Treatment:
Cognitive Behavioral Therapy for Binge Eating Disorder
2015 EST Status:
Treatment pending re-evaluation
Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings
Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources
Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved
Insufficient Evidence: No meta-analytic study could be identified
Insufficient Evidence: Existing meta-analyses are not of sufficient quality
Treatment pending re-evaluation
1998 EST Status:
Strong Research Support
Strong: Support from two well-designed studies conducted by independent investigators.
Modest: Support from one well-designed study or several adequately designed studies.
Controversial: Conflicting results, or claims regarding mechanisms are unsupported.
Strength of Research Support
Empirical Review Status
2015 Criteria
(Tolin et al. Recommendation)
(Tolin et al. Recommendation)
Very Strong
Strong
Weak
Insufficient Evidence
Treatment pending re-evaluation
1998 Criteria
(Chambless et al. EST)
(Chambless et al. EST)
Strong
Modest
Controversial
Find a Therapist specializing in Cognitive Behavioral Therapy for Binge Eating Disorder. List your practice
Brief Summary
- Basic premise: Dietary restraint leads to binge eating, which leads to further dietary restraint. Thus, reducing dietary restriction via cognitive and behavioral interventions can reduce binge eating.
- Essence of therapy: Dietary restraint promotes and maintains binge eating pathology; thus, the treatment is designed to reduce dietary restraint through behavioral strategies (e.g., self-monitoring of behaviors, normalizing patterns of eating). The treatment also includes modifying dysfunctional thoughts and beliefs about one’s body shape and weight, which is also designed to reduce eating disorder pathology.
- Length: Approx. 16 sessions
Treatment Resources
Editors: Evan Forman, PhD; Stephanie Manasse, MS
Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice
Treatment Manuals / Outlines
Treatment Manuals
Measures, Handouts and Worksheets
Self-help Books
Important Note: The books listed above are based on empirically-supported in-person treatments. They have not necessarily been evaluated empirically either by themselves or in conjunction with in-person treatment. We list them as a resource for clinicians who assign them as an adjunct to conducting in-person treatment.
Clinical Trials
Other Treatment Resources
Cognitive Behavioral Therapy (CBT) is an evidence-based treatment model focused on the premise that an individual’s thoughts, feelings and behaviors are intertwined and can ultimately be re-structured to support more productive actions. Historically routed in the treatment of depression and anxiety, CBT is becoming more prevalent in eating disorder treatment settings, particularly more recently, with Binge Eating Disorder (BED).
CBT focuses on three phases of treatment – the behavioral phase, cognitive phase and maintenance and relapse phase. Below is an overview of each stage, with critical treatment components specific to the Binge Eating Disorder population:
Behavioral Phase: In this phase, the patient and the clinician/therapist build rapport. The patient identifies negative emotions and behaviors, and with the support of the clinician/therapist, a plan for normalizing eating behaviors is developed.
This requires:
1. Addressing & minimizing negative behaviors associated with BED such as episodic binge eating and subsequent behaviors derived from guilt and shame.
2. Providing education and awareness about balanced eating, meal planning and nutrition.
3. Developing coping strategies for managing negative emotions that provoke episodic binge behaviors. Distraction, prolonging urges and thought stopping are some of the skills taught to cope with overwhelming urges.
Cognitive Phase: In this phase, “cognitive restructuring” techniques are introduced. Patients are encouraged to challenge their thought process and learn to identify unhealthy, treatment-interfering thoughts. They are supported in reshaping their thoughts by developing new perspectives.
This requires:
4. Conquering concrete & distorted thoughts about negative body image or self-worth as it applies to an unrealistic level of perfectionism.
5. Improving interpersonal relationships begins here. Patients identify unhealthy thought patterns, looking introspectively into the impact of their thoughts on relationships and patterns of communication with others.
6. Providing increased hopefulness, as patients gain insight into how their thoughts affect their behavior and begin to embrace positive change.
Maintenance & Relapse Prevention Phase: This final phase focuses on maintaining the skills learned in the previous stages of treatment. A comprehensive relapse and recovery plan is developed by the patient, with the clinician/therapist’s support, to assist the patient in managing the negative thoughts and behaviors associated with BED.
This requires:
7. Improving self-confidence as patients become more comfortable using the acquired skills and can identify triggers before they manifest into negative thoughts and behaviors. Patients should be positively reinforced by the noticeable progress that is visible to themselves and others.
8. Achieving holistic healing as the BED symptoms are improved and stabilized. Patients should be able to focus on the root cause and subsequent areas of mental and physical health that will assist in transitioning them into a life of recovery.
