Overcoming Your Eating Disorder: Workbook

Eating disorders are serious difficulties that can affect anyone. It is estimated that 0.3% and 0.9% of people will experience bulimia nervosa and binge-eating disorder respectively at some point in their lives. Symptoms of include recurrent episodes of binge eating (i.e., eating in a way that feels uncontrolled and distressing), preoccupation with one’s shape and weight, and the use of compensatory behaviors such as self-induced vomiting, laxative use, strenuous exercise, and restriction (note that use of compensatory behaviors applies only to bulimia nervosa). Overcoming Eating Disorders is a comprehensive program to assist clinicians in delivering effective CBT for bulimia nervosa and binge-eating disorder. The program includes two books:

• Overcoming Eating Disorders: Therapist Guide details the step-by-step cognitive behavioural treatment of bulimia nervosa and binge-eating disorder.
• Overcoming Your Eating Disorder: Workbook is the companion to this therapist guide. It will help your patients to become active participants in their treatment and learn how to establish a regular pattern of eating, address body-image concerns, and tackle intense moods and emotions that affect their eating.

About Treatments That Work®

Authored by leading psychologists including David Barlow, Michelle Craske and Edna Foa, Treatments That Work® is a series of manuals and workbooks based on the principles of cognitive behavioral therapy (CBT). Each pair of books – therapist guide and client workbook – contains step by step procedures for delivering evidence-based psychological interventions and will help you to provide the best possible care for your clients. 

At Psychology Tools, we are proud to make many of the Treatments That Work® titles available to our members. Each book is available to download chapter-by-chapter, and Psychology Tools members with a currently active subscription to our ‘Complete’ plan are licensed to share copies with their clients.

How effective is this treatment?

Developments in the conceptualization of eating disorders in 1980s and 1990s made possible significant improvements in psychological treatments for eating disorders, including bulimia nervosa and binge-eating. More recently, a ‘transdiagnostic’ cognitive-behavioral model of eating disorders has been proposed (Fairburn et al., 2003), which emphasizes the maintaining factors which are shared across eating disorder subtypes. 

Since then, a substantial body of evidence supporting eating disorder-focused cognitive behavioral therapy has accumulated. This treatment is recommended in clinical practice guidelines produced by the American Psychiatric Association (APA) and the National Institute for Health and Care Excellence (NICE), which produces guidelines for the National Health Service in the United Kingdom (Yager et al., 2014; NICE, 2017). 

Evidence for this approach is impressive. A recent, comprehensive review of studies (Linardon et al., 2017) found that eating disorder-focused CBT delivered either by therapists or in a guided self-help format were both more effective than an inactive (waiting list) control condition. Improvements were also maintained at follow-up. In addition, therapist-led CBT for bulimia nervosa and binge-eating disorder was found to be more effective than comparison psychotherapies.

Chapters in Overcoming Eating Disorders: Workbook: 

• Chapter 1: Introduction
• Chapter 2: Binge Eating and Purging
• Chapter 3: Health Effects of Binge Eating and Purging
• Chapter 4: Treatments for Binge Eating and Purging
• Chapter 5: Evidence for the Effectiveness of Guided Self-Help
• Chapter 6: An Assessment of Your Eating Problems: Is It Time to Begin Treatment?
• Chapter 7: Understanding and Applying the CBT Model
• Chapter 8: Using Daily Food Records to Monitor Eating
• Chapter 9: Establishing a Regular Pattern of Eating Plus Weekly Weighing
• Chapter 10: Feared and Problem Foods
• Chapter 11: Body-Image Concerns
• Chapter 12: Handling Intense Moods and Emotions
• Chapter 13: Working Through Problem Situations and Thoughts
• Chapter 14: Handling Challenging People
• Chapter 15: Preventing Relapse and Maintaining Change
• About the Authors

About the authors

W. Stewart Agras earned his medical degree from University College, London, England, in 1955 and then completed his residency and fellowship at McGill University, Montreal, Canada. He was an early leader in the field of behavior therapy. At the University of Vermont, he became interested in phobia as a model for psychotherapy research, and, in collaboration with Harold Leitenberg, PhD, discovered that exposure to the feared situation was a principal ingredient of treatment for phobias. After moving to the University of Mississippi Medical Center as chairman of the Department of Psychiatry in 1969, he established the department as an active research center focused on behavioral psychotherapy, establishing the psychology residency program with David Barlow. In 1973, he moved to Stanford University as a professor of psychiatry, establishing one of the first behavioral-medicine programs in the country, and becoming the first and founding president of the Society for Behavioral Medicine. When the upsurge in patients with bulimia nervosa occurred in the late ‘70s, he began research into the etiology and treatment of the disorder, conducting a number of important treatment trials for bulimia nervosa, together with the first treatment studies for binge-eating disorder. He has been president of the Association for the Advancement of Behavior Therapy and editor of the Journal of Applied Behavior Analysis and the Annals of Behavioral Medicine, and has twice been a fellow at the Center for Advanced Studies in the Behavioral Sciences. He is presently Professor (Emeritus) of Psychiatry in the Department of Psychiatry and Behavioral Sciences at Stanford University School of Medicine, and is continuing his research program in eating disorders.

Robin F. Apple received her PhD from the University of California – Los Angeles in 1991 and has published articles and chapters about eating disorders. She has also cowritten a patient manual and a therapist guide that use cognitive-behavioral therapy to help patients prepare for weight-loss surgery. In her former role as associate clinical professor, Department of Psychiatry and Behavioral Sciences, Stanford University, she had an active role training postdoctoral psychology fellows and psychiatry residents to use CBT and other treatment techniques, and has provided short- and long-term individual therapy and group therapy for those dealing with eating disorders and a range of other issues. Dr. Apple maintains a varied caseload in her private practice in Palo Alto, California, and she is a consultant with the county medical center’s eating-disorders program, a contributor to a multi-center weight-loss surgery research study, and has been an expert witness in forensics related to weight-loss surgery.

Each Treatments That Work® title is published in two volumes:

• Clients use the Workbooks which contain elements of psychoeducation, skills development, self-assessment quizzes, homework exercises, and record forms.
• Therapists use the Therapist Guides which contain step-by-step instructions for teaching clients’ skills, overcoming common difficulties.

Although written for the client, the exercises in the workbook are intended to be carried out under the supervision of a mental health professional. The authors suggest that the most effective implementation of these exercises requires an understanding of the principles underlying the different procedures, and that mental health professionals should be familiar with both the Overcoming Eating Disorders: Therapist Guide as well as this client workbook. 

Therapists with an active subscription to a Psychology Tools ‘Complete’ plan are licensed to use Treatments That Work® titles, and to download and share chapters with their clients.

• Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour research and therapy, 41(5), 509-528.
• Linardon, J., Wade, T. D., De la Piedad Garcia, X., & Brennan, L. (2017). The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85, 1080-1094.
• National Institute for Health and Care Excellence (NICE) (2017). Eating Disorders: Recognition and Treatment. NICE Guideline 69. London.
• Yager, J., Devlin, M. J., Halmi, K. A., Herzog, D. B., Mitchell, J. E. III, Powers, P., Zerbe, K. J. (2014). Guideline watch (August 2012): Practice guideline for the treatment of patients with eating disorders. Focus, 12, 416