Cognitive behaviour therapy is a kind of psychotherapy. Sometimes it's just called therapy. During cognitive behaviour therapy you talk to a trained therapist about your problems. Most people with bulimia see a therapist regularly for about 20 weeks, but you can see a therapist for longer if you need to. Each meeting with the therapist usually lasts about an hour. Your therapist could be a psychologist, a psychiatrist, a psychiatric nurse, a psychotherapist, or even a family doctor.
Three phases of therapy
Cognitive behaviour therapy for bulimia is often split into three phases.
Phase one
You start by learning to reduce bingeing and dieting. This takes about seven to nine weeks. Usually, you keep a diary of how often you eat and how often you binge, purge, or exercise. You might also write down your thoughts about food in your diary.
The first phase is all about allowing yourself to eat. For example, if you never eat breakfast or lunch, you might agree to eat a small breakfast every day (yogurt and an apple, say) as part of your treatment.
You also learn basic facts about bulimia and treatment, and how these affect your body. Here's one important fact: most people do not put on weight during cognitive behaviour therapy.
Phase two
You start talking more about what you eat, not when. You slowly branch out so that you're eating a lot of different foods, even ones you've craved or thought were banned, like doughnuts. When foods are not forbidden in your mind, you'll probably find that you don't crave them.
In this phase, you begin talking about your feelings, including feelings about your weight and eating. You may feel desperate to be thin, or you may think that losing weight will make you happy. You and your therapist might explore why you feel this way. Your therapist will help you find healthier ways to feel good about yourself. If you binge on food because you feel stressed, your therapist will help you deal with that too.
Phase three
By phase three, you are likely to be feeling better and bingeing less. During the last few weeks you learn how to keep it that way. You also learn what to do if the symptoms of bulimia come back.
What's involved in the treatment
Therapists use many different techniques to help people change their thinking and behaviour. Your therapist will teach you some of them. And you'll have homework to do between sessions. Writing in your food diary might be one kind of homework. Eating a small meal that you would normally skip could be another. Homework is an important part of cognitive behaviour therapy.
Treatment doesn't end when you stop going to a therapist. You'll be able to use the techniques you've learned by yourself. You can be your own therapist whenever you feel bulimia taking over again. So the treatment may be especially good for people who want to help themselves get better.
There's even a kind of “do it yourself” or self help cognitive behaviour therapy. Your therapist gives you a book with information and homework exercises in it. You work through the book on your own for a few weeks, but go to the therapist every now and then for advice and encouragement.
Competing interests: None declared.