Throughout the lockdown many of our habits have changed and, for some of us, it’s been our eating habits. Sometimes we can turn to food for comfort, but it can get out of hand.
We spoke to leading consultant psychologist, Dr Beverley Marais about binge eating and treatment available for overcoming binge eating disorder.
What treatment for binge eating is available?
The National Institute for Health and Care Excellence (NICE, 2017) guidelines recommend the following evidence-based treatment for binge eating disorder:
1. Guided self-help
This initial approach to treating binge eating disorder involves engaging with materials more independently, for example, using a recommended workbook or online course whilst also engaging with a therapist for additional support. Sessions with a therapist are generally brief, lasting approximately 20 minutes and used to facilitate and guide the patient through the workbook or online course effectively.
2. Cognitive Behavioural Therapy (CBT)
Should the patient require a different approach, CBT is recommended, ideally within a group setting. Treatment would involve
- psychoeducation about food and food choices,
- identifying triggers to binge eating,
- introducing regular eating patterns,
- addressing concerns about body, weight and shape,
- developing skills and alternative coping strategies for dealing with triggers to bingeing and
- learning how to reduce and recover from lapses.
How is treatment personalised to each patient?
In order to personalise treatment to the patient, the initial assessment involves an in-depth clinical assessment, taking into account the person’s current eating patterns, how these changed over time, their attitudes to food, their weight and body image, and a review of any interventions they might have tried in the past.
The patient is encouraged to engage in self-monitoring in order to help understand and identify triggers and situations eliciting a binge. Therapist and patient use this information to collaboratively formulate an understanding of their binge eating. This formulation then informs an individualised treatment package meeting the specific needs of the individual.
How do patients’ relationships with food and body image change during treatment?
During treatment, patients become more conscious of the reasons behind their eating patterns. Part of the function of binge eating is to block out or numb uncomfortable thoughts and feelings. Over time, eating then becomes a learned coping strategy for dealing with difficulties, however, this coping strategy (bingeing), then becomes the problem focus.
Treatment helps to identify some of the punitive rules and negative attitudes associated with food and body image as well as the patient’s behaviours which would reinforce them. The focus of treatment is largely on behaviour change through the application of regular tasks designed to challenge unhelpful thoughts and assumption about food. As patients are provided with alternative strategies to manage binge eating whilst learning to tolerate and process uncomfortable thoughts and feelings, their relationship to food and their body changes.
What guidance is given to patients to cope with emotional binge eating triggers?
Patients are guided to begin identifying their emotions, understand them, and learn how to communicate these in order to meet their needs. Instead of habitually blocking these out, initial strategies are provided to help tolerate overwhelming emotions. Some of these might involve delaying a binge response by engaging in an alternative behaviour or task such as going for a walk, making a call, spending time with others or changing the environment.
When is it determined that someone has overcome their binge eating disorder?
Patients will feel more in control of their eating and a less preoccupied with food, weight and body image. They would have established a regular pattern of eating and learned how to make use of lapses. Eating no longer serves as the sole strategy for coping with difficulties and they are able to value their emotions, even uncomfortable ones as necessary and important features maintaining recovery.