CBT & DBT

If you’ve read my article on cognitive behavioral therapy, and clicked the link to this page, yay! If you’ve just stumbled upon this article that’s also great! In my previous article on cognitive behavioral therapy I discussed what it was, and why it’s helpful in treating binge eating. If you want to read that first, the link is here.On this page I will briefly go over what CBT is, and review the parts I’ve divided recovery into (based on my own recovery experience). Then below there will be links to all the tools I’ve provided. They can also be found on my “resources” page. 

What is Cognitive Behavioral Therapy?

The basis of cognitive behavioral therapy is that our thoughts, emotions and behaviors are all interconnected. Thus, by understanding the way we think and feel, we can work towards changing our actions. Below I have broken down the steps to overcoming your eating disorder through CBT and DBT exercises into manageable portions. 

Part 1

The first step is being able to identify each (our thoughts, emotions and behaviors). 

*Part 1 actually uses many DBT skills as DBT’s focus is on managing emotions

Part 2

The second is to understand why we might be thinking/feeling/behaving these ways, and begin to see the overarching ways we might see the world.

Part 3

The third step is to begin changing any disordered thoughts and feelings we have, in hopes that it will also change the behaviors that are affecting our lives in negative ways. 

Part 4

The fourth step involves identifying our triggers and planning ahead for future challenging circumstances. 

Part 5 

This last step includes tools for interpersonal effectiveness. You will learn how to accept yourself and how to best communicate with others. 

*Part 5 also includes many DBT skills as one of DBT’s focuses is on communication

The end goal of CBT is to give our brains a pause to make a conscious decision (1), so that our thoughts don’t immediately determine our actions. This way the want to binge doesn’t automatically mean that we will engage in it. 

So how do I start? 

Beginning your recovery journey 

These are listed in order but you are welcome to jump around to different tools that you feel might be useful to you. All these tools may seem overwhelming at first, but just do one step at a time. One tool at a time. You can do this. Also, while you are going through you may notice that “Work on ways to reduce maladaptive behaviors” is in each section. This was not a mistake. It is a reminder to continue doing these helpful tools each step of the way.

Part 1

The first step is being able to identify each (our thoughts, emotions and behaviors). 

1. Identify your thoughts, feelings and emotions. 

   1. Begin checking in with yourself. Start with 5 minutes at the beginning of the day, 5 minutes after you get home from work/school etc, and 5 right before you go to sleep. Oftentimes our days are busy and we don’t even have time to think about how we are doing. This practice of seeing what you are actually thinking and feeling gives important clarity to your life as a whole.  

      1. Tool: Self-Check in

      2. Tool: Emotion identification - for distressing events

2. Identify your mood shifts. 

   1. After learning to identify your thoughts, feelings and emotions, you may begin to notice with more clarity when your mood changes. This is a tool to use for when you feel a negative shift in your mood. The purpose of this tool is not meant to “solve” negative mood changes but rather to give a different perspective on them. It is also helpful for beginning to recognize your triggers for maladaptive coping.

   2. Tool: Thought record - for when you feel a negative shift in mood 

3. Begin to identify your maladaptive behaviors

   1. Common maladaptive behaviors

   2. Tool: Reverse behavior chain 

4. Work on ways to reduce maladaptive behaviors 

   1. Tool: Box-Breathing - for immediate coping in overwhelming situations

   2. Tool: PEARS worksheet - daily plans for a more well-rounded life

   3. Tool: Cope ahead - for upcoming situations that you know will be difficult

   4. Tool: STOP skill - I recommend printing this out and taping it on your pantry.

Part 2

The second is to understand why we might be thinking/feeling/behaving these ways, and begin to see the overarching ways we might see the world.

5. Begin to understand the lens you view the world in (Cognitive Distortions) 

   1. After numerous thought records, you may begin to see a pattern in the way you think. Below is a link to some common ways people view the world (cognitive distortions). Every single person sees the world in a different way. Understanding your specific views is helpful in identifying common cognitive distortions you may have. 

      1. Cognitive distortions

      2. Tool: Cognitive distortion identification

      3. Maladaptive schemas - I encourage everyone to at least take a look!

      4. Early maladaptive schema test - this is a 30 minute FREE survey where you will answer questions to determine what schemas are most present in your life. Your schemas help you to see what kind of lens you view the world through and I HIGHLY recommend you take this quiz. 

6. Work on ways to reduce maladaptive behaviors 

   1. Tool: Box-Breathing - for immediate coping in overwhelming situations

   2. Tool: PEARS worksheet - daily plans for a more well-rounded life

   3. Tool: Cope ahead - for upcoming situations that you know will be difficult

   4. Tool: STOP skill - I recommend printing this out and taping it on your pantry.

Part 3

The third step is to begin changing any disordered thoughts and feelings we have, in hopes that it will also change the behaviors that are affecting our lives in negative ways. 

