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Beating Your Eating Disorder A Cognitive Behavioral
Self Help Guide for Adult Sufferers and their Carers 1st
Edition Glenn Waller Digital Instant Download
Author(s): Glenn Waller, Victoria Mountford, Rachel Lawson, Emma Gray,
Helen Cordery, Hendrik Hinrichsen
ISBN(s): 9780521739047, 0521739047
Edition: 1
File Details: PDF, 3.11 MB
Year: 2010
Language: english
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Beating Your Eating Disorder: A Cognitive Behavioral
Self-Help Guide for Adult Sufferers and Their Carers
Beating Your Eating Disorder:
A Cognitive Behavioral
Self-Help Guide for Adult
Sufferers and Their Carers
Glenn Waller
Consultant Clinical Psychologist, Vincent Square Eating Disorders Service,
Central and North West London NHS Foundation Trust, and Eating Disorders Section,
Institute of Psychiatry, King’s College London, UK.
Victoria Mountford
Principal Clinical Psychologist, Eating Disorders Service, South London and
Maudsley NHS Foundation Trust, London, UK, and Honorary Research Fellow,
Rachel Lawson
Senior Clinical Psychologist, South Island Eating Disorders, Canterbury District Health
Board, and the Anxiety Clinic, Christchurch, New Zealand.
Emma Gray (née Corstorphine)

Consultant Clinical Psychologist/Service Coordinator, The British CBT & Counselling Service,
and Fellow at the Institute of Psychiatry, King’s College London, UK.
Helen Cordery
Trainee psychotherapist at the John Bowlby Centre, London, UK, and former specialist
registered dietitian working with eating disorders.
Hendrik Hinrichsen
Consultant Clinical Psychologist and Clinical Lead, Sutton & Merton IAPT,
South West London & St. George’s NHS Trust, and Visiting Research Fellow,
CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore,
São Paulo, Delhi, Dubai, Tokyo
Cambridge University Press

The Edinburgh Building, Cambridge CB2 8RU, UK
Published in the United States of America by Cambridge University Press, New York
www.cambridge.org
Information on this title: www.cambridge.org/9780521739047
© G. Waller, V. Mountford, R. Lawson, E. Gray, H. Cordery and H. Hinrichsen 2010
This publication is in copyright. Subject to statutory exception and to the

provision of relevant collective licensing agreements, no reproduction of any part
may take place without the written permission of Cambridge University Press.
First published in print format 2010
ISBN-13 978-0-511-90948-1 eBook (NetLibrary)

ISBN-13 978-0-521-73904-7 Paperback
Cambridge University Press has no responsibility for the persistence or accuracy

of urls for external or third-party internet websites referred to in this publication,
and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.
Every effort has been made in preparing this book to provide accurate and up-to-
date information which is in accord with accepted standards and practice at the
time of publication. Although case histories are drawn from actual cases, every
effort has been
made to disguise the identities of the individuals involved. Nevertheless, the
authors, editors and publishers can make no warranties that the information
contained herein is totally free from error, not least because clinical standards are
constantly changing through research and regulation. The authors, editors and
publishers therefore disclaim all liability for direct or consequential damages
resulting from the use of material contained in this book.
Readers are strongly advised to pay careful attention to information provided by
the manufacturer of any drugs or equipment that they plan to use.
Praise for Beating Your Eating Disorder
“Decades of clinical experience come to light in this plain-speaking self-help

text for both sufferers and carers. There’s no sugar-coating here, just a pragmatic
and evidence-informed step-by-step approach for gaining control of your
own eating disorder. Through the use of rich vignettes and colorful analogies,
the authors provide a context for recovery. The chapter on motivation is a
unique contribution that allows both sufferers and carers to self-appraise their
readiness for change. The book is infused with hope for recovery provided
the reader is prepared to dig-in and do the work necessary for a successful
self-help journey.”
Cindy Bulik, William Jeanne Jordan Distinguished Professor of Eating
Disorders, University of North Carolina at Chapel Hill, USA.
“Comprehensive and thorough. The information is provided in an approachable

and forthright style. The authors clearly describe what is involved in overcoming
an eating disorder and encourage the reader to do the necessary work.
It doesn’t underestimate the effort it will take, but rather gives very helpful,
practical and evidence based information. The book is equally helpful
for families and friends of someone working to beat their eating disorder –
giving them the support they need to be a powerful ally in recovery. Most
importantly, this book gives hope that life without an eating disorder can be
lived to the full.”
Susan Ringwood, Chief Executive, beat, UK nationwide self-help organiza-
tion for sufferers of eating disorders.
“This clearly written self-help guide for adults with eating disorders successfully
translates the best available treatment we have – cognitive behavioral therapy –
into a user-friendly and highly practical self-help approach. It is thorough and
detailed without being overly long, and the material is presented in a fresh,
interesting way. This excellent book is highly recommended for adult sufferers
v
vi Praise for Beating Your Eating Disorder
with eating disorders who wish to use a self-help guide for the first step, and
hopefully the only step that will be necessary, in overcoming their eating
problems.”
James Mitchell, Christoferson Professor and Chair, Department of Clinical
Neuroscience and Chester Fritz Distinguished University Professor, University
of North Dakota School of Medicine and Health Sciences, USA.
“The writers communicate in a clear, direct, compassionate and honest voice,

