What to expect from CBT for EDNOS

April 4, 2019 2:59 PM

What will seeing a therapist to treat an eating disorder be like? What specific things does CBT involve, particularly related to eating disorders in adults? What happens in a therapy session? What happens in between? How long will this go on for? Basically, give me "CBT for eating disordered dummies 101", please!

I'm sure every therapist is different, and every client is different, but I'd really like some specifics on what, exactly, is involved in "therapy".

It has been strongly recommended to me that I go see a therapist for treatment for a long standing (but not currently life-threatening) eating disorder, technically classified as EDNOS, but in practice a vacillation between periods of extreme restriction and milder restriction + purging. CBT in particular was recommended to me, and I have a short list of recommended providers. I am considering actually doing this and calling one of them, but first I would really like a better idea of what I am getting into. Knowing as many specifics as possible will help me manage my anxiety around making that first call.

I have done some googling, but first-hand experiences would be helpful to help me get a range of possible situations to expect. I realize I could call one of these providers and ask them what to expect/what their approach is (and I will do that, once I actually make the call....), but I really have no baseline here and would like to calibrate my expectations.

I've never done therapy before, of any kind. Having lived with this disorder for an awfully long time, I am very skeptical that sitting in a room and talking about my feelings or my childhood will be useful. Will this be that? If I am going in with this skepticism, is it even worth it?

Any and all anecdotal and personal experiences with CBT and/or therapy for ED would be helpful.
Thanks.

posted by anonymous to Human Relations (4 answers total)

CBT is very much not "sit down and talk about your childhood." It's a set of techniques for changing the way you think about things, and the way your normal habits run. It's strongly linked to mindfulness exercises - be aware of what you're thinking, of what you're feeling, of what your body is experiencing, and learn how you can take action to change those.

Going in with skepticism is fine. A lot of CBT's approach is specific exercises, which you'd have to be willing to do even if you're skeptical. None of them are heavy "woo-woo" exercises. The closest are the meditation practices, and those are generally pleasant, even for people who find them ineffective.

(I've done a bit of CBT and haven't liked it. It was assigned/prescribed for depression, and a whole lot of it seems to be tied into fixing anxiety, which I either don't have, or it isn't tied to my depression.)
posted by ErisLordFreedom at 3:27 PM on April 4, 2019

This paper includes an in-depth rundown of what treatment involves starting on p. 616.

CBT for eating disorders works really well. Here's a study of it that found that about 2/3 of patients lost their eating disorder diagnosis after 20 once-weekly sessions, compared to 1/3 of patients in a short-term form of talk therapy.

One thing to be mindful of is that a lot of therapists will say that they do CBT when what they mean is they talk about thoughts and behavior- which is not CBT. You want someone who is specifically trained in the CBT treatment manual for eating disorders. They should be assigning weekly homework, telling you about how many sessions it will take for treatment to be over (usually 12-20), setting an agenda with you at the beginning of every session, and teaching you concrete skills.

Feel free to memail me if you want help finding a clinician in your area. I can reach out to my professional networks for ideas.
posted by quiet coyote at 3:42 PM on April 4, 2019 [5 favorites]

A lot of it may be about exposure, asking you to eat foods you normally avoid (without purging), etc., if that's a concern for you. This is about habituating to anxiety around eating.
There may be some behavioral chaining to understand the antecedents of your actions if you're binging.
There may be some thought records to get at core schemas (deep beliefs/distortions) that underlie your symptoms.
It does really depend on the behaviors.
Good luck! Good for you for pursuing treatment.
posted by namesarehard at 4:45 PM on April 4, 2019

Hi -- i am someone who actually got better from a severe eating disorder. I've done traditional therapy and CBD with varying results. CBD ended up really helping me, because it gave me specific strategies i could use to change my behavior. Two things I want you to know:

1. it is actually possible to get better, like, really better.
2. the most important thing, i've found, is to find a therapist you will be honest with. i know it can be hard to make connections with people especially when you feel pressured / under the gun / etc but if you're not clicking with a therapist, find a new one. (i know, easier said than done.) my eating disorder was kinda tied up in my people-pleasing personality traits so it was hard for me to admit to a therapist that i wasn't actually doing okay. When i found a person i could be honest with, it helped so much.

please memail me, if even just to check in. i am so glad you are doing this.
posted by capnsue at 5:57 PM on April 4, 2019 [6 favorites]