“Cognitive Behavioral Therapy for Binge Eating Disorder” was presented at the Minnesota Psychological Association’s First Friday Forum on January 8, 2016. Drs. Koball and Grothe focused on discussing diagnostic criteria for binge eating disorder, reviewed recent research on the efficacy of CBT for binge eating disorder, and described specific CBT skills using pertinent case examples. Finally, they offered information on behavioral weight management for individuals who are in remission from binge eating disorder, but who desire further weight-related intervention.

Binge Eating Disorder (BED) is characterized by episodes of eating in a discrete period of time (e.g., within 2 hours) a larger amount of food than what most people would eat in a similar period of time under similar circumstances (e.g., 4 bowls of cereal, 1 pint of ice cream). Additionally, individuals with BED experience a sense of lack of control over eating during the episode(s) (e.g., feeling that one cannot stop eating or control what or how much one is eating). Furthermore, to meet criteria for BED, binge eating episodes must be associated with 3 or more of the following: 1) eating much more rapidly than normal, 2) eating until feeling uncomfortable full, 3) eating large amounts of food when not feeling physically hungry, 4) eating alone because of feeling embarrassed by how much one is eating, and/or 5) feeling disgusted with oneself, depressed, or very guilty afterward. Finally, marked distress regarding binge episodes must be present to meet diagnostic criteria, binge eating must occur on average at least once a week for 3 months, and binge eating is not associated with recurrent compensatory behaviors (e.g., vomiting or laxative use; APA, 2013). Today, BED is more common in the U.S. than anorexia nervosa or bulimia nervosa, occurs in approximately 3-5 % of women and 2% of men, and is commonly associated with other mental health conditions including low self-esteem, borderline personality disorder, substance abuse, and depression (ANAD, 2012). Individuals who engage in binge eating often struggle to balance eating, and may cycle between periods of significant restrictive eating, episodes of binge eating, and severe guilt and shame.

One of the gold standard treatment approaches for BED is Cognitive Behavioral Therapy (CBT) which targets problematic behaviors associated with binge eating (e.g., restrictive eating, binge episodes, irregular eating) and cognitive factors (e.g., all/nothing thinking patterns, body shame).  A wealth of research has suggested that CBT is an efficacious treatment for individuals experiencing BED as well as those with sub-threshold binge eating (e.g., Grilo, 2012; Wilfley, 1993). CBT sessions generally follow seven steps, as guided by Fairburn’s 2013 book (a great self-help resource for patients as an adjunct to their treatment; Fairburn, 2013).

For those individuals who are in full remission from BED, or who struggle with subthreshold binge eating in their efforts at weight loss, behavioral weight management strategies grounded in empirical foundations can be helpful. Individual or group interventions that focus on self-monitoring (e.g., food diary, activity tracking, and/or weekly weighing), goal setting, mindful eating, stimulus control, stress management, social support, and cognitive restructuring have been shown to be most effective (Butryn, 2011; Wadden, 2000). Self-monitoring has long been suggested as the best predictor of weight loss and weight maintenance over the long term (Butryn, 2007) and is a great place to start in helping patients to better manage eating practices and weight.

There are various resources available to providers and patients including The National Eating Disorders Association (http://www.nationaleatingdisorders.org/) and the National Association of Anorexia and Associated Disorders (http://www.anad.org/). Additionally self-help resources are available including “Overcoming Binge Eating” by Christopher Fairburn, “The Body Image Workbook” by Thomas Cash for binge eating treatment, “The LEARN Manual” by Kelly Brownell, and “The Mayo Clinic Diet” for weight management.

Afton Koball, Ph.D., L.P., graduated with a Ph.D. in clinical psychology from Bowling Green State University. Dr. Koball’s primary research and clinical interests are in behavioral intervention for obesity and eating disorders. Her work has focused on psychological correlates of behavioral and surgical weight management, food addiction, weight bias, and patient-provider communication about weight. 

Karen Grothe, Ph.D., L.P., ABPP, graduated with a Ph.D. in clinical psychology from Louisiana State University. Dr. Grothe’s research and clinical work has focused on psychological factors that influence health and health behaviors. In particular, she has examined psychosocial aspects of weight loss surgery, obesity and physical activity, especially those that predict outcome or influence adherence to medical recommendations. 

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