enriched by extensive clinical experience, that will help the reader to feel under-
stood, to understand what maintains their eating disorder, and to have the
courage to experiment with learning to eat healthily again.
This is a valuable resource for people with eating disorders considering
change, for carers who feel lost, and for therapists who are seeking to help their
clients build a foundation for enduring change.”
Tracey Wade, Professor of Psychology, Flinders University, Australia.
“This is the long-overdue book that adult sufferers of an eating disorder and
their carers have been waiting for. It has been masterfully written from a wealth
of practical experience and will without doubt become a mandatory resource.
It surpasses any of the other self-help guides in quality and scope, and will ensure
that those who read it are impelled to act.”
Stephen Touyz, Professor of Psychology, The University of Sydney,
Australia.
Contents
Preface: read this bit first page xi

Who is this book for? xi
What is this book about? xii
Final points before starting xii
Who are the authors of this book? xiii
Acknowledgements xiv
About the authors xv
Section 1 Getting started 1

First things first: staying physically safe and well enough
to use the help provided in this book 1
1 Who is this book for? 3

“Do I have an eating disorder?” 3
“Does my eating problem really deserve any attention?” 5
“What can I do if I care for or live with someone with an eating
disorder?” 7
“Why should I use self-help, rather than getting more formal help
from a professional now?” 8
“So what do I do now?” 8
2 The key elements of cognitive behavioral therapy

and the self-help approach 10
What is cognitive behavioral therapy (CBT)? 10
The key elements of CBT 10
Your journey through CBT: some landmarks 11
What is CBT self-help? 12
“I’m not sure that I’m ready to change”: a quick word
about motivation 14
vii
viii Contents
3 How to use this book 15

Read it all 15
If you are a sufferer 15
If you are a carer 15
Whoever you are 16
Section 2 For the sufferer 17
4 Am I making a fuss about nothing? 19

Some important definitions 19
Myths to dispel 20
5 Motivating yourself to treat your eating disorder 23

Motivational states 23
The pros and cons of having an eating disorder 25
6 Is now the time to act? 29

Life circumstances 29
The balance between the pros and cons of your eating disorder 29
Accepting responsibility for change 30
7 Getting started with CBT 33

Becoming your own therapist 33
What to expect 34
Giving yourself the best chance of success 35
Summary 41
Section 3 The CBT self-help program 45
8 Start here: how to use this program 47

If you are a sufferer 48
If you are a carer 48
Practicalities 48
Anxiety and safety behaviors 49
Final tips on maximizing your chances of success 50
What do I need to get started? 51
The CBT plan for change 52
Building your own road map to recovery 56
9 The practical steps of CBT for your eating disorder 58

What if it is not working? Overcoming “therapy interfering behaviors” 59
Step 1: Developing and maintaining your motivation 59
Step 2: Developing a regular, balanced pattern of eating 60
Step 3: Challenging your thoughts and anxieties about weight 71
Step 4: Addressing negative thoughts and feelings about your body 83
Step 5: Addressing residual difficulties 91
Step 6: Maintaining the gains 92
Where to next in this book? 93
Contents ix
Section 4 For carers 95

10 Am I to blame for the eating problem? 97
Stop blaming yourself 97
Why didn’t I notice before? 98
11 What can I do to support the sufferer? 99

Dealing with emotional distress 99
Should I feel so stressed and impotent? 99
How do I talk to the sufferer? 100
Dangers of collusion 100
What about the rest of the family? 101
What can I do if I am worried about the sufferer? 102
How to ask for help and who to ask? 102
Where can I get information? 102
Getting help for yourself 103
How can I keep the sufferer interested in change? 103
I am a friend of the sufferer: how can I help? 105
Sufferers with chronic disorders 106
Supporting the sufferer while they are following the self-help
program outlined in this book 106
Section 5 Transitions into more formal help 109

Before you go any further 109
12 Thinking about getting more formal

therapeutic help 111
What has stopped me seeking help before,
and what might stop me now? 111
13 Starting the process of getting therapeutic help 114

Who should I talk to? 114
Preparing for your assessment 115
How do I involve my carers 116
What treatment will I be offered? 116
Coping with waiting 117
Attending your first session of CBT 118
14 What to look for in a good CBT practitioner 120

The therapeutic relationship 120
Accreditation/registration 121
Willingness to talk about method 121
Willingness to talk about the process of therapy 123
15 The role of carers in the transition to more formal help 124

What can I do to help my loved one get help? 124
So why is it so hard to help my loved one? 125
x Contents
Section 6 Letting go of the eating disorder 127

16 The journey of recovery 129
Are there healthier alternatives to my eating disorder behaviors? 130
Who am I if I do not have my eating disorder? 131
What if I can’t make all the changes now? 131
Can I stay “a bit anorexic/bulimic”? 132
What if the eating disorder comes back? 133
17 Relapse prevention 136

