Fairburn's Cognitive Behavioral Therapy for Treating Bulimia Nervosa

Fairburn's cognitive behavioral therapy is currently the most empirically validated treatment for bulimia nervosa. This treatment is superior to other treatments, such as pharmacotherapy and others. In this article we'll examine it.
Fairburn's Cognitive Behavioral Therapy for Treating Bulimia Nervosa

Last update: 17 January, 2022

Fairburn’s cognitive behavioral therapy is a treatment for fighting bulimia nervosa on a psychological level. Bulimia nervosa is an eating disorder, characterized by frequent bouts of binging, along with an unbalanced diet and manner of eating. Furthermore, eating is often followed by compensatory behavior, like self-induced vomiting or the use of laxatives. This occurs in response to the immense anxiety that a person with bulimia feels when they’ve binged. In effect, they’re attempting to purge themselves of the act of binging, due to their feelings of guilt and shame.

As we mentioned earlier, Fairburn’s cognitive behavioral therapy is one of the most effective and widely used treatments for this disorder in clinical practice. Its methodology is semi-structured, problem-oriented, and lasts around five months. Furthermore, Fairburn’s therapy focuses primarily on the present and future, rather than the past.

The therapy consists of three different stages. The main objective is for a patient suffering from bulimia nervosa to gain control over their own diet. Another important goal of note is creating a healthy perspective on weight and body image over time.

A patient will be made to understand that they’re responsible for change. The therapist maintains the role of motivating, supporting, and offering them guidance and information.

A sad person wielding a tissue, discussing with their therapist.

Fairburn’s three-step plan to beat bulimia nervosa

Step one: understanding bulimia nervosa

The first step lasts approximately eight weeks. During this time, the patient will undergo weekly interviews, unless more severe symptoms appear. However, the therapist may dedicate additional sessions to those with dangerous dietary habits. During these eight weeks, the therapist will attempt to identify any specific points of interest and design a treatment plan. In order to do this, they must take into account the cognitive structure of bulimia nervosa.

The vicious cycle of bulimia nervosa means that sufferers have an unrealistic idea of their ideal weight and their appearance. This causes them to consume extremely low-calorie diets.

This kind of extreme dieting facilitates binge eating. That’s because the patient feels more hungry than normal. Following the binging, guilt, shame and other negative emotions often emerge. They lead the sufferer to induce vomiting and use laxatives. This short-term release of their negative emotions once again makes the idea of dieting appeal to the patient. Hence the cycle begins again.

Keeping a diary

Self-esteem based on body image, or rather the cognitive factor, is key to understanding the disorder. Typical cognitive impairment, the leading cause of bulimia nervosa consists of two things. Firstly, is the sufferer’s dissatisfaction with their body shape. Secondly, is their tendency to place too much importance on their weight. Researchers find the latter in all cases of bulimia.

It’s important for patients to monitor and note their daily food intake in a diary. In this way, they learn to be aware of the problem and any approaching binges.

Each therapy session focuses on the notes in the patient’s diary. They need to understand the factors and triggers that led to their binging behavior. In fact, when they binge, they need to remember the thought processes that led up to it.

Evaluating the importance of weight

As some patients weigh themselves five to six times a week for reassurance, others don’t do it at all, due to avoidance. The first step of Fairburn’s therapy directs the patient to weigh themselves no more or less than once a week.

In addition, the patient notes down their weight, food intake, and any destructive thoughts in their diary. As previously mentioned, one of the therapist’s jobs is to provide information and educate the patient about bulimia nervosa. Therefore, they’ll discuss matters such as dietary patterns and the adverse effects of using laxatives and diuretics while dieting.

The therapist will prescribe a regular meal pattern, such as five moderate meals a day. This equips the patient with the means to avoid binge eating and stints of hunger.

Lastly, the patient will be made to experience different scenarios of stimulus control. This has been shown to assist patients with issues concerning instant gratification.

Patients are taught to only focus on their food when eating and to and savor it. Another tip is for them to always eat in the same place and leave some food on their plate. Finally, limiting their exposure to ‘dangerous’ or overly unhealthy food is always a good idea.

Step two: beating the diet

This step focuses on cognitive structure and restructuring. Like step one, it tends to last around eight weeks, with weekly sessions. The main objective is to completely stop the patient from dieting. Indeed, since the patient is already prone to binging, it’s essential that they stop dieting.

The therapist encourages the patient to start eating meals they’ve been avoiding thus far. Both therapist and patient will rank these meals into four groups of increasing difficulty. For each of the eight weeks, the therapist will encourage the patient to consume one of those ‘forbidden’ meals, starting with the easiest.

After combating their dietary trends and encouraging the patient to eat their previously avoided meals, cognitive therapy can begin. In step one, the patient learned to identify negative thought processes. Now, they should learn about different cognitive distortions. They then point out which cognitive distortion they identify with the most.

Once the patient can identify their own cognitive distortion, they’re encouraged to conduct Socratic self-dialogue. In this way, with questions, the patient discovers that their bulimia nervosa related thought processes were unrealistic and exaggerated.

A person during a consultation, over a glass of water.

At this point, the therapist will likely assign homework. For example, they might suggest the patient should look at themselves in the mirror or wear tight clothes. Such activities will help them learn to identify their negative thought processes. They write these in their diary and discuss them with their therapist in the weekly sessions. In addition, any related thought processes will be evaluated for coherence and veracity.

Lastly, the therapist will prepare the patient for difficult real-life scenarios. However, some day-to-day obstacles won’t have clear or unambiguous solutions. Learning how to implement a problem-solving strategy for such scenarios, with step-by-step alternatives, is vital for patients.

Step three: staying on course

In the last step of Fairburn’s cognitive therapy for the treatment of bulimia nervosa. therapy sessions are reduced to three visits, one every two weeks. The main goal of step three is in preventing the patient from returning to their previous behavior. That’s because, while Fairburn’s therapy leaves the patient feeling better, their symptoms will still be present. Thus, the therapist should teach the patient about differentiating between slipping up and relapsing.

Making mistakes, or slipping up, is all part of the process. However, a relapse means returning to the starting point. Therefore, patients must avoid bulimic relapses at all coats. For this reason, they must create a written plan of steps to follow in the case of a relapse.

In conclusion, Fairburn’s therapy for bulimia nervosa is one of the most empirically supported treatments. Indeed, not only has it shown great promise in helping those suffering from bulimia, but also individuals with binge eating disorders.

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  • Fairburn, C, G. (1985). Cognitive-behaviural treatment for bulimia. Handbook psychotherapy por anorexia nervosa and bulimia (pp 160-192). New York: Guildford Press