Cognitive Behavioral Therapy (CBT) is a form of psychological treatment that focuses on restructuring thoughts, emotions, and behaviors to obtain constructive rather than destructive outcomes. Working with a therapist who specializes in CBT for BED can be very helpful, and if you have one in your area, we encourage you to connect. There are many techniques, however, that you can do on your own that can dramatically change how you eat.
Here is a stepwise approach that I have been using with my patients for over sixteen years that can also work for you!
Step 1: Identify the triggers that lead to binging and write them both down. Triggers can be visual (someone brought donuts to work, and I walked past), emotional/psychological (I was having a bad day), physiological (eg. hunger or low blood sugar) etc. Often, the behavior is tied to a past behavior and is our “go to” response. Don’t be embarrassed, just write them all down. Then we can conquer them one by one!
Here are some examples of triggers and actions that followed:
- I had a craving for chocolate and bought a bag of Hershey Kisses and ate them all.
- I saw a t.v. advertisement for a burger and it looked so good I drove to my closest fast-food restaurant and ordered a bunch of bad stuff.
- I felt fat looking in the mirror and said, “Who cares?” and got a bag of chips out, put on a movie and ate them all.
- I saw a guy checking me out and it made me uncomfortable, so I opened the M&Ms in the cupboard and got lost in them until I felt better.
- I was hungry because I didn’t eat all day, so I ordered a large pizza and ate the whole thing.
Step 2: Ask yourself- is there something that made me vulnerable or at risk? Look at the examples you wrote down and take a couple of minutes to think deeper about the circumstances that led to your binging episode. If you look at the examples above, the first risk factor could be “I was having PMS” or “I just finished a hard workout at the gym and could feel my blood sugar dropping.” The last example could be “I got too busy at work and skipped breakfast and lunch.” Take a deeper dive and write that down next to each example.
Step 3: How did you feel afterwards – Identify the emotion. It could be “full”, “stuffed”, “satisfied”, “guilty”, “ashamed”, “upset”, or “disappointed in myself” for example. Even if it is an ugly emotion, write it down. We are going to change negative self-talk immediately, but we need to understand the language we use to talk to ourselves. As you do this, think about your history. Is there someone from your past who used these words with you or on you? We need to break that off as part of our treatment strategy.
Step 4: What alternate language could you have used instead? Think about someone you love or respect. It could be a friend, family member or even one of your children. Now look at the words you chose above. If he or she came to you with this issue, what language would you use instead? Write a few words down next to the language you chose above. Learn to talk to yourself like you would talk to the people you love.
Step 5: What could we do to prevent this in the future? Go back to step 2 and see what we you could have done to prevent the binging episode? The answer to this depends on the specific situation. Here are some examples:
- I could have had a protein shake for breakfast and brought my lunch to work so I wasn’t so hungry when I came home.
- I could have ignored the donuts on the table and gone to my desk and had the protein bar I brought to work.
- I could have prepared myself to say, no matter how I feel, “You are beautiful!”
- I could have stuck to my diet during the day so that my craving for fast food would not have occurred.
Step 6: What is an alternate behavior to binging in the Future? Once you have identified your triggers, you need to do “pre-emptive strikes” so that you are never vulnerable. Additionally, you should always have a plan to execute if the urge to binge arises.
In my practice, I like to use tables and have specific plans with my patients for specific situations. Each visit, we review the tables and record (and celebrate) the improvement which will occur if keep at it. Look at the examples below and see if they would work for your circumstance. Additionally, create your own list with solutions that have been successfully used in the past.
Step 7: Rinse and Repeat! It can be challenging and emotional at times to go through these exercises, but this process works if you just stick to it and don’t give up. If the alternate behavior fails, choose another approach. Here is a personal example I will share with you. When I was growing up, we would always have something sweet after dinner. As an adult, I never have felt I was done with a meal unless I had something sweet at the end. I love chocolate, so I have tried Hershey Kisses, Dove chocolates, and other small treats but they never worked because I always wanted more. What has worked, however, is a couple of Cinnamon coated almonds with a tiny coating of Dark Chocolate underneath, or 70% Dark Chocolate instead of Milk Chocolate. They are both sweet enough to tell my brain that the meal is complete but doesn’t trigger me to go for more.
Finally, be patient with yourself and remember some of these behaviors are wired in our brains in our childhood. Our job is to “rewire” and create a different pathway to follow that is constructive and not destructive. I promise that CBT works if you stick with it, and the more you do it, the easier it is to avoid the behavior altogether.