Forewarned is forearmed 136
Planning for the future – getting your life back 139
Review sessions 139
A word of warning: the risks of weight loss 140
Dealing with other issues 141
18 Have I done myself permanent damage? 142

Bone structure 142
Fertility 143
Will my eating disorder have had an impact on my children? 144
19 Carers need to move on too 145

Understanding the sufferer’s perspective 145
Who is this new person? 145
What can I do if I think I see the eating disorder returning? 146
Who was to blame for the eating disorder? 146
Conclusion: eating normally again 147

For the sufferer 147
For the carer 147
Appendices 149
References and further reading 189
Index 191
Preface: read this bit first
Who is this book for?
If you are an adult who suffers from an eating disorder, this book is designed to
help you overcome your eating problems. It is designed to help you regain
control whether you have anorexia nervosa, bulimia nervosa, or an atypical
problem (where you have some of the symptoms but do not meet all the criteria
for one of those better-known diagnoses). You might have been directed to this
book by a clinician (e.g., your family doctor might have recommended it, or a
specialist clinician might have suggested that you try it while you wait for more
formal treatment). However, many sufferers will never have received a formal
diagnosis, but will know that they are not happy with their eating and their
associated thoughts and feelings. This book is for you, whether or not you have a
diagnosis.
If you are a carer, relative, partner, friend or child of a sufferer, this book is
designed to help you advise, support, and work with the sufferer as she or he
works to overcome the eating problem. This process includes learning how to
cope with your own level of stress and concern, because you are likely to be
severely affected by the sufferer’s experiences. If you can deal with your own
feelings, then you are in a stronger position to support the sufferer.
Our aim is to help any adult sufferer to eat normally again, without being
plagued by worries about their shape or weight, and without feeling that you are
out of control. If that is too much to imagine, then we aim to help you get as far
along that path as you are ready to go right now. This book is not aimed at
adolescents with eating problems, because the evidence is that such sufferers
benefit more from a family-oriented approach. However, there are lessons in here
that might be useful ones to add to the family perspective.
This book will not be enough for you if you have serious complications from
your eating disorder. For example, we strongly recommend that you should seek
professional support from your doctor if:
• you are very depressed or feel hopeless all the time
• you have physical symptoms of your eating problem that place you in danger
(see the start of Section 1 on staying safe)
• you are using self-damaging behaviors (e.g., self-cutting, binge-drinking)
• you have a young child who you fear might be suffering as a result of your
eating problems
xi
xii Preface
You might still be able to use this book, but only when those other issues are
dealt with and you are safe and stable.
You might be afraid that going to your doctor will be difficult or embarrassing,
but if you go to your doctor with a clear idea of your concerns then she or he has
a much better chance of helping you. You will not be the first sufferer or carer
that your doctor has seen and there are very clear guidelines that your doctor
can use to help in your care and support. One such recommendation is that
many sufferers should be encouraged to try a self-help book ahead of any referral
to specialist services. A good example is the National Institute for Health and
Clinical Excellence (NICE) guideline on eating disorders for professionals, which
is available online at: http://guidance.nice.org.uk/CG9/niceguidance/pdf/. There
is a linked version of this document for sufferers and carers, which we recom-
mend that you read. This version is available online at: http://guidance.nice.org.
uk/CG9/publicinfo/pdf/.
What is this book about?
The self-help approach outlined here is based on the strongest evidence-based

