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As a result, an extended version of cognitive
behavioural therapy (CBT) has been designed specifically for the treatment of
eating disorders, it is widely used and understood by the name of CBT-E, that
is, Cognitive behavioural therapy for Eating disorders. However, researchers
claim that these modified and specific scales are not so strictly used by the
psychotherapists as they tend to customise these manuals according to the
requirement of the intensity of disorder. Whereas, it is a common belief among
scholar and researchers that CBT has been most effective for the treatment of
Eating disorders since its formation, a vast number of researches available on
the topic justified this claim as well.

Behavioural therapy the formulation and result
of the evolution of behaviourism. Behaviourist approach to psychoanalysis
involves the study, inspection and understanding the behaviours to identify the
core problems in the cognition of a person. When the behavioural theories
started getting popular among early psychologists, they decide to get deeper
into the analysis and therapy approach. Therefore, the cognitive behavioural
therapy was formed, which basically involves the treatment of psychological
disorders or emotional issues that has an impact on the behaviour and attitude
of patients through deeper analysis and identification of the core problem by
breaking through to the cognitive functions and cognitive values of a person
and modifying them. This approach is now widely accepted and applied to the
treatment of most of the disorders all around the world. Most specifically, the
systematic approach of cognitive behavioural approach is widely implemented for
the identification and eradication of Eating Disorders among adults such as;
anorexia and bulimia.



Murphy et al. (2010) also identified in their
study that CBT-E is a form of cognitive behavioural therapy and is communal
with other empirically maintained forms of CBT it concentrates primarily on the
maintaining procedures, in this case those maintaining the eating disorder
psychopathology. It uses detailed strategies and a supple sequence of
serialised therapeutic measures to achieve both cognitive and behavioural
modifications. The approach of treatment is parallel to other forms of CBT,
that of collaborative empiricism. Although CBT-E uses a variety of generic
cognitive and behavioural interventions (such as addressing cognitive biases),
unlike some forms of CBT, it favours the use of strategic changes in behaviour
to modify thinking rather than direct cognitive reformation. The eating
disorder psychopathology may be compared to a house of cards with the strategy
being to recognise and eliminate the key cards that are supporting the eating
disorder, thus bringing down the complete house. Resultingly, the core features
of the fixated and broad varieties of CBT-E, includes adaptations that need to
be made for patients who are underweight (Murphy et al., 2010).

Banksoff et al., (2012) identified the
Dialectical Cognitive Behaviour therapy method for eating disorders, where the
Dialectical Cognitive Behaviour therapy or DBT is a multimodal cognitive-behavioural
approach adapted in numerous ways for individuals with eating disorders who,
like those with Borderline Personality disorder, may face difficulties in the
regulation of their emotions. DBT has been used as a treatment for the complex
cases of eating disorders that have been discussed in the former section of
this essay and also in an altered form for less complicated cases in which
other first-line approaches alone have been ineffective. Banksoff et al. (2012)
quoted, “Many patients struggle with black-and-white or all-or-nothing
thinking. An example would be, ‘Since I binged and purged today, I am a total
failure in life.’ Looking at that same circumstance from a dialectical
perspective would be, ‘I binged and purged today, and I am continuing to work
on my recovery.”

Furthermore, Kass, Kolko and Wilfley (2013)
separately identified the ways of treatment of anorexia nervosa and bulimia
nervosa, they suggested that to treat the anorexia nervosa eating disorder,
Maudsley model of treatment for adults with anorexia nervosa (MANTRA) is the
most prominent type of cognitive behavioural therapy (Kass et al., 2013).
However, specialist supportive
clinical management (SSCM) is another prominent method of therapy for the treatment
of the patients with anorexia. Whereas, for the treatment of bulimia nervosa
Integrative cognitive-affective therapy (ICAT) alongside the enhanced version
of CBT, called CBT-E are the major tools to help minimize and eradicated the
cognitive or behavioural causes of such disorders (Kass et al., 2013).
However, Tobin, Banker and Weisbery (2007) argued on the basis of their
research that only 6% of the therapists adhere to the manuals designed for the
treatment of eating disorders. In contrast, they therapists tend to merge more
than one methods or theories while treating their patient according to their
individual attitudes. In summary, they psychotherapists use randomised and
customised methods and manuals for treatment, which invalidates the manual solely
created for the treatment of eating disorders (Tobin et al., 2007).

Fairburn and Harrison (2003) also agree with
the fact that many psychological theories have been projected to minimize the
progress of eating disorders. In this regard, they suggest that the cognitive
behavioural theories have been most influential for the treatment of eating
disorders. A summary of these theories can be identified as that there are two
main procedures regarding the restriction of food intact by a behavioural
therapist that helps prevent eating disorders, where, both of said ways can be
operative at the same time. At first, the person should be able to have or at
least to feel in control of life, which gradually takes shape of the control of
eating habits. Second, is the overestimation of the body weight in comparison
to the ones who have been sensitised to the situation. However, both instances,
require highly reinforcing restriction regarding the eating habits (Fairburn
and Harrison, 2003). Consequently, other procedures get activated to operate
and help to preserve the eating disorder. They comprise of withdrawal from
social setting and groups because the fact that extreme and inflexible dietary
limitation encourages binge eating in convinced individuals and of the negative
outcome of binge eating on apprehensions about body shape or image. The
evidence increases regarding that the modification of discussed processes is
necessary for recovery, especially in those with bulimia nervosa.

