Eating disorders are complex mental and physical illnesses with varying biological, psychological, and social contributing factors. Treatments that are most effective for eating disorders often address all of these aspects. Below are the most common therapeutic treatments for eating disorders, many of which are used in combination with one another.
Cognitive Therapy for Treating Eating Disorders
Cognitive therapies are based on the foundational work of identifying the thoughts and beliefs that influence symptoms, choices, and behaviors. Research has found cognitive therapies to be some of the most effective treatment ideologies for mental illnesses including eating disorders.
Cognitive Behavioral Therapy (CBT)
Cognitive Behavioral Therapy (CBT) is the leading evidence-based treatment for eating disorders. This therapy is time-limited and goal-oriented, meaning sessions will focus on how skills, work in session, and homework assignments can support the individual in reaching their specific recovery goals.
For eating disorder treatment, CBT involves identifying the beliefs and thoughts that influence eating disorder pathology and engaging in work to replace these disordered thoughts and beliefs with recovery-focused thoughts and beliefs in order to alter mood and behavior. Research finds this effectively treats eating disorders as well as comorbid personality characteristics and mental health diagnoses such as alcohol abuse, depression, and anxiety .
Dialectical Behavior Therapy (DBT)
Dialectical Behavior Therapy (DBT) is a type of cognitive therapy developed by Marsha Linehan. DBT emphasizes the integration of opposites, referred to as the “dialectical.” This is intended to combat an individual’s black-and-white thinking and subsequent choices by emphasizing that one can be happy and stressed, love someone and be angry with them, or miss their eating disorder and acknowledge it is not good for them.
DBT teaches skills focused on 4 main areas that can improve mood and behaviors – emotion regulation (regulating uncomfortable emotion-states), distress tolerance (tolerating distress when the situation cannot be changed), mindfulness (existing in the present moment without judgment), and interpersonal effectiveness (communicating needs and boundaries while maintaining relationships). These are all areas individuals with eating disorders often struggle with and strengthening them can support improved mood stabilization, reduction of behaviors, and, ultimately, recovery.
Acceptance and Commitment Therapy (ACT)
Acceptance and Commitment Therapy (ACT) involves encouraging individuals to identify their values and act in alignment with these. ACT considers values to be the meaningful and purposeful parts of life that individuals care about and that motivate them to engage in actions .
ACT teaches individuals to “make a behavior change according to your values and accept, defuse, stay aware of your core self and contact the present moment in order to support such behavioral change .” This therapy also acknowledges barriers to doing this and encourages individuals to continue learning and practicing making choices and choosing cognitions based on their values despite these barriers.
For individuals with eating disorders, ACT would involve identifying an individual’s core values that are not related to the eating disorder and practicing thoughts, beliefs, and behaviors that reflect these values as opposed to their disordered values.
Exposure and Response Prevention Therapy (ERP)
ERP involves exposing individuals to the thoughts, feelings, and situations that trigger their distress or disordered behaviors and then encouraging them to utilize different skills. An individual with an eating disorder might be exposed to fear foods or encouraged to engage with their weight-restored body and would then be taught skills to cope instead of coping with these distressing situations using eating disorder behaviors.
This treatment can be effective because individuals are not simply taught coping skills and are isolated from the things that trigger them. Instead, they face that which is triggering head-on and learn how to maintain recovery despite them.
Interpersonal Psychotherapy (IPT)
Interpersonal Psychotherapy is a type of cognitive therapy that specifically emphasizes the impact interpersonal interactions can have on mental health and disordered behaviors. This therapy focuses on relationship conflicts, impactful life changes, grief and loss, and difficulties in sustaining supportive relationships.
For those with eating disorders, each of these areas can be a key trigger to disordered behaviors. Addressing how an individual can cope with life changes, conflict resolution, and communication and boundary-setting can go a long way in reducing the negative impact of these triggers as well as allowing the individual to effectively utilize their support system as they work toward recovery.
