How Cognitive-Behavioral Therapy Helped Me Recover from Bulimia
The step by step process that changed my life
It was the end of my first year in high school when I decided to restrict my calories and lose weight. I believed there was something deeply wrong with me.
I had fallen in love but I was never loved back no matter how hard I tried. Becoming more beautiful seemed the best way I could cope with the feelings of inadequacy that were eating me from the inside.
I hated my body so I guessed changing it was the way to go. My first experiment was simple: I would have a normal breakfast, lunch, and a snack but I would skip dinner. I applied my plan and I was hungry at night, but I held on.
When I lost the first pounds I started receiving compliments and greater attention from the people around me. This led me to continue with my regime, which got stricter over time.
I lost more pounds and my period, but I didn’t care. I could wear all of the clothes I wanted and go to the beach without feeling too ashamed. However, I was never happy. I still suffered because of my imperfections and the guy I loved did not fall in love with me despite my new physical shape.
After some months I started to eat compulsively unacceptable amounts of food. I couldn’t stop so I did my best to compensate for that by taking laxatives, fasting and running.
My days were draining because they revolved only around food and how to compensate for binges. I felt empty and miserable. Time passed by and I gained all the weight back.
One lonely night in October something happened. I binged as usual but this time I felt extremely sick. My body wouldn’t stop shivering and sweating. Suddenly I had the urge to throw up. And I did. I never felt worse after a binge, so before bed, I decided to ask for help.
I talked to my mom and I went to therapy. The psychiatrist was so calm when she told me I had bulimia. I already knew it but she looked confident and positive when she said it, so I felt instantly hopeful. Deep inside recovery was all I wanted because my life had turned into a living hell.
My psychiatrist’s approach was holistic. Not only did she help me develop a more optimistic mindset, but she also helped me look at my life as a whole to see how I could be more proactive to experience greater happiness and satisfaction. The process she used is called cognitive-behavioral therapy.
In this article, I would like to share with you more information on the science of why cognitive behavioral therapy worked so well for me and why it still does for many bulimic patients, how I implemented it during recovery and how you can use it not only to overcome your eating disorder but to improve your life.
At the same time, I strongly recommend you rely on a medical professional for an individualized plan to guarantee you receive the appropriate treatment for you.
The Science of Cognitive Behavioral Therapy for Bulimia
Evidence suggests that cognitive behavioral therapy is the most effective treatment for bulimia nervosa. It has been tested in research studies countless times and appears to be beneficial even for anorexia nervosa. But how does cognitive behavioral therapy work?
Cognitive behavioral therapy has two components: the cognitive one, which targets thought patterns and consequent feelings, and the behavioral one, which focuses on actions.
Thoughts and actions are as connected as two sides of a coin. In fact, thoughts trigger emotions which trigger actions. When the action brings a sense of reward, the individual is more likely to perform it again.
Cognitive behavioral therapy works because it targets directly thoughts, emotions, and actions involved in the development and the continuation of bulimia, giving the patient the opportunity to gain awareness of the whole process.
Now I will take the progression of my eating disorder as an example to show you how the three elements of thought, emotion and action created a domino effect that led to bulimia.
1. Thoughts
When I was 15 years old I had thoughts and beliefs about myself such as “I am not beautiful enough nor worthy of love. My imperfections are unacceptable”. Perfectionism and low self-esteem are risk factors of bulimia so it makes sense I had those beliefs.
My thoughts originated from several circumstances: social, as our culture idolizes skinny bodies, and personal since my experiences led me to think I was not lovable.
Indeed, whenever I had fallen in love I was never loved back. Individuals often make assumptions based on past events. When these assumptions are coupled with the ideas of beauty and worthiness pushed by the media, they become powerful.
2. Emotions and actions
Since I believed I was not lovable I felt broken-hearted, sad and hopeless. These emotions made me decide to perform the action of restricting my calories. This is typical as bulimic people often have a history of dieting.
When dieting led to weight loss and praise from other people, I experienced a sense of reward that motivated me to repeat the action of limiting my calorie intake. Unfortunately, the mind and the body cannot stand extreme dieting because it threatens the survival of the individual. This survival mechanism triggers compulsive eating.
After eating compulsively, there’s another sense of reward as the body finally receives calories. However, the binge-eater experiences also guilt and the desire to keep the benefits of weight loss. Therefore, they try to compensate for the binge.
This is the cycle of bulimia that repeats itself through thought, emotion and action. It becomes habitual and that is why it is challenging to overcome. I’m one of those people who made it, so I would like to share with you exactly how that happened.
My Story: How I Recovered from Bulimia
My psychiatrist worked on my thought patterns right away. I interpreted adversities in a pessimistic way that over time compromised my self-esteem and led to dangerous behaviors such as extreme calorie restriction.
