Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that helps people manage thoughts and behaviors in order to heal from mental health conditions. CBT has been shown to be an effective treatment for depression, anxiety, OCD, PTSD, and eating disorders. Whether you’re struggling with binge-eating disorder, bulimia nervosa, anorexia nervosa, or another eating disorder, I specifically put together this guide of CBT techniques for eating disorders that will help you manage distress tolerance and change behaviors. 

1. Cognitive Restructuring

Cognitive restructuring involves identifying negative thoughts and replacing them with healthier, more realistic ones. In eating disorder recovery, this technique helps clients challenge harmful beliefs by engaging in “eating disorder versus healthy self” dialogues. For instance, by reframing these thoughts, clients can develop more balanced perspectives on food and body image, leading to healthier coping strategies (Craske et al., 2020).

As an eating disorder recovery coach, this is one of the many cbt techniques for eating disorders that I use often with my clients and find very supportive to their recovery. Throughout my recovery, I would consistently challenge negative thoughts by asking myself if there was a more realistic, positive thought I could replace it with.

2. Journaling

Journaling is the act of writing down your thoughts, feelings, and experiences, and it is one of many frequently recommended CBT techniques for eating disorders. It provides a safe space to process negative emotions, helping you understand and release difficult feelings instead of suppressing them. Additionally, writing can make harmful thoughts more visible, allowing you to challenge and reframe them with compassion. By reflecting on your experiences, journaling grounds you in the present moment, fostering self-awareness and a deeper connection to your recovery journey.

3. Mindfulness

Mindfulness is the ability to be fully present without judgment. It plays an important role in eating disorder recovery in being able to sit with and overcome negative feelings. Meditation and breathwork are two wonderful coping skills in the realm of mindfulness because they can help you connect with your healthy self. For example, as an eating disorder recovery coach, I recommend my clients engage in meditation before or after a tough moment working on fear foods. Practicing mindfulness can also create space to observe negative body image thoughts without reacting to them, making it easier to choose recovery-aligned actions. Over time, integrating mindfulness into your recovery plan can build emotional resilience and strengthen your trust in yourself.

4. Activity Scheduling

This technique helps people engage in activities that improve their mood. It’s just as it sounds, scheduling meaningful activities to establish a better routine. For those in eating disorder recovery, activity scheduling can be a powerful tool to challenge low self-esteem by intentionally incorporating self-care and joy into daily life. Moreover, it can help break cycles of excessive exercise by promoting balanced, restorative activities that support overall well-being. When paired with meal planning, scheduling enjoyable activities after meals can reinforce positive core beliefs about nourishment and self-worth.

5. Unraveling cognitive distortions

This is the process of identifying and challenging negative thought patterns. A few examples of cognitive distortions include all or nothing thinking, jumping to conclusions, mental filter, and mind reading. By recognizing these distortions, you can begin to replace unhealthy thoughts with more balanced perspectives, reducing the urge to engage in compensatory behaviors. Using different strategies, like reframing or thought-stopping, can help break the cycle of negative thinking. Over time, this practice helps to create healthier thought patterns and more positive behaviors, supporting long-term recovery.

6. Guided Discovery

The therapist will ask a series of open-ended questions known as Socratic Questioning. This will help adult patients explore their current thoughts, behaviors, and emotions, fostering deeper reflection. This technique encourages patients to challenge unhelpful beliefs, gain insight into their thought patterns, and discover healthier perspectives. For adult patients in eating disorder recovery, guided discovery can be especially useful in unpacking rigid beliefs about food, body image, and health, leading to greater self-awareness and empowering more balanced, recovery-oriented decisions.

7. Roleplay

This is the act of a client and therapist role-playing a difficult scenario. For example, someone in eating disorder recovery might be nervous about an upcoming social gathering that involves food. The therapist and client will challenge negative thought patterns and behaviors that align with recovery goals. 

8. Thought Reframing

As an eating disorder recovery coach, this is one of my favorite CBT techniques for eating disorders. I always encourage my clients to engage in eating disorder self & healthy self dialogue. You can find specific examples of this type of dialogue in the 8 Keys to Recovery. I also provide a variety of examples on my Instagram page, @merritelizabeth.

9. Credit List

This is simply a daily list of positive events, it’s very helpful for recognizing positive beliefs. Keeping a credit list can also support relapse prevention by helping you focus on the progress you’ve made, rather than dwelling on setbacks. By reviewing this list in therapy sessions or meetings with your eating disorder coach, you can identify patterns of growth and challenge negative thoughts that may arise during difficult moments in your recovery.

