Treatment for Anorexia
People with anorexia often don’t seek help; perhaps because they’re afraid of changing their eating or because they don’t recognise they have a problem. Many people have successfully hidden their condition for a long time – sometimes years. The most important first step is for someone with anorexia to realise that they need help and want to get better.
If you suspect someone you know has anorexia, you should try to talk to them about your worries and encourage them to seek help. This can be a very difficult conversation because they may be defensive and refuse to accept they have a problem. But it’s important not to criticise or pressure them as this can make things worse.
Cognitive behavioural therapy and supportive psychotherapy are the two most commonly recommended treatments for adults with anorexia nervosa. For children with anorexia, family treatment is almost always recommended, either in isolation or in combination with individual therapy.
Cognitive Behavioural Therapy
CBT is one of the current leading treatments for anorexia (NICE Guidelines, 2004 / 2017). Our CBT therapists have extensive experience in providing high quality CBT to individuals with all eating and body image disorders. CBT focuses on your thinking (cognitions), your behaviours (what you do in response to certain thoughts), and your emotions (how you feel in response to certain thoughts). People can often recognise patterns in their thinking (e.g. I am not good enough, people dont like me, I need to be thinner to be successful). These thoughts result in familiar emotions and behaviours that often involve manipulation of food or eating. CBT helps individuals to recognise their unhelpful or negative thinking, see the patterns in their behaviours and develop healthy strategies and skills to challenge or cope with their unhelpful thoughts. CBT is a structured skills based therapy that is most suitable for people who want to be guided by their therapist to find new ways of coping.
In treatment for anorexia, CBT also involves weight gain. This is because being at a low weight is both dangerous for your health, and maintains the eating disorder through semi-starvation syndrome. Your therapist and/or one of our dietitians will guide and support you in making these changes, whilst helping you address the psychological aspects of the anorexia at the same time. In later CBT sessions, you would continue to address underlying psychological causes or triggers to anorexia, whilst also learning how to maintain a healthy weight. The content of the CBT sessions will vary depending on each individual’s needs, but could include work on body image, expressing and managing emotions, addressing unhelpful eating disordered behaviours or food rules, and challenging unhelpful thoughts around eating, shape or weight. CBT can also be used to address any other difficulties that you may be experiencing, such as low mood, anxiety or low self-esteem.
Maudsley Model for of anorexia nervosa treatment for adults (Mantra)
MANTRA is a specialist integrative therapy that has been developed specifically for the treatment of Anorexia Nervosa. MANTRA consists of seven core modules usually conducted over 20-40 sessions. MANTRA aims to address the factors that keep people attached to their anorexia - ie the things that maintain it. This will often include a persons motivation to change, difficulties with emotions and / or relationships, problematic or inflexible thinking styles, and problematic responses from a persons support network. Every person with anorexia is different, and the factors that contribute to you feeling unable to let go of anorexia will differ person to person. The focus of MANTRA will therefore differ depending on the factors that have most relevance to you. Initially therefore the task will be to understand the factors that contribute to maintaining your anorexia and to agreed which order to address these in. MANTRA is a flexible treatment that involves working collaboratively, and at a pace that works for each individual client.
Specialist Supportive Psychotherapy / SSCM
Specialist Supportive Psychotherapy has also been shown to be an effective treatment for anorexia nervosa. This treatment is sometimes referred to as Specialist Supportive Clinical Management (SSCM). Supportive Psychotherapy combines features of clinical management (ensuring your medical safety) with supportive psychotherapy and dietetic advice. Supportive psychotherapy allows you to explore and talk freely about issues that you feel are relevant to your current mood or eating patterns. Together with your therapist you can then be supported to find solutions to these difficulties so that rigid control over your weight and eating is no longer used as a solution. Your therapist will use supportive encouragement, psychoeducation, gentle exploration and advice to help you to set and reach your own eating and life goals.
Family Based Treatment
Family Based Treatment (FBT) is well evidenced as a treatment in adolescents and children with anorexia. FBT is a treatment that involves utilising the whole family to help the adolescent overcome their eating difficulties. FBT has three specific phases. The first phase focuses on empowering the parents to assist in the re-feeding of the child. Family meals are undertaken (with the therapist initially). The second phase focuses on the relationships that exist between family members and aims to help the family to negotiate new, more adaptive relationships. In the third phase the focus is on maintaining healthy adult or adolescent relationships between family members in which the eating disorder does not form the basis of the relationship.
Other therapies
Whilst each of the above treatments are known to be effective in treating anorexia nervosa, these approaches do not suit everyone. You may have tried these and found that they don’t work for you, or you may feel that they don’t quite “fit” for you. The NICE guidelines recommend that if any of these treatments are “ineffective or unacceptable” to adults with anorexia nervosa, they may want to consider eating-disorder-focussed Focal Psychotherapy (FPT). Alternatively, other therapies have also been shown to be effective for people with eating disorders, including Schema Therapy, Cognitive Analytic Therapy and Dialectical Behaviour Therapy- RO. Your therapist will help you to determine which of these treatments is most appropriate for you during your initial assessment session.