Life events can be interpreted in many ways but the interpretations I chose were generally negative. For example, if the guy I loved didn’t love me back I would quickly reach the conclusion that I was an unlovable person.
This pessimism showed permanence and personalization, which psychologist Martin Seligman discusses in his book Learned Optimism. In fact, the thought “I’m an unlovable person” implies that the condition of being unlovable is unchangeable (permanent) because of something inherently wrong with me (personal).
Not only were my interpretations permanent and personal, but at times even pervasive. For instance, one of my main convictions was that I was not beautiful enough and therefore I would never be successful as an actress or in my love life. This thought is pervasive as I felt that not being beautiful enough influenced other important areas of my life.
I overcame this habitual thinking modality by reframing: the act of consciously replacing negative interpretations with positive interpretations to life events, which is central in cognitive behavioral therapy. These interpretations needed to exclude the elements of permanence, pervasiveness, and personalization typical of my pessimism.
The way I practiced reframing was particularly pleasurable and artistic: I drew the comic book version of the event that was bothering me. Then, I let myself draw my negative explanation of the event. Finally, I would reject that explanation by drawing a positive interpretation.
My psychiatrist recommended this exercise after she realized I enjoyed drawing. So, an amazing mixture of art therapy and cognitive behavioral therapy was born! Moreover, I would often end up drawing funny comics and laughing about my adversities. I quickly learned to look at my imperfections with humor and self-love.
As I started nurturing positive thoughts, I began to experience pleasant emotions and my behaviors changed. I ditched restrictive dieting and, as soon as I decided to give myself more freedom around food, I broke the binge-compensation cycle. No more laxatives, fasting nor extreme sport. No more shivering and purging.
I was done with bulimia.
The direction my mind had taken was simple: health over vanity. I promised myself that if I’d ever want to lose weight again, I would choose only the healthiest route or no route at all if it meant triggering another eating disorder.
During my recovery, other important elements were getting rid of significant stressors and finding new passions: I changed school and I began to study singing and piano regularly. The new school environment and these activities created more positive emotions.
Before I took these initiatives, my eating disorder was so time-consuming that I did not have the space to do anything different from studying and compensating for binges. Food used to be my only resource to feel some sort of pleasure (before guilt and shame kicked in).
Although I overcame bulimia successfully, I still struggled with emotional eating several times over the years that followed recovery. My emotional eating never consisted of binges but rather in mild overeating episodes.
Therefore, emotional eating never compromised my health as bulimia did. Nevertheless, I took care of that too. If you want to know more about that story, feel free to read my other article on How to Use Mindfulness Meditation to Overcome Emotional Eating.
How to Use the Cognitive Behavioral Approach to Overcome Bulimia
1. Reframe adversities effectively
You need to reframe adversities repeatedly to cultivate a positive mindset and better self-esteem. Something is always happening and each event is an opportunity to create positive interpretations.
Let me give you a practical example.
You go to a party and run into an old friend. You make eye contact but he ignores you.
Your pessimistic self might be tempted to jump to the following conclusion: “I don’t look interesting and people always avoid me”. Then you feel awful. You focus on all of the times you have been rejected by others. Now you don’t feel like talking to people and leave the party.
Now, let’s look at the situation again and a possible way to reframe it.
Same event: You go to a party and run into an old friend. You make eye contact but he ignores you.
More optimistic thought: “he must have made eye contact with countless people today and doesn’t know whom to talk to first”. Then you feel empathy. You focus on all of the happy moments you spent with that old friend in the past. You smile and look around the room with bright eyes. You can’t wait to make new friends.
Do you see the difference?
Just thinking a positive thought automatically changed your emotional state and your decisions. Moreover, if you stop jumping to the conclusion that there is something inherently wrong with you, you will protect your precious self-esteem.
There are two ways you can boost the effectiveness of your reframing process. If you know you have negative thoughts that show permanence, pervasiveness, and personalization, you need to convince yourself those thoughts are wrong. Psychologist Martin Seligman recommends the following steps to dismantle unhelpful negative self-talk convincingly:
#1: You need evidence
Use evidence to prove your negative belief is objectively incorrect because it is most of the time… especially when such belief is permanent, pervasive and personal.
Example: Where is the evidence for the thought, “I was rejected because I’m ugly”? Does physical appearance always matter in the first place? Does one rejection prove I will always be rejected? Is there proof I am a likable person? Oh, now I remember someone gave me a compliment once. And now I remember also that girl who loved me in high school. Maybe I’m not that bad, after all (keep going…).
#2: Alternatives
Adversities may happen because of different factors. However, pessimists think these factors are permanent and influence all of the other areas of their life. Pessimists also believe there is something wrong with them which caused the adversity. What helps shift negative thinking is to choose alternative explanations that are not pervasive, permanent and personal.