CBT isn’t easy – and certainly requires patience. But using these steps, clinicians can truly make a difference in re-shaping the mindset and providing invaluable skills for binge eating disorder patients in their journey forward.
Click here to learn more about innovative Binge Eating Disorder treatment.
Research shows that cognitive behavioural therapy (CBT) is the most effective form of therapy for the treatment of eating disorders especially bulimia nervosa, binge eating disorder and other specified eating disorders. CBT is a psychotherapeutic approach to treat eating disorders and involves different techniques. The different techniques allow you to comprehend the interaction between your thoughts, feelings and behaviours, and plan strategies to change negative thoughts and behaviours to improve your mood and health.
Structure of CBT for Eating disorders
The cognitive behavioural model acknowledges the importance of thoughts (cognitive) and actions (behaviour) has an important role in maintaining the eating disorder.
Cognitive factors
Consists of negative body image, self-evaluation, beliefs about self worth, and overthinking your weight and body shape.
Behavioural factors
Consists of behaviours to control weight such as restraint, restriction, purging, binge eating, self-harm, body avoidance and body checking.
The different CBT techniques
- Cognitive restructuring
You are encouraged to challenge your thinking processes of your self and your body and identify unhealthy behaviours and thoughts that are interfering with the treatment. Instead of unhealthy thoughts you will develop new healthy thoughts that will help you to change your perspective of yourself.
- Coping strategies
Coping strategies are developed to manage negative emotions such as distractions and urges, but also to prevent negative thoughts in order to cope with overwhelming triggers and feelings.
- Nutritional counselling
It is necessary with education around nutritional needs and planning meals and monitoring your food choices.
- Relapse prevention
Focuses on the skills you will learn in the sessions with your therapists and to develop a relapse and recovery plan. This also includes improvement of self-confidence as you will become more comfortable with the skills you will learn and able to identify triggers to help prevent relapse.
- Homework assignments
It is common that CBT is time limited and goal oriented, and also includes tasks you have to complete outside sessions with your therapist. CBT requires collaboration between you and your therapist, and an active participation from you as a client.
Treatment
Our therapists at WeightMatters have received specialised training, and can work with all presentations of disordered eating and eating disorders as well as other mental health conditions such as anxiety, depression and trauma.
Binge eating disorder (BED) is the most common eating disorder in the United States. According to the National Eating Disorders Association, it is believed to affect 3.5% of women, 2% of men, and up to 1.6% of adolescents.
The disorder is characterized by repeated episodes of binge eating without the compensatory behaviors (such as purging) found in bulimia nervosa. Binge eating disorder was only recently (in 2013 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; DSM-5) classified as an official diagnosis. As such, knowledge about it lags behind that of anorexia nervosa and bulimia nervosa.
This article discusses some of the treatments for binge eating disorder including cognitive behavioral therapy, interpersonal therapy, and medication.
Diagnosis
It is important to note that BED is not something new. Prior to the publication of the DSM-5, binge eating disorder was listed in the appendix and could be diagnosed as an “Eating Disorder, Not Otherwise Specified” (EDNOS).
Being identified as a distinct eating disorder means that people with this condition can receive more support and treatment. It also may result in further research on the condition and help reassure people that others share the same experience.
Although commonly thought to be a “less severe” eating disorder, binge eating disorder can cause significant emotional and physical distress and is associated with significant medical issues and an increased mortality rate.
Binge Eating Disorder Treatment
The first-line treatment for binge eating disorder in adults is individual psychological therapy. While there are a number of approaches that might be used depending on an individual’s situation and needs, some of the most common include:
CBT for Binge Eating Disorder
Manual-based cognitive behavioral therapy (CBT) is the most researched psychotherapy for BED, and at present, is the best-supported among all treatment options. CBT is a time-limited approach that focuses on the interaction between thoughts, feelings, and behaviors.
Key components of the treatment include psychoeducation, mindfulness, self-monitoring of key behaviors, cognitive restructuring, and establishing regular patterns of eating. CBT for BED addresses dietary restriction and the incorporation of feared foods. It also tackles thoughts about shape and weight and offers alternative skills for coping with and tolerating distress.
Finally, CBT teaches people strategies to prevent relapse. It is important to note that the goal of CBT is behavior change, not weight loss. When used for treating binge eating disorder, CBT doesn’t necessarily lead to weight loss.
Findings from randomized control trials consistently show that CBT can help people recover and abstain from binge eating.
Interpersonal Therapy
Interpersonal therapy (IPT), a short-term treatment that focuses on interpersonal issues, and dialectical behavior therapy (DBT), a newer form of CBT designed to address impulsive behaviors, are two therapies also supported by research for treating binge eating disorder.
