Bulimia nervosa is an eating disorder in which the patient experiences binge eating when consuming large amounts of food. After them, he experiences regret, shame and guilt and, to reduce these negative emotions and “correct” the situation, he practices purgative behaviors such as vomiting or the use of laxatives.
Among the interventions to help people with this disorder, the one that is considered to be the most effective is Fairburn therapy, a three-phase method that takes about 5 months to treat.
Next, we’ll find out what is done in these steps and how it works to improve the lives of people with bulimia nervosa.
What is Fairburn Cognitive Behavioral Therapy?
Bulimia nervosa is an eating disorder in which the patient has frequent binge eating, followed by compensatory behaviors which usually involve vomiting or the use of laxatives.
These behaviors occur in response to the patient’s great anxiety about eating huge amounts of food, feeling shame and guilt, and, with the intention of “fixing” what she did, she said. purge any food eaten or you exercise too much.
It is a female key disorder, because although men can suffer from it as well, it is much more common in women, driven by the canons of beauty where thin girls are glorified and those who are fat are demonized.
The fear of gaining weight by losing control over what you eat It is a key aspect of the disease, which is why patients follow very restrictive diets in order to achieve ideal body weight and shape. However, since these are very poorly nutritious diets, it does not take long for hunger to appear, which increases the risk of binge eating.
The most effective treatment for bulimia nervosa is 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 linked to episodes of bulimia and to anxiolytic behaviors.
Treatment with the Fairburn method is done in an individual format, lasting about five months. The procedure is semi-structured, problem-oriented and mainly focused on the present and the future of the patient, more than in her past. This therapy consists of three differentiated stages, the priority objectives of which are for the patient to acquire control over his diet, to modify his cognitions on weight, figure and body image and for the changes to be maintained over time.
Therapy places responsibility for change on the patient, giving them an active role in improving and overcoming bulimia nervosa. The role of the therapist is to motivate, support and provide the information and advice the patient needs throughout therapy.
The stages of Fairburn therapy
The stages of Fairburn therapy for bulimia nervosa are mainly the following three.
The first stage of the Fairburn treatment lasts approximately 8 weeks (2 months) and carried out with weekly maintenance. In cases where the patient shows a great lack of control in her eating behaviors, the duration of this stage will have to be stretched a little more, by performing more than one weekly session in case of failure.
The first step is to know the personal history of the patient and to identify the main points of interest in designing the treatment.. After that, we will explain what is the cognitive model of bulimia nervosa that therapy is based on, based on the idea that the disorder operates through a vicious cycle of dieting, binge eating, and purgative behaviors.
The crucial factor in bulimia nervosa is ideation of body weight and silhouette, ideas that lead the patient to try to lose weight by the most extreme methods in order to acquire his ideal weight and figure. For this, the patient followed low-calorie, low-nutrient diets and, as a rule, very little variety (eg: pineapple, grapefruit, maple syrup, etc.)
Following this type of diet has the side effect of increasing the bulimia attacks since, little nourishing and little variety, the patient is very hungry and, in addition, since her food is monotonous and repetitive, it bores her and increases her desire. to eat “forbidden” foods (for example, chocolate, hamburgers, candies, ice cream, pizzas…). This situation is untenable, coming at a time when you can’t take it anymore and stuff yourself, eating huge amounts of high-calorie, fatty, and super-appetizing foods.
After the binge comes negative feelings, especially guilt and shame. To try to reduce them and, also, to avoid gaining weight due to the enormous amount of calories she has just consumed, the patient practices purgatory behaviors such as vomiting or taking laxatives, believing that she is not not absorb fat at all. the food she just ate. After a while, after releasing her negative emotions, the patient tries to diet again until the next binge, then purges herself.
According to this therapy, the fundamental cognitive factor of bulimia nervosa is to base self-esteem on body image, an aspect considered essential in the disease. The cognitive impairment typical of bulimia nervosa has two main aspects:
- Dissatisfaction with one’s own body shape.
- Overdone ideas on 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 the meals she takes, when and how much.. The idea behind self-registration is to make the patient more aware of their problem and thus identify what precipitates their binge eating. Food records must be meticulously analyzed session by session, and the patient must connect with what he is feeling and doing before gorging.
There are cases of patients who never weigh themselves, who don’t want to know what they really weigh (avoidance behavior) while others are able to weigh themselves 7 or more times a week, wanting to control the weight. slightest change at any time. been in your weight (driving reinsurance). The patient is advised to start weighing herself only once a week.
To try to make your eating habits healthy, the patient is prescribed a regular behavior, 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, at this point, the patient is trained to perform a stimulation check. Some guidelines are recommended: do no activity while you eat, always eat in the same place, leave food on your plate and limit your exposure to “tempting and dangerous” foods.
Other strategies implemented during the initial phase include: information and psychoeducation on dietary recommendations, compensatory behaviors such as the use of laxatives or diuretics or the adverse health effects of extreme diets. .
The second step focuses on the cognitive part, this is the time when restructuring is applied as a star technique. The duration is also 8 weeks, with one session per week. In this period, the priority is focused on the total elimination of the diet, because hunger and the monotony of foods that it causes predisposes and facilitates binge eating. This is why it is essential that you stop doing it.
The patient is recommended to start eating these tempting foods, which she considers to be prohibited and dangerous.. These avoided foods will be classified according to the degree of rejection, classified into 4 groups of increasing difficulty. Each week, the psychotherapist will tell the patient to take one of these prohibited foods, starting with the easiest group.
After putting these techniques into practice, the cognitive therapy itself begins. As in the first step, the patient has already identified these negative thoughts about the weight and the shape of the body, it is time to teach her the different cognitive distortions that exist, by discovering and analyzing those with which she identifies the most. .
Once this step has been taken, the patient learns to make a Socratic dialogue. Through various questions, the patient will discover that her negative thoughts about weight and body shape are totally unrealistic or exaggerated, and that she will need to change them.
To facilitate the process of identifying thoughts and, thus, have the opportunity to work on them, the psychotherapist can offer different behavioral experiences or send home tasks such as looking at oneself in the mirror, wearing tight clothes, drawing on a paper. the figure he thinks he has and compare it to the one you really have …
From these tasks, the patient You will have to write down what goes through your mind, to bring it to the session with the psychologist and analyze its veracity, its consistency and the advisability of thinking so.
The third and final phase of Fairburn therapy is performed in 3 sessions every two weeks.. This last part of the intervention focuses on the objective of relapse prevention.
Patients are expected to feel much better at the end of treatment, 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 a slip on the road to recovery and overcoming the disorder.. These are incidents that are part of the process and should be seen as something normal, something that does not spoil it and which, even if they do occur, must continue.
In exchange, a relapse involves going back to the starting point, with monitoring of restrictive diets, binge eating and purgative behaviors, all behaviors that should be controlled and avoided. Given the severity of relapses, it is necessary that before the end of Fairburn therapy the patient has a personal and written strategic plan that specifies what she will do if a relapse is identified, and thus avoid going further. .
Currently, Fairburn therapy for bulimia nervosa is considered to be one of the most empirically supported treatments. Given its high efficacy against bulimia, this intervention has been extended to other eating disorders such as binge eating, in which it also has excellent results.
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