Cognitive Behavioural Model Of Bulimia

A new cognitive-behavioural theory has been designed in order to supplement the former model, hence why it is called the extended cognitive-behavioural model of bulimia (Fairburn et al., 2003). It has to be emphasised that this model is aimed at supplementing the former model rather than replacing it. This model assumes that in certain patients, one or more of four additional maintaining processes interact with the core mechanisms, thereby making them more resistant to change in treatment. As can be seen in figure 3 (Fairburn et al., 2003), these additional mechanisms include clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties.
Clinical perfectionism
Clinical perfectionism can be defined as “the over-evaluation
The first type of CBT of bulimia is divided into three stages, spread over approximately 15 to 20 sessions in 20 weeks (Cooper & Fairburn, 2011).
In the first stage, the cognitive model is explained to the patients (Anderson & Maloney, 2001). Moreover, techniques which aim at beginning to reduce dietary restraint, such as meal planning and stimulus control, are taught. When eating patterns become normalised, reductions in binge eating and purging often follow. This stage focuses on behavioural change, although attention is paid to thoughts and feelings as well. The second stage is characterised by a more cognitive approach. In this stage, standard cognitive therapy techniques are taught. For example, cognitive restructuring is used to deal with dietary restraint, concerns about eating, shape and weight, issues concerning self-esteem and more general cognitive distortions. The third stage concentrates on developing relapse prevention
Moreover, the eating problem is addressed and a formulation of the processes maintaining the eating disorder is created. Two important procedures are introduced in this stage, namely ‘weekly weighing’ and ‘regular eating’. The second stage is a transitional stage, in which progress is reviewed, barriers obstructing change are identified, and the formulation is modified, if necessary. In the third stage, the key mechanisms which maintain the eating disorder are addressed. This stage focuses on tackling several mechanisms, including the over-evaluation of shape and weight, dietary restraint and event- and mood-related changes in eating. The final stage has two aims, namely ensuring that the changes made in treatment will be maintained in the following months and minimising the risk of relapse in the long