10. Exposure Therapy

Exposure therapy is a well-established CBT technique for eating disorders, particularly useful for confronting fear foods or challenging rigid food rules. For those with eating disorders, repeatedly being exposed to fear foods helps the client conquer the food and eventually make peace with it. This approach is especially effective when integrated into a structured treatment plan, where exposures are gradually introduced and paired with coping strategies. Addressing food restriction through exposure helps clients break rigid food rules, reducing anxiety and fostering a more flexible, intuitive relationship with eating. Over time, this practice supports long-term recovery by reinforcing that nourishment is safe and essential for well-being. Throughout my recovery process, I would gradually include the number of fear foods I challenged per week, until eventually I could confidently eat everything I wanted with confidence.

FAQ’S related to Cognitive Behavioral Therapy & CBT Techniques for Eating Disorders:

1. How long does CBT take to see results?

Each client is different, and no provider can guarantee a specific timeline for seeing results. The length of time it takes to see progress in CBT depends on various factors, including the severity of the condition, the client’s willingness to engage in the process, and the complexity of the issues being addressed. However, many individuals start to notice some positive changes within the first few weeks of treatment.

Results can often be seen faster when the client actively engages in the skills and activities outside of sessions. This might include practicing new coping techniques, completing homework assignments, or journaling thoughts and emotions between sessions. The more consistently someone applies what they learn in therapy to real-life situations, the more quickly they can experience improvements in their thought patterns, behaviors, and emotional regulation.

For some people, significant changes may take several months, especially if they are working through deeper-rooted issues. It’s important to remember that CBT is a collaborative, gradual process, and long-term recovery can take time. Building and reinforcing new, healthier ways of thinking and behaving is an ongoing effort, but with regular commitment, many individuals experience improvements in areas like managing anxiety, improving self-esteem, and reducing the frequency of problematic behaviors.

2. Why is CBT effective for treating eating disorders?

CBT is effective for treating eating disorders  and a variety of mental health problems because it helps the individual struggling understand the relationship between their thoughts, feelings, and behaviors. It is also particularly effective in treating eating disorders by addressing the distorted thinking patterns related to food, body image, and self-worth, as discussed by Fairburn, Cooper, and Shafran (2003) in their transdiagnostic approach to eating disorders. CBT also helps individuals identify core beliefs that drive unhealthy eating behaviors, such as perfectionism, control, or fear of weight gain.

By challenging these beliefs, clients can learn to reframe their thinking and approach food and body image in a more compassionate and realistic way. In addition, it also teaches practical skills, like managing distress and emotional triggers, which are often tied to disordered eating patterns. 

3. Who benefits from CBT?

CBT can be used with individuals of all ages. It’s great for anyone who needs help challenging unhelpful thoughts and developing positive coping skills. Anyone seeking to better understand their thoughts and feelings and create meaningful change in their lives can benefit from CBT. It is highly structured, goal-oriented, and typically focuses on both the present moment and the future, making it an ideal choice for individuals looking to make lasting improvements in their mental health.

4. Can CBT be combined with other treatments?

Yes, CBT can be effectively combined with other treatments to enhance recovery outcomes, especially in eating disorder treatment. For example, CBT can work alongside nutritional counseling, medication, or other therapeutic approaches like Dialectical Behavior Therapy (DBT) to address co-occurring concerns such as anxiety or emotional dysregulation. A well-rounded treatment plan that integrates multiple modalities can provide a more comprehensive approach to healing, addressing both the cognitive and physiological aspects of recovery.

5. How can parents assist their child in CBT treatment?

Parents can play a vital role in supporting their child’s progress in CBT. One of the most impactful ways they can help is by creating a safe, non-judgmental environment where their child feels comfortable expressing their thoughts and emotions. Encouraging open communication and actively listening without immediately trying to “fix” things helps build trust and validates the child’s experiences.

Parents can also reinforce CBT techniques at home by learning the strategies their child is working on in therapy — like challenging negative thoughts or practicing coping skills. For example, if the child is learning to reframe unhelpful thoughts, parents can gently guide them through the process when they notice distressing moments.

Additionally, encouraging children to complete CBT homework such as journaling can make a big difference. For younger children or teens, parents might collaborate with the therapist to understand how best to support exposures or manage triggering situations.

References:

Craske, M. G., et al. (2020). Cognitive restructuring and psychotherapy outcome: A meta-analytic review. PMC, https://pmc.ncbi.nlm.nih.gov/articles/PMC10440210/

Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behavior therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41(5), 509-528. https://doi.org/10.1016/S0005-7967(02)00088-8

Published by Merrit Elizabeth on March 12, 2025.

Merrit Elizabeth

Merrit Elizabeth Stahle is an Eating Disorder Recovery Coach certified by The Carolyn Costin Institute. She holds a master’s degree in Health Promotion Management and a certification in Applied Neuroscience. She is fully recovered from an eating disorder and she has years of experience working with women with eating disorders.