Cognitive Behavioral Therapy

I have made a self-guided CBT/DBT workbook here - Coming FEB 2025. There’s a link for the workbook at the bottom as well. 

A Little Introduction to 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. 

I have provided tools for each “Part”. If you would like to start learning about yourself and begin your journey to recovery, I have linked my article that goes more in depth about the tools and skills for CBT/DBT here - Coming FEB 2025. Still not convinced that this will help you? Continue reading a deeper dive into CBT and you can see if this is for you.  

A Deeper Dive Into Cognitive Behavioral Therapy

CBT is a form of psychotherapy that combines cognitive therapy and behavioral therapy. The treatment is founded on the idea that our thoughts, feelings, and behaviors are all interconnected and influence one another (2). It is a very well studied practice, and many people have recovered from their eating disorders after participating in CBT treatment. One thing I want to note, for the best chance at recovery, CBT should be paired with an eating plan (mine is coming FEB 2025).

The cognitive aspect of CBT focuses on identifying and evaluating thought patterns. Its goal is to “recognize and change false and distressing beliefs” (3). The cognitive aspect uses tools like the “thought record” to identify what’s going on in your head when you feel a change in your mood, as well as “cognitive distortion identification” so you can see the thoughts you have that may be untrue. 

The behavioral aspect of CBT is rooted in the belief that behavior is a learned practice and can therefore be changed. Its goal is to figure out what behavioral patterns make the patient's life more difficult, and then focus on changing those (3). The behavior aspect uses tools like the “behavior chain” to evaluate your binges and “cope ahead” strategies to plan for future triggers. 

Why will participating in CBT help my eating disorder? 

In terms of eating disorders, overvaluation of shape and weight is often both a cause of them, and a reason they continue (1). Recall that cognitive therapy focuses on recognizing your thought patterns and changing false or distressing beliefs. Understandably, most of us focus on our shape and weight and may want to change that. I had to do many iterations of “thought records” and “radical acceptance” tools before I was able to understand the importance of not overvaluing my body shape. My belief is still that shape and weight is important. HOWEVER with the realization that losing weight or gaining muscle is not done in a day or even a week, having distressing, negative thoughts about shape and weight EVERYDAY is not productive. My constant distressing beliefs often led me to try and fast, or extreme diet, which only increased my binge episodes. Therefore, using the tools from CBT like the “thought record” and “radical acceptance” to challenge these views is helpful in improving one's daily life. 

The behavioral aspect of CBT is equally important for those with eating disorders because it focuses on changing harmful behavioral patterns. Binge/purge habits are definitely harmful behavioral patterns and the tools from CBT guide the user through dissecting these maladaptive behaviors. I know for me, at first it was very difficult to figure out why I was bingeing, it seemed like most of the time I felt “off” and then the binge just happened. After using the CBT tool the “behavior chain” I was able to start analyzing my binges and begin to identify my triggers. There is also a “cope ahead” tool I’ve included. It’s technically part of DBT but is very helpful for eating disorder recovery. The premise of the “Cope ahead” tool is to literally plan coping mechanisms or skills to use for upcoming situations that you know may trigger a binge. Some of these for me were “going grocery shopping” and “studying for a test”. This tool has you go in-depth and analyze all parts of a given situation that might trigger negative emotions. You then plan HEALTHY ways you can cope with such situations, lowering your chance of bingeing. 

The best part about CBT, is that most of the tools combine the cognitive side and the behavioral side. In the behavior chain for example, you have to write out the thoughts and emotions you had before you binged. The intention behind this is that the individual will begin to see how their thoughts influence their feelings and behaviors, in essence creating their bad habits. By using these tools to learn about yourself and what makes you tick, you begin to understand your binges and can ultimately find ways to change your behaviors. It takes practice, so don’t give up, but I promise, your effort isn’t in vein. 

CBT and other Disorders

More often than not, eating disorders are comorbid, meaning that they are accompanied by other psychodisorders. CBT is a great tool because it is not only focused on treating eating disorders, but also helps with the disordered thinking and behaviors that come with these other psychodisorders. To date it is also used to treat depression, anxiety, OCD, PTSD, panic disorder, phobias, bipolar disorder, borderline personality disorder, schezophrenia, and sleep problems to name a few (4). Participating in CBT is beneficial because not only can it help treat your eating disorder, but also any underlying disorders that you may not have even been aware of. 

A Snippet From me About Why CBT is IMPORTANT

Recall that the brain is a muscle, and that thinking patterns and neural pathways CAN be changed (video snippet here)! 

My friend’s therapist once said to her, "We repeat 70% of what we said yesterday" meaning, if I say a lot of negative things today, I will more than likely repeat them again tomorrow and the next day and so on, so, if I can start trying to say positive things about myself, my self talk will improve over time.

