensive treatment manual. In C. G. Fairburn & G. T. Wilson (Eds.), Binge eating: Nature, assessment and treatment. New York: Guilford Press
• 2. Fairburn, Christopher G.(2008), Cognitive Behavioral Therapy and Eating Disorders. The Guilford Press: New York
• 3.Lock, J., Le Grange, D., Agras, W.S., Dare, C. (2002). Treatment Manual for Anorexia Nervosa: A Family-Based Approach. The Guilford Press: New York.