Cognitive Remediation for Eating Disorders

What is it?

Monday Musings: Cognitive Remediation for Rigidity and Fixations in Eating Disorders.

Many of you readers are not sure what we do to treat eating disorders and overweight. So, these musings are to give you a peep into the secrets of treatment.

Eating disorders are problems with behaviour. Therapists seek to know what lies beneath problem behaviour like purging, starving and binge eating. Some therapists say it is all about early experiences. Other therapists think it is all caused by trauma or not having better ways to self-soothe.

People get into eating disorders by one road only. For whatever reason, they want to change their weight to feel better about themselves. So, they stop eating what they want and begin eating what they think they should.   The unintended consequence for some people is getting into serious food restriction. For other people,   dieting or cutting out food groups leads to binge eating and a small number of people  end up purging to try and manage their binges.

A tangle of different “maintaining factors”.

Tangles of EDs

Very few people know what keeps people stuck inside the tangle of an eating disorder.  There are many different things and so we must UNPICK the eating disorder, one tangle at a time. One of these tangles is very stuck habits. Everything inside an eating disorder is a habit, what food you binge, how you binge or purge, how and when you exercise, how often and when you might weigh yourself.

Some people with eating disorders,  especially people with anorexia or ARFID are very rigid by nature and they are easily fixated by the small details of the food they eat and what they think it does to them.  Many show signs of Obsessive Compulsive Disorder. This is partly to do with how their brain works. If we ask a person with anorexia to describe a picture, they tend to focus on a great deal of detail.  A person who eats normally tends to tell us about the overview of a scene, such as “This is a picture of the countryside in autumn”.

To recover from eating distress,  a person needs to become more flexible – to allow them to make more helpful food choices, and to worry less about their eating.

Cognitive Remediation (CRT) is a therapy  that works directly with the brain. The therapist is trained to do tasks with their client like picture work, or use of symbols, so that the brain learns how do several useful things. Firstly, to stop focusing on small details like “the food I just ate for lunch” and secondly to stop obsessing about ideas and thoughts so that the sufferer develop better coping strategies.

Cognitive Remediation Therapy is not the only thing we use to help restore a client to health. This is simply addressing one of the tangles in which they are trapped. Most good eating disorder specialists, like ours,  will have done some training in CRT.  If you need help with an eating disorder, have a look at our counsellor list at