approach that currently exists for working with adults with eating disorders –
cognitive behavioral therapy, also known as CBT. This form of therapy is not an
easy solution to your problems, but it has been proven to have the strongest
and/or fastest impact on most types of eating disorder (other than anorexia
nervosa) among adults, and is more effective than most other forms of therapy
for these disorders. Recent evidence also supports this approach with anorexia
nervosa, although the evidence base is not as large.
Final points before starting
It is important that you remember that there are no miracle cures for eating
disorders. If there were then it is pretty likely that you would already have found
one that worked for you. Doing CBT is not easy – it is hard work. You can
probably bet that the harder you work at it, the more likely this approach is to
work for you.
So remember, simply owning this book is not the same as using it. Too many
of our patients have bought books like this and then waited for them to be
helpful, rather than putting them into action. You would be better not to buy this
book (or any other) than simply have it sitting on a shelf. For this book to help
you, you need to read it and use it. Using this book means learning how to do
CBT and applying it to yourself – to take on the role of being your own therapist.
There are many tasks in this book that you will find hard, but remember that the
reward is that you get to eat normally again and to lead a life where every
thought, feeling, and decision is not influenced by what you eat, your shape and
your weight.
Preface xiii
If your eating disorder were an easy problem to solve, you would have solved it
already. Eating disorders are real, serious and complex problems. That complex-
ity makes them difficult to resolve, but with the right approach it is possible to
overcome them.
So a key thing to remember is that overcoming your eating disorder is going to
be a complex and challenging task, and that it will require you learning to eat
healthily again in order to succeed. That will mean working to develop an
appropriate structure to your eating, and then changing the content of what
you eat. Your thoughts, feelings, relationships, and motivation will all be import-
ant, but working on them without working on your eating (from the beginning)
is unlikely to help you to escape your eating disorder.
Who are the authors of this book?
We are clinicians with many years of experience in working with the whole range
of eating disorders, using CBT to help people with eating disorders to eat
healthily and to feel good about themselves. Our goal in writing this book is to
make this approach available to many sufferers (and their carers) who find it
difficult to get clinical help, for whatever reason.
Acknowledgements
We would like to thank the many colleagues, trainees, and patients who have
helped us to shape our ideas and the program that we have outlined here. We
would also like to thank all of the editorial and production teams at Cambridge
University Press for their encouragement, patience and assistance throughout the
preparation of this book. Although others have played a valuable role, particular
thanks are due to Richard Marley, Katie James and Frances Peck.
We would like to dedicate this book to our families.
xiv
About the authors
Glenn Waller has worked in the field of eating disorders for over 20 years. He
works as a Consultant Clinical Psychologist for the Vincent Square Eating
Disorders Service, Central and North West London NHS Foundation Trust,
where his clinical specialty is cognitive behavioral therapy for eating disorders.
He is also Visiting Professor of Psychology at the Institute of Psychiatry, King’s
College London. He has published over 200 peer-reviewed papers and 20 book
chapters on the pathology and treatment of eating disorders, and has presented
his work at many national and international conferences. He is also the lead
author of a book on cognitive behavioral therapy for eating disorders (Waller, G.,
Cordery, H., Corstorphine, E., et al. [2007]). He is a member of the international
Eating Disorders Research Society and the British Association for Behavioural and
Cognitive Psychotherapies, and is a Fellow of the Academy for Eating Disorders.
He is registered as a practitioner with the Health Professions Council.
Victoria Mountford is a Principal Clinical Psychologist with the Eating Disorders
Service, South London and Maudsley NHS Foundation Trust and an Honorary
Research Fellow at the Institute of Psychiatry, King’s College London. She has
both published and presented widely on eating disorders and has a particular
interest in body image in eating disorders. She is currently involved in large
treatment trials to evaluate the use of psychological therapies, including CBT, in
anorexia nervosa. She is also co-author of a book on cognitive behavioral therapy
for eating disorders (Waller, G., Cordery, H., Corstorphine, E., et al. [2007]).
Victoria is an accredited member of the British Association of Behavioural and
Cognitive Psychotherapy and the British Psychological Society, and is a registered
practitioner with the Health Professions Council.
Rachel Lawson is a Senior Clinical Psychologist at the South Island Eating
Disorders, Canterbury District Health Board in New Zealand, and is in private
practice with the Anxiety Clinic, Christchurch, New Zealand. She has published
research on eating disorders and regularly teaches about this area. She presents at
national and international conferences on eating disorders.
xv
xvi About the authors
Emma Gray (née Corstorphine) was Consultant Clinical Psychologist/Clinical

Manager with the Oxford and Buckinghamshire Eating Disorders Service until
recently. She left this post to expand her private practice (The British CBT &
Counselling Service) and her family. She has published peer-reviewed papers and
a book chapter on eating disorders and has presented papers and workshops at
national and international conferences. She is also co-author of a book on
cognitive behavioural therapy for eating disorders (Waller, G., Cordery, H.,
Corstorphine, E., et al. [2007]). She is a member of The British Psychological
Society and the British Association for Behavioural and Cognitive Psychothera-
pies. She is registered with the Health Professions Council. She is a Visiting
Research Fellow at the Institute of Psychiatry, King’s College London.
Helen Cordery had been a dietitian for about 17 years at the time of co-writing
this book, 12 of which had been spent specializing in working with people with
eating disorders. This work was mainly within the National Health Service
(NHS) and within a variety of settings (with outpatients, and on both in-patient
and day-patient units). She is currently in the process of training to become an
attachment-based psychotherapist.
Hendrik Hinrichsen is a Consultant Clinical Psychologist and Clinical Lead for
the Sutton & Merton IAPT Service based in Wimbledon, London. He is also a
Visiting Research Fellow at the Institute of Psychiatry, King’s College London.
Dr Hinrichsen has both published and presented research on cognitive behav-
ioral therapy (CBT) for eating disorders and anxiety disorders, and he is the
co-author of a book on CBT for eating disorders (Waller, G., Cordery, H.,
Corstorphine, E., et al. [2007]). In 2003 and 2009, he was a joint recipient of
South West London Excellence Awards for clinically relevant research and
working in partnership. Dr Hinrichsen is registered as a professional psychologist
with the Health Professions Council, and he is fully accredited by the British
Association for Behavioural and Cognitive Psychotherapies (BABCP).
Section 1
Getting started
This section contains important information that will help you decide how to
use the rest of the book. We use the section to outline:
• who this book is for, and why cognitive behavioral therapy (CBT) is likely to be
relevant to you
• the key elements of CBT for the eating disorders
• how to read this book to get the maximum benefit
First things first: staying physically safe and well enough