Research suggests that people who have BED tend to have more interpersonal problems, which can contribute to feelings of psychological distress. While such problems predate the onset of the eating disorder, they often contribute to it.
While IPT shows promise in the treatment of binge eating disorder, one study found that it was less effective than CBT.
Other Psychotherapies
Additional psychotherapies for binge eating disorder have been studied and have shown promise, although there are at present too few studies to definitively conclude if they are effective.
Mindfulness-based eating awareness training (MB-EAT), which blends mindful eating with mindfulness strategies, has shown promise. This approach utilizes mindfulness practices to help people become more aware of hunger cues and alter eating behaviors in order to avoid binge eating.
Family therapy and group therapy may also be options, although little research exists to evaluate the potential efficacy of these treatment modalities.
Medications
Antidepressants, primarily selective serotonin reuptake inhibitors (SSRIs), have shown to be helpful in clinical trials in reducing the frequency of binges as well as eating-related obsessions. Antidepressants also (not surprisingly) reduced comorbid symptoms of depression.
Vyvanse (lisdexamfetamine), an ADHD medication that became the first medication to be approved by the Food and Drug Administration (FDA) for treatment of BED, has been studied in three trials and was associated with reductions in binge episodes per week, decreased eating-related obsessions and compulsions, and reductions in weight. Anticonvulsant medications, particularly topiramate (available as Trokendi XR, Qudexy XR, and Topamax), have also been studied and there is some limited evidence to suggest its usefulness.
While the research on Vyvanse and FDA approval for the treatment of BED is promising, all medications carry a potential risk of adverse side effects not found with psychotherapy alone.
A thorough discussion with your doctor can help you understand the pros and cons of your treatment options and whether any medications are right for you.
Binge Eating Disorder Discussion Guide
Get our printable guide to help you ask the right questions at your next doctor’s appointment.
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Self-Help and Guided Self-Help
Researchers leading a 2015 review study note that “the number of therapists with expertise in CBT for BED is limited.” Given a large number of afflicted individuals, this limitation poses a challenge.
One strategy to bridge the treatment gap has been the development of self-help and guided self-help treatments for binge eating disorder, which show promise.
Nutritional Counseling
Professional counseling that helps people learn more about nutrition can also be helpful in the treatment of binge eating disorder. Because many people with BED have a history of trying to lose weight, this counseling should not be focused on weight loss until the eating disorder has been treated.
Nutritional counseling can help people learn more about healthy eating habits and the essential nutrients they need to be healthy. It can also help people establish eating habits that will help them avoid binge-eating behaviors.
Concerns About Weight Loss Treatments
Because a significant percentage of people who have BED have obesity, people with BED have historically sought treatment for and been treated for weight loss. While some earlier studies seemed to show that behavioral weight loss might be effective for the treatment of BED, many of these studies were small and poorly designed.
A 2010 study found that behavioral weight loss was inferior to CBT in reducing binge eating and also did not result in significant weight loss; the study researchers concluded that “effective methods for producing longer-term weight loss remain elusive.”
Many eating disorder professionals now believe that attempts at weight loss among patients with BED may only exacerbate the problem and further entrench the disorder, causing intense shame and resulting in weight gain. While CBT and behavior change tends to result in weight loss, the main focus of these treatments is not on losing weight.
Recap
When treating BED, the focus should be on reducing binge eating behavior and not on weight loss. Efforts to lose weight during treatment can have detrimental effects and make the eating disorder worse.
How to Find Treatment
The National Eating Disorder Association (NEDA) maintains an online directory of member providers. Furthermore, some eating disorder specialists have experience in treating BED. It may be helpful to find a therapist who specializes in cognitive behavioral therapy.
Many CBT therapists work with disordered eating behaviors even though they may not specifically list BED as a specialty. If you are unable to find a local specialist, you may want to consider guided self-help or online therapy options.
Summary
Binge eating disorder is a serious condition that can have serious health consequences. Effective treatments are available, including cognitive behavioral therapy. Other options including interpersonal therapy, family therapy, medications, and self-help can also be beneficial. It is important to note that the focus should be on treating BED and not on weight loss.
A Word From Verywell
Binge eating disorder can disrupt your life, create distress, and have serious consequences on your health. If you are experiencing episodes of binge eating, talk to your doctor. Getting a diagnosis can help you get the treatment that is right for you.
If you or a loved one is coping with an eating disorder, contact the National Eating Disorders Association (NEDA) Helpline for support at 1-800-931-2237.
For more mental health resources, see our National Helpline Database.
