Psychotherapy Treatment for Bulimia

Therapist using ACT for treating eating disorders

Contributor: Leigh Bell, BA, writer for Eating Disorder Hope

Bulimia, like all eating disorders, are challenging to overcome, but with the right treatment and dedicated participation from the person suffering, complete recovery is possible.

To date, the most successful based on evidence and research is cognitive behavioral therapy or CBT. Like its name suggest, CBT, aims to change thinking patterns (cognitive) and actions (behavioral) causing bulimia. This type of therapy is short-term, goal-oriented, and hands-on practical approach to problem-solving. [1]

CBT is effective treatment for bulimia mainly because the illness’s core psychopathology, over-evaluation of shape and weight, is cognitive in nature; and the binge-purge cycle is behavioral. [2]

The United Kingdom’s National Institute for Health and Clinical Excellence, or NICE, conducted an authoritative meta-analysis to establish evidence-based guidelines for clinical management of CBT for bulimia nervosa, called CBT-BN, and this is used in the United States as a baseline. [3]

Still, because only half of clients recovered with CBT-BN, researchers developed an “enhanced” version of the treatment, or CBT-E, and it appears to be more effective by using behavior changes to modify harmful thinking patterns.

CBT-E has four stages:

  1. First goal is to gain mutual understanding of the person’s eating problem and help the individual modify and stabilize eating patterns. This first stage also includes an emphasis on education and addressing any weight concerns.
  2. The brief second stage creates a treatment plan.
  3. The third phase includes weekly session’s focuses on what’s causing the bulimia. It usually involves the individual’s worries about body image and eating; and enhancing the ability to deal with day-to-day events and moods.
  4. During the transition from stage three to four, the emphasis shifts to the future — dealing with setbacks and maintenance of the changes already made.

Doctor and patientRoughly 60 percent of people who receive treatment for an eating disorder recover from it, and why the other 40 percent don’t is unknown. Cognitive behavioral therapy seems quite effective, but some clinicians just aren’t using it.

One study found Implementation of specific CBT techniques to treat eating disorders was far lower than protocols would suggest, particularly for clinicians who were anxious, older, or more experienced in working with the illness. [4]

The study suggests if CBT were used more regularly and effectively, patients would have a greater chance to recover from an eating disorder.

About the Author:

Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. Leigh is recovered from a near-fatal, decade-long battle with anorexia and the mother of three young, rambunctious children.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.


  1. Ben, M. (n.d.). In-Depth: Cognitive Behavioral Therapy. Retrieved May 23, 2015, from
  2. Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive Behavioral Therapy for Eating Disorders. The Psychiatric Clinics of North America, 33(3), 611–627.
  3. Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. (n.d.). Retrieved May 23, 2015, from
  4. Waller, G., Stringer, H., Meyer, C. (2012). What cognitive behavioral techniques do therapists report using when delivering cognitive behavioral therapy for the eating disorders? Journal of Consulting and Clinical Psychology, 80(1), 171-175.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on May 26th, 2015
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About Jacquelyn Ekern, MS, LPC

Jacquelyn Ekern founded Eating Disorder Hope in 2005, driven by a profound desire to help those struggling with anorexia, bulimia and binge-eating disorder. This passion resulted from her battle with, and recovery from, an eating disorder. As president, Jacquelyn manages Ekern Enterprises, Inc. and the Eating Disorder Hope website.