CBT forces you to see how your current thinking patterns may be flawed. You will do this by comparing your thoughts to what are called “cognitive distortions” in the CBT tool “cognitive distortion identification”. Then, through repeated identification of these distortions, you will begin to catch these “untrue” thoughts in the moment. By “catching” and “changing” these thoughts, you build new thought pathways (which we already know, lead to different behaviors). 

The key is REPETITION. Writing down one “cognitive distortion” is not going to change your path of thinking. REPEAT it to yourself. Keep doing those tools! Connect the dots enough to where you can start predicting “this situation will lead me to think this. BUT I DON’T WANT TO THINK THAT. Therefore I am going to THINK LIKE THIS INSTEAD” . 

One example from my own life: I know that when I wake up, I am usually hungry and my first thought is, “I want chocolate” followed by “I haven’t eaten anything yet so maybe it would be ok if I had a little bit”. But I KNOW that this usually leads me to overeating and feeling bad about myself. So instead I replace that thought with, “I feel like I want to eat chocolate, but I know that I will likely overeat. Instead I could have something sweet like yogurt and fruit. I can eat enough to feel full and I don’t have to feel bad about it.” After telling myself that, I walk out to the kitchen, and eat the yogurt from the fridge instead of the chocolate from the cupboard. After doing this enough times, my hope is that eventually I wake up thinking, “I want yogurt”. 

  These tools are helpful because they will likely also point out other negative behaviors and thought patterns that may be TRIGGERS for disordered eating behaviors. For instance, I realized that many situations and events made me anxious. I also realized that FEELING overly anxious was a common reason I would binge eat. Thus I began working on my thought pathways and coping mechanisms when I noticed I was becoming very stressed out, which in turn has helped me with my eating disorder behaviors. I highly encourage you to at least take a look at some of the tools and skills associated with CBT. It may be helpful not only for your eating disorder but for your life in general. 

A quick note on DBT

In my broken down guide to overcoming your eating disorder, there are also many DBT tools used, so I wanted to give a brief overview of DBT in relation to CBT. DBT BY ITSELF has not currently been studied in eating disorder treatment (as far as I have researched). However, I personally have found many DBT tools (such as the emotion identification and cognitive distortion worksheet, as well as tools for interpersonal effectiveness) helpful in my own recovery, so I wanted to include them to give you the best chance at recovery possible. I do want to note that CBT is very well studied and has been proven effective for eating disorder treatment so I tried to include as many CBT tools as I could. In the eating disorder program that I attended they used a combination of CBT and DBT tools to aid in our recovery. 

Ok, so what is DBT? 

While CBT is about recognizing detrimental thought patterns and finding ways to change them, DBT is more about regulating emotions, being mindful, and learning to accept pain (6). DBT has four modules including mindfulness, distress tolerance, interpersonal effectiveness, and emotion regulation (7). 

Often, people will use DBT skills to regulate their emotions and then can transfer to more CBT related skills that address detrimental thought patterns and how to change them (6). In the 5 parts that I laid out above, that’s exactly what you will do. Learn to recognize and regulate your emotions first, then delve into changing your thought patterns and behaviors, and finally, learn how to communicate your wants and needs with others. 

Thanks for reading!

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 as well as guided instructions. 

Resources 

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

   
   

2. “In Brief: Cognitive Behavioral Therapy (CBT).” InformedHealth.Org [Internet]., U.S. National Library of Medicine, 2 June 2022, www.ncbi.nlm.nih.gov/books/NBK279297/. 

informedhealth.org. (n.d.). Cognitive behavioral therapy (CBT) | informedhealth.org. 

3. informedhealth.org. (n.d.-b). Cognitive behavioral therapy (CBT) | informedhealth.org. informedhealth.org. https://www.informedhealth.org/cognitive-behavioral-therapy-cbt.html

   
   

4. Department of Health & Human Services. (n.d.). Cognitive behaviour therapy (CBT). Better Health Channel. https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cognitive-behaviour-therapy

   
   

5. “Therapy Worksheets, Tools, and Handouts.” Therapist Aid, www.therapistaid.com/. Accessed 13 Nov. 2024. 

   
   

6. Shannon. (2023, May 26). CBT vs. DBT | Skyland Trail. Skyland Trail. https://www.skylandtrail.org/4-differences-between-cbt-and-dbt-and-how-to-tell-which-is-right-for-you#:~:text=CBT%20focuses%20on%20how%20your,potentially%20destructive%20or%20harmful%20behaviors.

   
   

7. The four Skill Modules | DBT Skills Group of NJ. (n.d.). https://dbtskillsgroupnj.com/four-skill-modules/