7. Restructure your thinking - begin replacing your distorted thoughts with realistic ones

   1. An important note is that often we cannot change our initial emotions when a situation arises. Hopefully though, the previous tools have taught you WHY you might feel that way emotionally. These tools are also found in previous steps, but this time FOCUS on the “replacement thought” or “wise mind”. This is how you WANT your brain to start thinking. 

      1. Thought Record - a repeated tool, really focus on the wise mind now. 

      2. Cognitive distortion identification - another repeated tool, focus more on your replacement thought. 

8. Work on ways to reduce maladaptive behaviors 

   1. Tool: Box-Breathing - for immediate coping in overwhelming situations

   2. Tool: PEARS worksheet - daily plans for a more well-rounded life

   3. Tool: Cope ahead - for upcoming situations that you know will be difficult

   4. Tool: STOP skill - I recommend printing this out and taping it on your pantry.

Part 4

The fourth step involves identifying our triggers and planning ahead for future challenging circumstances. 

9. Identify triggers/vulnerabilities that make you susceptible to future depression/anxiety/maladaptive behaviors. 

   1. Tool: Trigger Identification 

10. Make a plan. Recovery is not linear. Continue to learn from and document your struggles. 

    1. My recovery journal - Try and write in the journal at least 5 minutes per day. Habit forming behaviors are important and the only way to change your neural pathways is through repetition.  

    2. Radical acceptance - Accepting your life

    3. Personal Bill of Rights - Good as daily reminders

11. Work on ways to reduce maladaptive behaviors 

    1. Tool: Box-Breathing - for immediate coping in overwhelming situations

    2. Tool: PEARS worksheet - daily plans for a more well-rounded life

    3. Tool: Cope ahead - for upcoming situations that you know will be difficult

    4. Tool: STOP skill - I recommend printing this out and taping it on your pantry.

Part 5 

This last step includes tools for interpersonal effectiveness. You will learn how to accept yourself and how to best communicate with others. 

12. Interpersonal communication 

I left this part of CBT for the end because now that you have a better grasp on who you are and what makes you tick, you can begin to see how thoughts, feelings, and behaviors might affect your relationships. Many people who struggle with something like an eating disorder have difficulty expressing themselves. As a result of holding negative or angry thoughts and emotions in, it is common to turn to food for a sense of relief. The goal of this is to begin using the assertive communication style to express your wants and needs instead of turning to food.

1. Tool: you are enough (I know this sounds cheesy but please don’t skip it) 

2. Styles of communication

3. Tool: DEAR MAN - this is actually a DBT tool, but is very helpful for learning to communicate your needs. 

4. Use your other skills and tools to identify your cognitive distortions when communicating with others. Use your cope ahead when you know you are going to be in a stressful situation involving others (first day of a job, going on a date etc.). Use your thought record when you notice that an interaction affects your mood. 

13. Work on ways to reduce maladaptive behaviors 

1. Tool: Box-Breathing - for immediate coping in overwhelming situations

2. Tool: PEARS worksheet - daily plans for a more well-rounded life

3. Tool: Cope ahead - for upcoming situations that you know will be difficult

4. Tool: STOP skill - I recommend printing this out and taping it on your pantry.

This is a lot. I provided a lot of skills and tools, so try not to get overwhelmed. Start with just writing in your journal for 5 minutes a day. Then begin to section out 15 minutes to complete a tool. Recovery is not overnight, although many of us may hope for that. This takes time and patience. Don’t give up. 

My last piece of advice, once you get a hang of things, CONTINUE USING ALL THE TOOLS. Repetition is CRUCIAL. If you like one tool more than another, keep using it. Using the same tool over and over doesn’t mean you’re not making progress! In fact it actually means the opposite, you are LEARNING ABOUT YOURSELF. That is the most important part of recovery! Keep at it! 

If you would like a more guided, tangible book, I have written one for purchase HERE - Coming FEB 2025. It’s a $30 interactive book with multiple printouts of the above mentioned worksheets. It also comes with an attached journal and incorporates a rewards system for helpful motivation. 

  I want to make a disclaimer, I am not a certified anything. I have however done quite a bit of research on this topic, and participated in an intensive outpatient program for my own eating disorder. Luckily my insurance covered the IOP program, but I know that not everyone is able to afford such a thing or take off so much time from work to participate in an ED program. Many of us even find it difficult to afford therapy. My goal is to make these resources more accessible to people struggling, and to suggest reasonable ways to begin tackling your eating disorder without breaking the bank or usurping all of your time. 

Resources

1.  Fairburn, C. G. (1995). Overcoming binge eating. Guilford.