Bulimia nervosa is an eating disorder in which the patient carries out binge eating in which they consume enormous amounts of food. After them, she feels regret, shame and guilt and, to reduce these negative emotions and “correct” the situation, she carries out purgative behaviors such as vomiting or using laxatives.
Among the interventions to help people with this disorder, the one considered the most effective is Fairburn therapy, a method consisting of three phases whose treatment lasts about 5 months.
Below we will discover what is done in these stages and how we work to improve the lives of people with bulimia nervosa.
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What is Fairburn Cognitive Behavioral Therapy?
Bulimia nervosa is an eating disorder in which the patient carries out frequent episodes of binge eating, followed by compensatory behaviors. which usually involve vomiting or using laxatives.
These behaviors occur in response to the great anxiety that the patient suffers from having eaten enormous amounts of food, feeling shame and guilt and, with the intention of “fixing” what she has done, she purges all food ingested or exercises excessively.
It is a female disorder, since although men can also suffer from it, it is much more common in women, pressured by beauty canons where thin girls are glorified and those who are fat are demonized.
The fear of gaining weight by losing control of what you eat It is a key aspect of the disorder, which is why patients follow very restrictive diets in order to achieve the ideal weight and body shape. However, because they are very low-nutrition diets, hunger does not take long to appear, which increases the risk of binge eating.
The most effective treatment for bulimia nervosa is considered to be Fairburn therapy, an intervention created by Christopher G. Fairburn specifically to treat this eating disorder. It is such an effective method that it has become one of the most common in clinical practice. in the context of cognitive-behavioral therapy, in addition to being extrapolated to other disorders related to binge eating episodes and anxiety-reducing behaviors.
Treatment with the Fairburn method is done individually, lasting around five months. The procedure is semi-structured, problem-oriented and focused mainly on the present and the future. of the patient, more than in her past. This therapy consists of three different stages, whose priority objectives focus on the patient acquiring control over their diet, modifying their cognitions about weight, silhouette and body image, and ensuring that the changes are maintained over time.
The therapy places the responsibility for change on the patient, granting them an active role in their improvement and overcoming bulimia nervosa. The therapist has the role of motivating, supporting and providing the information and guidance that the patient needs throughout the therapy.
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The stages of Fairburn therapy
The stages of Fairburn therapy for bulimia nervosa are mainly the following three.
The first stage of Fairburn therapy lasts approximately 8 weeks (2 months) and is carried out with weekly interviews. In those cases in which the patient shows a great lack of control in her eating behavior, the duration of this stage will have to be extended a little longer, carrying out more than one weekly session in case it is disruptive.
The first step is to know the patient’s personal history and identify the main points of interest to design the treatment.. After that, we go on to explain the cognitive model of bulimia nervosa on which the therapy is based, based on the idea that the disorder works through a vicious cycle of diets, binge eating and purgative behaviors.
The crucial factor in bulimia nervosa is ideation of weight and body shape, ideas that lead the patient to try to lose weight using the most extreme methods in order to achieve their ideal weight and silhouette. To do this, the patient has followed low-calorie diets, with few nutrients and, as a general rule, very little variety (e.g., the pineapple, grapefruit, maple syrup diet…).
Following this type of diet has the side effect of increasing binge eating since, as they are not very nutritious and not very varied, the patient feels very hungry and, furthermore, since her food is monotonous and repetitive, it bores her and increases her desire to eat food even more. “forbidden” (e.g. chocolate, hamburgers, candy, ice cream, pizza…). This situation is unsustainable, and the moment comes when she can’t take it anymore and goes on a binge, eating huge amounts of high-calorie, greasy, and hyperpalatable food.
After the binge, negative feelings come, especially guilt and shame.. To try to reduce them and also avoid gaining weight due to the huge amount of calories she has just consumed, the patient engages in purgatory behaviors such as vomiting or taking laxatives, believing that in this way she will not absorb the fat from all the food she has just eaten. After a while, after releasing her negative emotions, the patient tries to diet again until the next binge occurs and, later, she purges.