to use the help provided in this book
However, before you go any further with this approach, it is vital that you make
sure that you (or the sufferer) are physically safe. Self-help can help you with
many aspects of an eating problem, but there are some problems that require
additional help. The eating disorders have a physical and emotional/psycho-
logical component, and both need to be addressed. Therefore, you should discuss
the physical symptoms with your family physician anyway. However, if you
(or the sufferer) experience any of the following, then you must get extra support
and monitoring from your doctor in order to ensure safety:
• losing weight rapidly over several weeks (e.g., more than 1kg a week for more
than four weeks)
• fainting, dizziness or blackouts
• your BMI (body mass index) is less than 16 (we will show you how to work out
your BMI shortly)
• vomiting (especially if it is happening more than twice a day and/or you see
blood in the vomit)
• taking laxatives frequently
• taking diet pills
• muscular weakness (e.g., you cannot stand without using your arms to lever
yourself up)
1
2 Section 1: Getting started
• shortness of breath
• suffering from other medical conditions that affect your diet (e.g., diabetes,
cystic fibrosis), as well as your eating problem
• binge drinking of alcohol
• self-harm (e.g., self-cutting or burning)
• feelings of hopelessness or suicidal thoughts
Listing these points might sound like we are trying to scare you, but part of
working on your eating disorder is reducing the risks of these very real and
dangerous physical symptoms. As the signs and symptoms above can place you
at risk of serious physical consequences (e.g., heart irregularities, electrolyte
imbalance), the first step in managing and resolving your eating disorder must
be to ensure your physical safety. Therefore, it is important to get yourself
checked out. Your doctor might simply assess the risk (e.g., doing some blood
tests, testing your heart function) and give you the “all clear”, but she or he might
want to offer you some help with these problems (e.g., potassium supplements).
She or he might also suggest that you should be referred for specialist help with
your eating or other problems. (It is important to remember that comparatively
few individuals with an eating disorder are ever admitted to hospital, so being
referred for such specialist help does not mean that you are going to need to
be admitted.) However, as recommended in the NICE guidelines for eating
problems (see the Preface), many doctors will suggest that you should try a
self-help approach, even while waiting for that support. That brings you back
to this book.
1
Who is this book for?
This book is for you whether you have an eating disorder or whether you are a
carer for someone who suffers from an eating disorder (e.g., a partner, a parent
or a best friend). Ideally, both the sufferer and her or his carer will read it, and
share their thoughts. If you are the one who has the eating problems, then this
book is for you, whether you are male or female, whatever your age, whatever
your ethnicity, and whatever the nature of your eating disorder.1 We think that
every sufferer needs to learn how to be her or his own CBT therapist, but all this
effort can be made much more effective if she or he has the support of someone
close who understands the problem and who knows what CBT involves. As
putting CBT into practice can be challenging, having someone close to coach
you during this process can be invaluable and can sometimes make the difference
between failure and success.
Here are some questions to ask yourself at this point:
Question one: “Do I have an eating disorder?”
First and foremost, this book is likely to be for you if you believe that you have
issues about your eating and about your body. You might feel that those issues
are getting in the way of living your life in the way you want. Sufferers of eating
disorders often have concerns about their eating, shape and weight, and they
report high levels of anxiety about what would happen if they ate normally (i.e.,
like other people around them). The result is that you use eating-related behav-
iors to cope with your beliefs and fears – maybe food restriction, maybe exercise,
maybe taking laxatives, diuretic or diet pills, maybe overeating or binge-eating.
1
Please note that this book is not for individuals who are simply overweight. However, it will be
entirely relevant to someone who is overweight and who also binge-eats, for example.
3
Table 1.1 Questionnaire 1a: Do I have a problem with my eating?
Not at all
A little
Sometimes
Most of the time
All of the time

Just tick the answer that most closely describes your feelings or
actions on each of these points:
I spend time worrying about whether I have put on weight

I worry that my body will get bigger if I don’t keep my
eating very tightly controlled
I have to restrict what I eat and/or exercise in
order to compensate for the fact that I have eaten
too much
I take laxatives and/or make myself sick to help control my
weight and size
My eating pattern means that I cannot live the life that
I want to
I spend a lot of time checking my weight, measuring myself,
checking my reflection, etc.
I feel ashamed of my eating pattern
My eating distresses those around me (my family,
friends, etc.)
My health suffers as a result of my eating
My relationships are limited because I have an eating
problem
I eat because I am upset, rather than because I am hungry
Controlling what I eat is more important than any other
element of my life
I exercise a lot, even if I am injured or it gets in the
way of socializing with my friends (professional
athletes excepted)
You are also likely to find that eating, and weight and shape concerns have a big
influence over how you organize your life. Although this way of coping might
have given you a sense of control at first, it is likely to have ended up creating
more problems than it solved initially. Tick off your answers in the questionnaire
above (Table 1.1).
The more that your answers appear in the columns on the right hand side, the
worse your problem is right now. We will come back to these questions later in
the book to see if your attitudes, feelings and behaviors change as you work on
your treatment.
You will notice that there is nothing in the questionnaire about your age, gender,
ethnicity, or type of eating disorder (e.g., anorexia nervosa or bulimia nervosa).
Chapter 1: Who is this book for? 5
This is because the stereotype of an eating disorder sufferer (young, female, white,
and anorexic) is misleading. Although eating disorders are more likely to be
found among younger females, anyone can develop an eating disorder.
Question two: “Does my eating problem really deserve

