CBT Exercises for Treating Eating Disorders
Cognitive Behavioral Therapy (CBT) is the leading evidence based approach for treating eating disorders. Why it works so well for treating eating disorders is it helps those struggling look at the connection between their thoughts, emotions, and behaviors, which can often be challenging to identify and understand normally never mind while struggling with an eating disorder! It’s important to note that we know emotions can trigger behaviors, emotions can also trigger thoughts. Thoughts can trigger emotions, and thoughts can also trigger behaviors. It is a cycle where the three can influence and trigger others in any sequence! Is your head spinning yet? It’s a lot to take in! I’ll give an example to help clarify it.
When struggling with an eating disorder, a triggering event that can often set off emotions and behaviors is when food is spontaneously brought into an environment and you didn’t have a chance to mentally plan for it. If you are struggling with an eating disorder, you probably understand the discomfort when something spontaneous, out of your control happens, especially with food! The triggering event (food being brought in without your knowledge) might trigger thoughts like, “I didn’t plan for this,” or, “I can’t eat this, I didn’t exercise today.” Those thoughts might then trigger emotions such as fear, frustration, anger, and sadness. As a result of those thoughts and emotions, behaviors might looked like restricting completely, or allowing yourself to have some food but then feeling immense amounts of shame and guilt after. Those emotions might further trigger thoughts and behaviors, and so you can see the cycle continue.
CBT Triangles
I know this seems like a lot, but image experiencing all of this in a short amount of time and having no understanding as to how or why it’s happening. That’s where the first exercise comes in! CBT triangles help break down each of these three parts so you, the person experiencing all of this, can identify and better understand what exactly you were going through! A visual for this triangle comes from a great website called Therapist Aid.
Here you can see the situation, thoughts, behaviors, and emotions are all laid out. This also allows us to better understand how we could have changed the thoughts (cognitive restructuring, a main aspect of CBT) to influence different emotions, and thus, behaviors.
The ABCs of CBT
Another exercise I love is called the ABC’s of CBT. A stands for Activating Event, B stands for Beliefs, and C stands for Consequences. What I love about this activity is that it shows us deeper beliefs that we might be struggling with that influence the eating disorder or other unhelpful behaviors in our life. Similarly to the other activity, Activating Event means the triggering situation or experience. Using the example above, that would be food being brought in unexpectedly. Different than the exercise above though, Beliefs look at what underlying belief or narrative you defaulted to as a result of the trigger. In the example above, it might have looked something like, “I don’t deserve to eat,” or, “Everyone else can have that, but I can’t” which I call the “exception to the rule thinking.” This gives us a better look at different beliefs you might be holding onto that shape your thoughts and behaviors, not just in this situation but in others, as well! It also gives us an idea of beliefs you have that don’t have any evidence so we can challenge them with facts instead! Consequences is similar to behaviors in the activity above whereas we’re looking at what came as a result of the event and beliefs, how you reacted or how you treated yourself after. Below is a great visual for this activity, as well.
You don’t have to figure it all out alone.
If this is your first time seeking support for challenges you are facing, you are so BRAVE! Remember that seeking support is a sign of strength, recognizing that you need help and asking for it, not weakness. If this all feels confusing to you, also remind yourself that these exercises take practice and time! We often do them over and over in sessions so they become like second nature for you to apply right after and even during activating events. If you need support in navigating this, feel free to reach out for help! Also, check out the resources below for more information on CBT treatment for eating disorders and other mental illnesses.
Sources:
https://www.verywellmind.com/cognitive-behavioral-therapy-for-eating-disorders-4151114
https://www.verywellhealth.com/abc-therapy-5217670
