Integrative Cognitive Behavioral (Affective) Therapy For Treating Bulimia Nervosa

Treating Bulimia Nervosa

July 9th, 2018   |   Updated on May 22nd, 2021

Bulimia nervosa is an eating disorder affecting mostly young women. Characterized by recurring episodes of “binge” eating (consuming large amounts of food at one time), feeling unable to control the urge to eat even when they are full and forcing themselves to throw up afterward, bulimia nervosa can also cause health problems involving the teeth, esophagus and the heart.


In addition to vomiting, people with bulimia nervosa may also misuse laxatives and diet pills, exercise excessively and fast between episodes to avoid gaining weight.

Treatment for Bulimia Nervosa–from Cognitive to Integrative Cognitive Behavioral Therapy


First recognized in the late 1970s, bulimia nervosa was initially treated with a combination of cognitive behavioral therapy (CBT) and tricyclic antidepressants.

Currently, CBT remains the preferred type of psychotherapy for addressing bulimia nervosa while pharmacological treatment now involves prescribing selective serotonin reuptake inhibitors (SSRIs), a newer form of antidepressant exerting fewer side effects.

In recent years, researchers have been studying the effectiveness of integrative cognitive (affective) behavioral therapy for treating bulimia nervosa and found ICAT to be promising and evolutionary in the broad field of psychotherapy.

A highly structured, short-term designed to be conducted over 21, forty-five-minute sessions, integrative cognitive behavioral therapy retains some elements of CBT (self-monitoring, planning meals and deliberately mindful efforts to modify behavior).

ICAT-BN also includes handouts oriented towards an individual’s specific emotional problems and ICAT “skill cards” to help them remain cognizant of their thought patterns.

ICAT for BN introduces the following concepts contributing to the development of this eating disorder:

  • Negative life experiences (parental abuse/neglect, family instability/dysfunction, peer pressure/being bullied)
  • Lack of coping skills necessary to deal with problems in a healthy manner
  • Having personality/temperamental disorders such as harm avoidance (excessive shyness, pessimism, and worrying) and negative urgency (prone to acting rashly when stressed)
  • Inability to self-regulate and self-evaluate (underlies self-esteem and self-identity issues as a child matures

ICAT teaches people with bulimia nervosa to focus on their emotions instead of avoiding them while emphasizing the importance of the functional dependency between bulimia nervosa and emotions that are not fully addressed.

Although integrative cognitive behavioral therapy concentrates on improving a person’s emotion regulation skills, it is not didactic.

Instead, the effectiveness of ICAT-BN has been shown to emerge from the collaborative, empathetic relationship between therapists and their patients endeavoring to understand and assimilate past experiences and patterns of negative thinking that foster bulimic behaviors.

Experiential Therapy Concepts and ICAT-BN

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People suffering bulimia nervosa use compulsive eating and purging behaviors to avoid self-examination and experiencing their inner self.

Aspects of experiential therapy are infused in integrative cognitive behavioral therapy to allow them to become more self-aware in a structured, safe environment guided by their therapist.

By rehearsing solutions to emotional issues that compel them to fall back on bulimia nervosa behaviors, individuals receiving ICAT-BN will be able to expand and nurture their self-identity, self-esteem, and ability to redirect negative emotions into positive thoughts and activities.

The Recovered Self

Following completion of ICAT-BN therapy, individuals with bulimia nervosa will have the tools necessary for understanding the difference between perceived distress and objective distress, quickly recognize the onset of compulsive thinking and engage in cognitive modification to stop negative patterns of thinking before these patterns take control of them.

With an enhanced orientation to the here and now, combined with a renewed sense of independence and self-worth, bulimia nervosa patients learn to use ICAT coping skills consistently throughout their daily lives.

Strengthened with the ability to enjoy the capacity for expressing their feelings and developing meaningful relationships with others, those recovered from bulimia nervosa can go on to achieve the goals in life they have always wanted to achieve.

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