any attention?”
One of the most common themes when sufferers come to a specialist center for
the treatment of their eating problem is: “I don’t deserve any help – other people
need it more.” They are almost always wrong. If you are concerned about your
eating and body shape, and if it is impairing your life, then your eating disorder
deserves attention and this book is for you.
While every eating disorder manifests differently, it is useful to think
about some general profiles that might give you an idea of whether your
eating problems are comparable and need attention. These three cases are all
females, but they could equally be males. We will come back to these cases
as the book progresses, to illustrate how you can use this approach to help
yourself move on from your eating disorder. Please remember that there
is not enough space here to describe every individual who develops an
eating disorder, but many of the themes in these cases should be familiar,
particularly:
• the sufferer’s extreme concern about eating, weight and shape
• the behaviors that follow those beliefs and that maintain them
• the way that the eating attitudes and behaviors significantly impair the life of
the sufferer and carers
Case 1: Jenny
Jenny is a 32-year-old woman who has had anorexia for over 14 years. She
developed her problem at a time of considerable stress, when her parents
were divorcing in the run-up to her school examinations. In order to get a
sense of control over some aspect of her life, she began to diet. Initially, this
led her to feel a positive “buzz” as she lost weight. However, that was
followed by feeling scared of weight gain and having to diet even harder.
While her weight is low, she has only ever been hospitalized once, when she
was 19. Since then, she has maintained her weight near the top of the anorexic
weight range. This has allowed her to work, but she feels that she has not
reached her potential in her profession. Nor has she been able to sustain a
relationship. Almost all of her free time is taken up with exercising in her local
gym, trying to deal with how fat she feels. Although she would like to have
children, she is not biologically able to do so at present, because her low
Case 1: (cont.)
weight means that her ovaries have become non-functional and her periods
have stopped. In addition, she had a bone scan two years ago that indicated
substantial osteoporosis (loss of bone structure). Jenny’s mood is low and her
concentration is poor. She has investigated getting help twice, but still feels
afraid of engaging in such change.
Case 2: Katy
Katy, aged 23, has bulimia nervosa. She is slightly above the normal weight
range, at least partly because of the binge-eating, which she does four or five
times per week. She tries to control her weight by missing meals and snacks and
by exercising, but when she binges she makes herself vomit so that she can
reduce her anxiety about gaining weight. She weighs herself up to 20 times per
day, to feel safe about her weight being stable. Sometimes, she takes laxatives
to try to compensate for the larger binges. She describes all her thoughts as
being about how others see her and about whether they see her as fat. She
occasionally cuts herself when she feels very distressed, in order to cope with
those difficult feelings. At other times, she drinks to cope with her fear that
others will be judging her negatively.
Case 3: Polly
Polly is 44 and works as a teacher. She has a substantial record of absence from
work for reasons of illness. Like very many people with an eating disorder, she
does not fit neatly into an “anorexia” or “bulimia” category. She has been
concerned about her eating, weight and shape for all of her adult life. She is
also very concerned with eating “healthily,” which means that she eats from a
limited range of foods (most of which are low in fat and carbohydrate). The
result is that her overall diet is poor and unbalanced. She is slightly underweight,
but is not losing weight and is not in the anorexic weight range. She reports that
she binges, but this is actually her way of describing eating any foods that she
had not planned to eat. She vomits when she has eaten in that way. She has
children and her partner is concerned that they are developing similar concerns
about eating, weight and shape (though Polly herself does not accept that this is
necessarily true or a worry). She is more concerned that her eating pattern is the
reason that she has been passed over for promotion. Following a visit to a diet
clinic and a set of unverified “tests,” she reports a range of food intolerances
and irritable bowel syndrome (although full medical investigations have failed
to confirm these self-diagnoses).
Question three: “What can I do if I care for or live

with someone with an eating disorder?”
This book is also for you if you are a carer for someone with an eating problem.
Maybe you are a parent, partner or other family member, and you are concerned
that your child, partner, sister, brother or relative has a problem. Alternatively,
maybe you are worried about a friend’s eating and want to know how to help
them. Living with someone with an eating disorder can be challenging and
exhausting, so there may be some real value in being able to understand what
challenges they will have to overcome in order to get better and in being able to
assist them in this process. The next set of questions (Table 1.2) is for you as a
Table 1.2 Questionnaire 2a: Does my relative/child/partner/parent/friend have an

eating problem, and how is it affecting her/his life and mine?
Not at all
A little
Sometimes
Most of the time
All of the time

Just tick the answer that most closely describes your feelings on
each of these points. Because this questionnaire is for all types
of sufferer, we have not specified who the sufferer is (e.g., your
child, your partner, your friend, or your parent):
The sufferer’s eating controls her/his life