According to this therapy, the fundamental cognitive factor of bulimia nervosa is basing self-esteem on body image, an aspect considered key in the disorder. The typical cognitive alteration of bulimia nervosa has two main aspects:
- Dissatisfaction with one’s own body silhouette.
- Overrated ideas about weight and shape.
During this first stage of Fairburn’s therapy It is also necessary for the patient to monitor her intake, writing down in a diary what meals she eats, the time of intake and their quantity.. The idea behind self-recording is to make the patient more aware of her problem and, thus, identify what precipitates her binge eating. Eating records must be analyzed meticulously session by session, and it is necessary for the patient to connect with how she was feeling and what she was doing before carrying out the binge.
There are cases of patients who never weigh themselves, who do not want to know what they really weigh (avoidance behavior), while others are capable of weighing themselves 7 or more times a week, always wanting to monitor the slightest change that occurs. may have been due to its weight (reinsurance conduct). It is considered advisable that the patient begins to weigh herself only once a week.
To try to make your eating habits healthy, The patient is prescribed a regular behavior pattern, for which she should preferably eat 5 meals a day and in moderate quantities.. If this is achieved, the patient will avoid hunger, a physiological sensation that predisposes to binge eating.
Finally, in this stage the patient is trained to carry out a stimulation control. Some guidelines that are recommended are: do not do any activity while eating, always eat in the same place, leave some food on your plate and limit exposure to “tempting and dangerous” foods.
Among other strategies that are carried out during the initial stage are: information and psychoeducation about dietary patterns, compensatory behaviors such as the use of laxatives or diuretics or the adverse health effects of extreme diets.
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The second stage focuses on the cognitive part, This being the moment in which restructuring is applied as a star technique. The duration is also 8 weeks, with one session each week. During this period, the priority is focused on completely eliminating the diet, since hunger and the food monotony it causes predisposes and facilitates binge eating. That is why it is key that you stop doing it.
The patient is recommended to start eating those tempting foods, which she sees as forbidden and dangerous.. These avoided foods will be ranked according to the degree of rejection, classified into 4 groups of increasing difficulty. Each week, the psychotherapist will tell the patient that they should eat one of those prohibited foods, starting with those in the easiest group.
After putting these techniques into practice, the cognitive therapy itself begins. Since in the first stage the patient already identified those negative thoughts about weight and body shape, it is time to teach her the different cognitive distortions that exist, discovering and analyzing which ones she feels most identified with.
Once this step has been completed, the patient is taught to perform a Socratic dialogue with himself. Through various questions, the patient will discover that her negative thoughts about weight and body shape are totally unrealistic or exaggerated, and that she must modify them.
To facilitate the process of identifying thoughts and, thus, being able to have the opportunity to work on them, the psychotherapist can propose different behavioral experiments or send homework such as looking in the mirror, wearing tight clothing, drawing on paper the silhouette you think you have, and Compare it with what you really have…
From these tasks, the patient You should write down what is going through your head, to take to the session with the psychologist. and analyze its veracity, coherence and the convenience of thinking like this.
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The third and final phase of Fairburn therapy is carried out in 3 sessions on a biweekly basis.. This last section of the intervention focuses on the objective of preventing relapses.
It is expected that, at the end of treatment, patients will feel much better, although the majority still have some cognitive symptoms. In this sense, the patient is trained to differentiate falls and relapses.
We can define a fall as a small stumble or slip on the path to recovery and overcoming the disorder.. They are incidents that are part of the process, and must be seen as something normal, something that does not ruin it and that, even if they occur, they must continue.
Instead, a relapse means returning to the starting point, with following restrictive diets, binge eating and purgative behaviors, all behaviors that must be controlled and avoided. Given the severity of relapses, it is necessary that before completing Fairburn therapy the patient has a personal, written strategic plan that specifies what she will do if a relapse is identified, and thus avoid to go further.
Currently, Fairburn therapy for bulimia nervosa is considered one of the treatments that enjoys the greatest empirical support. Given its great effectiveness with bulimia, this intervention has been extended to other eating disorders such as binge eating disorder, in which it also has great results.