As a result, since the formulation of cognitive
behavioural therapy, numerous procedures related to the cognitive behavioural
therapy that are specific to the disorders have been created by behaviour
psychotherapists (Hoffman, 2012). These various disorder specific protocols for
treatment may slightly differ according to the requirement of the disorder but
they are based on one core model and they follow the general CBT approach to
treatment. One such protocol as identified by Fairburn et al. (2009) is CBT-E.
It is a disorder specific transdiagnostic approach for the treatment of eating
disorders. There are two specified eating disorders inscribed in DSM-IV that
are; Anorexia Nervosa eating disorder and Bulimia Nervosa eating disorder
(Fairburn et al., 2009).  Whereas, Agras,
Fitzsimmons-craft and Wilfley (2017) postulated the third type in DMS-IV
involves the atypical eating disorders termed in DSW-IV as ‘eating disorders
other-wise non-specified’, these disorders are the untitled and unidentified
disorders. They can be a combination of diseases or also the changing
disorders, that is, they might take new shape or form hence cannot be specified
(Agras et al., 2017). Loucas et al (2014) identified the 3 general stages of
practicing and implementing the cognitive-behavioural therapy in the patients of
Eating disorder. The three steps include; Functional Analysis-The stage of CBT
where the individual is learning to identify problematic beliefs. Actual Behaviours-The
second stage of CBT where new skills are learned, practiced, and applied to
real-world situations. Behaviour Change-Final phase of CBT that encourage an
individual to take steps towards implementing a developmental transformation
(Loucas et al, 2014).

et al. (2012) explained the premise and function basis for the psychotherapy or
psychological treatment approach related to the Cognitive-behavioural therapy,
commonly known as CBT. Hoffman et al. (2012) suggest that CBT is based on the
interventions that maintain that the mental distress or psychological disorders
are caused by the factors of cognitive functions. Beck (1970) and Ellis (1962)
established the core premise relate to the treatment approach that the
maladaptive functions of cognitions are the contributors for the maintenance of
emotional or behavioural disorders. The fundamental model postulates that the
strategies related to psychotherapy of such disorders operate by changing the
maladjusted cognitive functions which as a result, lead to positive changes in
the emotional and behavioural problems (Beck, 1970). 

Rachman (2017) studied the evolution of
Behaviour therapy and how it emerged as the Cognitive Behavioural Therapy.
Pavlov’s work on the conditioning process can be regarded as the origin of the
Behavioural therapy. The study conducted by Pavlov (1995) related to
conditional learning through salivary reflexes made way for many new
discoveries and through these discoveries with developing times he formulated
an experimental pattern for the investigation of behavioural problems. Rachman
(2017) further argues in his study that the formulation of behavioural form of
treatment did sound simple, but during that era psychologists faces strong repulsions
by the medical practitioners for the proposed therapeutic method of treatment.
The method was assumed as absurd by many researchers due to the fact that the
system merely relied on the study, understanding and changing of learnt
behaviours without the intervention of medicines, physiological treatments and
ignorance of deeper psychosexual complexes of consciousness, in short, medical
oppositions failed to find the benefits related to the mere modification of
individual’s behaviour. The oppositions involved the assumption of
psychoanalysts that the extraction of neurotic causes or symptoms of the
disorder through behaviour therapy will result in the replacement of the
symptoms and they were convinced that the behaviour therapy can be harmful to
the individual’s cognition on a broader perspective, which was later, proved to
be a false assumption (Rachman, 2017). However, there was a lack of treatments
related to depression and to aid the cause, as the prohibition regarding
cognitive based psychotherapy started to fade the behaviour therapists adopted
cognitive concepts following the models suggested by Beck (1976). Rachman
(2017) determined that Behaviour therapists set aside their uncertainties
regarding the inappropriateness of cognitive concepts they began applying
cognitive concepts for the treatment of their patients, which resulted in
success. After the successes involved with the therapeutic methods the
remaining doubts about unacceptability of cognitive therapy were lifted,
particularly when behavioural therapy was incorporated together with the
cognitive therapy with emphasis on the behavioural components of cognitive


Moore (2011) conducted a study on Behaviourism.
He explained how the psychological approach changed from introspection to
observing behaviour. Watson (1913) founded the behaviourist school of thought.
He claimed that Behaviourism is “purely objective experimental branch of
science” it comprehends psychological disorders as dysfunctional or maladjusted
learning of behaviour. Baum (2011) identified in his study that it is based on
the ideology of “Tabula Rasa” meaning, a blank slate, that is, individuals are
born as a blank slate and all the behaviours are then learnt from the
environment. Hence, the maladaptive learning causes psychological disorders.
Whereas, the method of therapy according to behaviourist approach, is based on
the idea that what can be learnt can also be unlearned (Baum, 2011).
Consequently, the treatment of psychological disorders such as; eating
disorders, bi-polar disorders, PTSD and others has evolved into Cognitive
Behavioural Therapy which incorporates methods such as; classical and operant
conditioning (Moore, 2011). This essay, however, focuses on the recognition
related to the integration of behavioural approaches for intervention of
psychological problems in adults. The problem that will be primarily discussed
throughout the essay will be based on the treatment of eating disorders
including, Bulimia Nervosa, Anorexia Nervosa, Orthorexia Nervosa, Obsessive
Eating Disorder and others.