The sufferer feels that she/he is in control of eating, but that
is not the case
My relationship with the sufferer is poorer because of her/
his eating pattern
My relationship with the sufferer is stressful because of
issues around food and eating
My life is constrained by the sufferer’s eating and body
concerns and related behaviors
I wish that I could have a normal relationship with the
sufferer, untainted by food
Our whole relationship is influenced by the sufferer’s eating
I can see that the sufferer’s quality of life is really suffering,
and she or he is not developing as she/he could
The sufferer’s eating takes up so much of her or his time,
that she/he has no time for a happy life
I am stressed by the sufferer’s eating problems and how they
affect her/his behavior
My own eating suffers as a result of the sufferer’s rules and
behaviors about food
My other relationships are damaged by the sufferer’s eating
problems
carer, asking you to think about whether the individual has a problem, and
whether that problem is distressing for you. Again, we will come back to these
questions later in the book, to see if things have changed.
As with the questionnaire for the sufferer (above), the more that your answers
appear in the boxes on the right hand side, the stronger are your concerns for the
sufferer and the more their eating difficulties are affecting your life right now. We
will come back to these questions later in the book to see how things have
changed as you gather the support and knowledge that will put you in a stronger
position to help the sufferer.
If you and the sufferer have both completed your questionnaires, then
now would be a good time to share your perspectives. Try reading one
another’s answers and discussing your viewpoints, but make sure you do that
at a calm time, well away from food and meals and not when either of you is
angry or upset.
Question four: “Why should I use self-help, rather than getting

more formal help from a professional now?”
It is difficult to say which treatment method is best and for whom. Sufferers and
carers need to find what is right for them, and this may change over time. For
many people, self-help methods are enough to help them, but many others
ultimately decide to seek out professional help. You may find that this book
can also help you if:
• you are not yet ready to take the next step towards seeking professional help
(e.g., too busy to attend when a clinic can see you; or feeling too ashamed
and fearful of discussing your concerns with someone you don’t know), and
self-help is an alternative to seeking more formal help
• you find it hard to access appropriate specialist help (e.g., financial reasons,
unavailability of effective treatment, time on a waiting list, geographical
location)
• you need help to prepare for entering more formal treatment at a later stage.
In this book, we will tell you what to look for in formal treatment, and why
You might also appreciate the support that you could get from talking to fellow
sufferers and carers. In such cases we recommend that you should get in touch
with a local support network (please see Appendix 1 for a list of such support
organizations).
Question five: “So what do I do now?”
In this book, we want to share with you the information and strategies that we
have found helpful in our work with patients over the years. Before we describe
the details of our approach, here is a brief outline of what we think are the key
elements of good treatment. First, you will learn about CBT and self-help. This is
background information, giving you a context to understand what to do and
why we will be asking you to do it. Therefore, we think this section should be
essential reading for sufferers and carers alike. Next, we describe how to use the
book. We hope that at this point you will feel ready to put at least some of what
you have read into action and start to work on the eating problem – either as a
sufferer or as a carer.
2
The key elements of cognitive behavioral

therapy and the self-help approach
What is cognitive behavioral therapy (CBT)?
This chapter will help you to understand CBT – the most effective psychological
treatment for most people with eating disorders. It is addressed to the sufferer,
but it is relevant to carers too, so everyone should read it. The clearer your
understanding, the better your position will be to make a decision about change,
to make changes, or to support someone else to make changes. A shared under-
standing with those around you will make the path to recovery an easier one.
The key elements of CBT
CBT is a treatment approach that provides us with a way of understanding

our experience of the world, enabling us to make changes if we need to. It does
this by dividing our experience into four central components: thoughts (cogni-
tions), feelings (emotions), behaviors and physiology (your biology). The CBT
approach suggests that if you can learn to identify and understand these four
elements and how they interact, you will be able to explain your problems and
how to solve them. These four elements are linked together in Figure 2.1 (known
as the “hot cross bun”), showing that all four influence each other. This structure
means that we have to work on all four to create lasting change.
The CBT model does not ignore other factors that are relevant to eating
disorders (e.g., environmental triggers, motivation, social settings, relationships).
Rather, CBT focuses on the four key elements as being the target of therapy,
but sees these other factors as potentially needing to be addressed in order to be
able to focus on the physiology, behaviors, cognitions and emotions.
Very often, people who have had psychological help for their eating problems
have been encouraged to change only some aspects of their experience (e.g.,
addressing their thoughts and emotions in isolation; or simply eating more),
but not others. However, because of the interlinked nature of these aspects,
10
Chapter 2: The key elements of CBT and the self-help approach 11
Thoughts
(e.g., “I am going to keep
gaining weight”; “I have
broken my rules”)
Physical state Feelings

(e.g., starvation) (e.g., anxiety)
Behavior
(e.g., avoid food; overeat;
over-exercise; checking my
body in mirrors)
Fig. 2.1 The CBT “hot cross bun,” showing the links between thoughts, feelings, physical state
and behaviors.
changing only one or two is not sufficient to facilitate long-term change. The CBT
model needs to address all the four core components of our experience – thoughts,
feelings, behavior and physiology – to ensure that changes are robust and
enduring.
For example, Katy (see earlier) had previously sought help on two occasions.
On the first, the recommendation was simply that she should monitor her
thoughts and feelings for several weeks, and challenge her emotional reactions
to the world. On the second occasion, she had been asked to change her eating
pattern and monitor her weight. Neither approach helped her to see how all four
elements of the hot cross bun tied together (e.g., understanding how her thoughts
about weight gain terrified her so much that the idea of eating “normally” was too
scary to undertake). Thus, she never learned about how important it was to
change her eating slowly, in a way that would help her to challenge her automatic
thinking and her emotions and that would help her to regulate her emotional state
through improving her carbohydrate intake (see below for details on all of
these points). The result was that she quickly gave up any attempt to change and
saw herself as a failure and unable to benefit from treatment.
Your journey through CBT: some landmarks
What does CBT involve? We are going to outline the approach here so that you
have a broad picture, and then we will fill in the details as the book progresses:
1. First, you will need to learn to identify your problematic behaviors as they
happen (e.g., food avoidance, overeating, other linked problems), and to spot
the beliefs and emotions that go with them and that can trigger them.
2. Next, CBT involves developing a clear formulation or understanding of your

