PSYCHOLOGICAL THERAPY FOR EATING DISORDERS
I work with adults with anorexia nervosa, binge eating disorder, body image issues, body dissatisfaction, bulimia nervosa, chronic or yo-yo dieting, eating problems, and/or low self-esteem. I do not work with children and adolescents.
I work with ARFID as long as clients are not nutritionally deprived. I will work in a neurodivergent affirming way to support clients to introduce new foods, within the CBT-E model.
Please note: I do not accept referrals for individuals with a BMI under 18.5 due to the health related implications of being at this low weight, which would benefit from the combined care of a multidisciplinary team.
The most recent NICE guidelines (National Institute for Health and Care and Clinical Excellence, 2017) recommend CBT-ED as an evidence-based treatment for all eating disorders. CBT-E is one major example of the specialist cognitive-behavioural therapies for eating disorders covered by the umbrella term “CBT-ED”. Probably CBT-E has the most evidence to support its use (of the “CBT-ED” therapies). There is a large body of research to suggest that CBT-E is effective in helping individuals suffering from eating difficulties to achieve full recovery. Due to this, CBT-E is the primary form of therapy I use in treatment. However, at times, other therapeutic approaches including psychodynamic, person centred and relational therapy might also be incorporated into the sessions, based on individual needs.
CBT-E
Cognitive Behavioural Therapy-Enhanced (CBT-E) is a specialised type of CBT created for eating disorders. It is based upon the evidence that our behaviours, feelings and thoughts are connected and have influence over one another. Eating disorders often are characterised by a pre-occupation with shape and weight and difficulties managing adverse life events and moods. This tends to lead to unhelpful behaviours around food (including restricting the amount or type of food consumed, overeating, binge eating and/or purging). This is a pattern that then has an impact on emotions, and can lead to feelings of anxiety, low self worth and/or low mood. The aim of CBT-E is to identify and address this cycle, in order to change behaviour around food, support adaptive thoughts about body shape and weight and improve upon self-worth.
CBT-E will usually last for about 20 treatment sessions over 20 weeks, with a check-in 20 weeks later.
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Treatment usually starts with two sessions a week. After a month or so, the sessions become weekly, and towards the end of treatment they are spread further apart. This pattern may differ in certain contexts. However, it is important to have as few breaks in treatment as possible.
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Very early in treatment you and I will create a diagram illustrating what is keeping your eating problem going. The diagram will be used to guide your treatment, rather like a road map.
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Early in treatment you will be taught how to monitor your eating behaviour and accompanying events, thoughts and feelings in real time (as you go through the day). I will help you to understand more about your body weight and how to assess it. Treatment will involve you knowing your weight and I will discuss with you any concerns you might have about this.
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You will then be helped to introduce an eating pattern that involves eating at regular intervals through the day.
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Later in treatment there will be an emphasis on the following (if these apply to you):
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Improving your body image and decreasing any concerns about your appearance.
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Helping you cope with life situations that are likely to influence your eating.
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Eating more flexibly whilst remaining in control of your eating.
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Towards the end of treatment you and I will devise a plan to help you stay well in the future.