A cognitive-behavioral approach to anorexia nervosa

The initial section of this paper presents a rationale for describing the development of anorexia nervosa in cognitive-behavioral terms. The limitations of conceptualizing the disorder simply as a behavioral pattern maintained by environmental contingencies or negative reinforcement are discussed. The remainder of the paper outlines a basic cognitive-behavioral model for intervention that is based on Beck's cognitive therapy. Recommendations particularly relevant to the management of anorexic clients are presented, including techniques for developing motivation for psychotherapy and for monitoring weight gain and food intake. Common irrational beliefs and systematic cognitive distortions are described. Assessment procedures and behavioral strategies that complement the cognitive approach are presented. Detailed examples are provided to illustrate the specific cognitive strategies that are recommended for evoking and modifying the irrational beliefs and assumptions of anorexic clients.The order of authorship on the article is arbitrary. The authors wish to thank Steven D. Hollon, Aaron T. Beck, and Paul E. Garfinkel for their helpful comments. An abbreviated earlier draft of this paper was presented at the meeting of the Association for the Advancement of Behavior Therapy, San Francisco, December 1979.