BMJ Group Medical Reference
What is it?
One type of cognitive therapy used to treat people with anorexia is cognitive behaviour therapy (CBT). The idea of CBT is that having extreme or unhelpful thoughts about yourself causes problems. Unhelpful thoughts make you behave in negative ways.
Here's how cognitive therapy tries to stop that cycle of thought and action.
What can it do for me?
At the start of each session, you and your therapist decide what you want to get out of it.
Each session with your therapist lasts about 50 minutes.
You talk about your feelings and how you feel about your weight and eating.
You and your therapist talk about why you are desperate to stay thin.
At the end of each session, your therapist asks you to do some homework. This might be to practice relaxation or write your thoughts in a diary.
The aims of this therapy are to help you:
What happens in cognitive therapy?
Learn the facts about anorexia and treatment, and about how they affect your body
Understand what might have caused your illness and what keeps it going
Understand that you can't be healthy unless you are a healthy weight
Express your emotions (how you really feel)
Understand how what you believe is linked to the way you behave
Change the things you believe about food and the way you view yourself and your body shape
Eat a healthy diet to keep your weight in the normal, healthy range for your height and build
Find ways to handle problems in your life.
There are lots of ways of doing cognitive therapy. But in all of them, you and your therapist try to change the way you think. You do this together by working out if you have hidden beliefs and ideas.
Here's a list of some of the things you might do.
Find out what thoughts are making you worried and ill. For example, you might think, "I'm too fat" every time you look in the mirror. Or, every time you have to try something new, you might think, "I have to be the best. Being second is no good". You feel that you can't control these thoughts. They just pop into your head. Thoughts that come up all the time like that are sometimes called 'automatic thoughts'.
Find out what your rules for living are. These are the general beliefs that you have about life. You develop them when you are young, and you may not even know you have them. One rule might be, "Unless I'm thin, nobody will like me". Beliefs like these control how you see what's going on around you. Often these thoughts are not true.
Get rid of bad rules and bad thoughts and replace them with better ones. The first step is to make a list of your automatic thoughts and your rules for living. Then you and your therapist will test them to see if they are really true. For example, you'll use questions like, "How will being thin make me happy?" Doing this can help you stand back, question these ideas, and find out how you think about yourself.
Learn and practice ways to be more positive. For example, you may learn how eating healthy meals makes you feel better and stronger. You may learn that putting on weight doesn't make people look down on you, and that you can feel good about the things you do well. Your therapist can help you as you try out new ideas and practice being more flexible.