Medical Nutrition Therapy
Medical Nutrition Therapy is often used in combination with other cognitive therapies, as it considers the impact that malnourishment has on physical health conditions as well as cognitions. Medical Nutrition Therapy focuses on the foundational belief that malnutrition will worsen medical health as well as an individual’s mood states.
The treatment focused on educating individuals on what nutrition supports their bodies and brains working optimally and encouraging them to engage in these nutrition choices consistently in order to maintain both physical and psychological wellness.
Learn More: Medical Nutrition Therapy
Alternative and Holistic Approaches
Holistic therapy approaches are becoming more common these days for good reason. These therapies might use tactics of the above-mentioned treatments while focusing on the individual as a whole being rather than as someone that is “sick.” These therapies address the entire person, not only their physical well-being, psychological state, or interpersonal dynamics. For this reason, a holistic approach can be helpful for those with eating disorders, as they never impact only one of these areas.
Art therapy supports eating disorder treatment and recovery because it provides individuals with another method of communication. Individuals might struggle with verbally communicating their thoughts and feelings. Without identifying these aspects, it is difficult to explore the roots of the eating disorder more deeply. Art therapy allows the individual a creative outlet to explore these aspects as they develop a language to communicate their experiences of their disorder.
Similar to Art Therapy, Dance Therapy can provide an opportunity for the individual to communicate using movement. Beyond this, Dance Therapy also encourages connection with the body and mindful movement, all of which can support healing the relationship an individual has with their physical body. It also provides individuals with another outlet for uncomfortable emotions that is more effective and less harmful than eating disorder behaviors.
Equine Therapy, or, therapy with horses, is becoming more common. The relationship between humans and animals can be very healing and this is found to be especially true with horses because they are particularly intuitive. Additionally, an individual’s response to an animal’s behavior can be telling of belief systems they hold without being aware of it. For example, if they believe the horse isn’t coming near them because they “don’t like them” or something is wrong with them as a person, this indicates an area of core beliefs about the self that can be explored. The interaction with a horse also requires intense focus on the task-at-hand, encouraging existing in the present moment mindfully and allowing the mind to focus on something other than eating disorder preoccupations.
Family and Group Therapy
Family-Based Treatment (FBT) is often incorporated into eating disorder treatment because of the importance of the family dynamic on eating disorder beliefs and behaviors. Whether due to the familial beliefs around food, weight, exercise, and the body or simply the family dynamics that may provide support or be a trigger, the family plays a large role in the development and mental wellness. Including the family in treatment can be helpful in allowing an individual to address these areas in a supportive and communicative environment.
Combined with Pharmacotherapy
Many individuals combine therapeutic treatment with pharmacotherapy and treatment centers often provide this service. Research indicates that the most effective treatment for many mental illnesses includes a combination of therapy and medication. While one is unlikely to recover from an eating disorder taking medication alone, the combination of both allows the individual support in stabilizing mood while they also develop insights into their mediating beliefs as well as strengthen their coping skills.
How to Get Help for an Eating Disorder
To learn more about how you can access one or more of the types of treatments mentioned above, the first step is to go to your therapist, primary care, or insurance company. These individuals can refer you to resources in your area that is covered under your insurance. Additionally, eating disorder advocacy websites often have resource lists that can help you in finding treatment centers accessible to you.
Resources Turner, H. et al (2016). CBT for eating disorders: the impact of early changes in eating pathology on later changes in personality pathology, anxiety, and depression. Behavior Research and Therapy, 77.  Moran, DJ. (2020). Values and committed actions in ACT. Psychotherapy Academy. Retrieved from https://psychotherapyacademy.org/acceptance-and-commitment-therapy-the-essentials/values-and-committed-actions-in-act/.
Author: Margot Rittenhouse, MS, LPC, NCC
Page Last Reviewed and Approved By: Jacquelyn Ekern, MS, LPC / 12.2.21