For example, if you get bad grades, your negative belief may sound like this:
I will always get bad grades (permanent) and fail at everything in life (pervasive) because I’m an idiot (personal, not changeable).
Replace with the following alternative:
This time I got bad grades because it was a difficult exam and I did not study enough.
As you can see there is no permanence nor pervasiveness because the statement above discusses a specific exam. It blames something that can be changed: I did not study enough this time but next time I can study more. It also blames a non-personal factor: it was a difficult exam.
#3: De-catastrophize
When a negative belief reflects the truth quite objectively you can hardly fool yourself. What you can do is to look at the implications and de-catastrophize them.
For example, you are overweight. What are the implications?
You think you will never attract a potential partner.
Is this true? Have you ever seen an overweight person who has a partner? You probably have. Then, being overweight is not such a catastrophe when it comes to romantic relationships. Keep searching for evidence proving being overweight does not equal singleness.
So, now you have the tools you need to reframe adversities effectively. Do it until it becomes second nature. The more you practice interpreting events positively the more you become good at it.
You can do reframing exercises even when adversities are not happening. Just pick five adversities from your life experience, describe them and change a negative interpretation into a positive one. Then notice how the positive interpretation makes you feel emotionally better. If you suffer from bulimia, I suggest you pick adversities or thoughts that are related to food, to your body and your self-esteem.
2. Learn how to eat
The behavioral component of cognitive behavioral therapy for bulimics focuses on stopping dieting and normalizing eating by helping the individual adopt a balanced diet outside of binging episodes.
This may be challenging if the mechanism you use to compensate for binges is to skip meals. However, you need to make a conscious effort to nurture your body properly and mindfully during your breakfast, lunch, dinner, and snacks. When you learn how to do so, you turn off your body’s survival alarm, which may be what is triggering your binges in the first place.
It is important to establish a new relationship with food by practicing mindfulness. When you eat a meal, you should savor your food with all of your senses and chew it slowly, which is the opposite of what happens during a binge.
During a binge, people usually feel out of control and eat a huge amount of food in a short period of time while mindfulness is an effective ritual to regain this control at least during your meals. This step is crucial also to reacquire over time the awareness of hunger and satiety.
Keeping a diary is a practical way to self-monitor and report any insight from your mindfulness eating sessions. What did you eat? How would you describe it (sight, smell, taste, consistency)? Did you chew your food? What time, where and with whom did you eat? What was happening while you were eating? What thoughts were you thinking? What emotions were you feeling? When did you start feeling full? How long did it take to consume your meal?
3. Problem-solving
Problem-solving is another element of the cognitive-behavioral approach for eating disorders. Not only do patients learn how to reframe adversities, but they learn also how to solve them!
Some bulimics are triggered by events or situations and end up binging instead of finding a solution. This happens especially with social situations as people with eating disorders generally suffer from low self-esteem and lack assertiveness.
The result?
They can’t say no or stand up for themselves so they feel hopeless and binge.
The problem-solving steps are the following:
#1 Identify the problem and describe it thoroughly
#2 Brainstorm possible solutions
#3 Analyze the pros and cons of each solution
#4 Choose the best solution and apply it
#5 Take note of the result
I know this process may look simple or obvious, but it’s not. Many people don’t use it and, even if they do, sometimes they struggle to apply the solution.
Having this five-step system can help bulimics cope with their issues instead of running away and provides them with enough challenges to develop the self-esteem and assertiveness they need.
4. Hobbies
This is an underestimated point but it’s vital. When you experience an eating disorder, you may be spending most of your time thinking about it. It fills your life with something that will not be there anymore once you recover (thank God!).
To navigate successfully the life transition from having an eating disorder to being eating disorder free, you need to fill that extra time with something. What’s better than a fulfilling hobby that creates happiness in your life? What about a new exciting goal that fits your personality?
Make a list of possible activities or objectives and test them until you find the right ones for you.
Conclusion
My biggest hope is that this article inspired you to start a recovery journey. What helped me the most was not therapy itself but my decision to make a change in the first place.
You need to understand that bulimia is not a joke. It is never going to give you the body of your dreams long term and it will only stop you from becoming truly content with your life. So the time to be courageous and seek help has arrived.
Once you start therapy with a professional, they will likely boost your motivation by explaining to you the horrible effects bulimia has not only on your mind but also on your body.
Besides, it is important not to struggle with your struggles alone. Having support, compassion and understanding from somebody else is the best tool you can use to recover, especially because you may face relapses. Relapsing is normal but can be discouraging if you have a long history of low self-esteem. A therapist can help you build resilience and strength.
Now you know what to do. Cognitive behavioral therapy is evidence-based and changed my life for the better. I hope it will help you too with your recovery. Good luck!
