Reviewing Advantages and Disadvantages

When a patient reports feeling “stuck” or unmotivated to practice interventions between sessions, working with her to identify the advantages and disadvantages of doing so can be valuable. In creating this list of pros and cons, the therapist should make sure that the patient includes historical and ongoing consequences of the targeted symptom (e.g., eating in secret creates a feel?ing of isolation and mistrust from others). The patient will often recognize that she has overestimated the amount of time and energy the assigned homework will require or that the associated discomfort is temporary and is outweighed by the potential gains. A review of the advantages and disadvantages can focus on a particular intervention with which the patient is struggling or on treatment engagement in general.

Behavioral Experiments

Patients with BN, even when highly motivated to recover from their eating disorder, commonly fear letting go of select rigid behaviors and cognitions. They often fear that doing so will cause them to gain weight, to lose control, to become more preoccupied with food, or to binge more frequently. This is particularly common when implementing interventions such as food records, eating on schedule, reincorporating restricted foods, decreasing perfectionistic standards, and body acceptance strategies. When patients are fearful of committing to a certain behavior (e.g., eating three normal-sized meals and two snacks daily), they may be more willing to comply when the intervention is framed as a time-limited experiment (4 weeks is often particularly effective). As an experiment, they are free to resume their old behavior if they find the new one too distressing or ineffective, but only after the agreed-upon trial period.

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