problems. While we will consider general models of anorexia and bulimia
(i.e., theories that provide a general understanding of how these two disorders
work) later on, it is essential that you develop a model that is specific to
you (especially as most people with eating disorders do not neatly fit the
diagnostic stereotypes). Your model will include all the elements from the
“hot cross bun,” but might also include issues such as your motivation and
your relationships with your family, friends and others. This formulation will
serve as a roadmap for how your therapy will help you move on from your
eating disorder.
3. Third, you need to learn to change your beliefs and your behaviors, so that
you can eat normally.
4. The final step is learning to fully “let go” of the eating problem, so that you
can get on with your life. This involves developing more positive life goals,
which you may have lost sight of. However, it also means that you will need to
identify when you are at risk of relapsing, and how to cope with such
pressures.
The rest of this book is about how to develop these skills and use them.
It is worth stating that many sufferers and carers find it hard to believe
that going through the process outlined above will be sufficient to help the
sufferer improve and recover. This disbelief is understandable, given that many
sufferers have had their eating disorder for years or even decades (see the
later chapter on motivation, and particularly the “miracle question”), and many
will have tried treatments that were not successful. However, we want to stress
that we have seen many such individuals make this journey successfully.
What is CBT self-help?
Self-help involves you learning an individualized approach to how to use the

right techniques at the right time, so that you can leave your problem behind.
However, while the self-help approach is an individualized one, it has some non-
negotiables – things that you will have to do in order to make it work.
There are many self-help books available (and CD-ROMs, DVDs and internet-
based packages) for a range of emotional problems (e.g., depression, anxiety),
including eating concerns. They vary in so many dimensions that it is impos-
sible to detail them here (though some key ones are detailed in the “Further
Reading” section of the References, p. 190). This book is specifically about the
CBT approach. However, unlike most existing books, it is not about either
anorexia or bulimia. In recent years, there has been a growing awareness that
anorexia and bulimia have more shared features than differences – that the
same thoughts, feelings and behaviors can be found in all such cases – and this
book reflects that fact. In fact, over time many people will suffer from different
Chapter 2: The key elements of CBT and the self-help approach 13
manifestations of their eating disorder. For example, anorexia may develop into
bulimia. Working with this knowledge is known as a “transdiagnostic”
approach.
We have to stress this point – CBT can work for you, if you put in the work. It
has the biggest evidence base for the eating disorders and its effectiveness is at
least on a par with every other therapy for anorexia, bulimia and atypical cases.
Self-help versions of CBT also have an evidence base in the eating disorders.
There is no reason why these benefits should not apply to you. However, CBT will
not work unless you do the hard work involved.
CBT is not a rigid, protocol-driven approach where you have to do a set of
things in a very specific order. Rather, it is an approach that depends on you
learning to apply principles in a way that gives you the best chance of recovery.
That flexibility can make CBT seem even harder, as there is a lot of thinking to
be done to make it work for you as an individual and for your own eating
problem.
There is good evidence that a self-help approach is a good first step towards
care for many patients with an eating disorder, with at least a moderate impact
on symptoms (e.g., Fairburn & Harrison, 2003). Research studies show that
many patients recover completely with this approach. Indeed, many guidelines
(e.g., National Institute for Health and Clinical Excellence, 2004) recommend
that self-help should be tried first, before undertaking more intensive individual
therapy. A large number of specialist clinics recommend using self-help before
being considered for one-to-one therapy, or while you are on the waiting list.
Indeed, that might be why you have this book in your hands.
The best single predictor of whether CBT will work for you is whether you do
the work that we outline in Sections 2 and 3. There is no way round that.
You need to have clear goals, and to work towards them.
You will only know if CBT self-help works for you by trying it out, as there
are no clear guidelines regarding which individuals will do well. If you have
tried the approach (rather than simply buying the book) and find that it is not
enough, then you might need to get more help, as outlined in Section 5.
You will need to consider how to find the right help and how to negotiate
the transition into formal treatment. This requires you to use an important
set of self-help skills – seeking and accepting support. How you handle the
transition and how to act as your own therapist once you enter treatment
will be very important in how well that additional help is likely to work
for you.
An important consideration is how to leave behind a disorder that has been so
much a part of your life for so long. While it might seem like an overwhelming
problem right now, you should know that this is a skill that many sufferers find
they need. So that you have it in mind, remember that Section 6 of this book is
about how to handle that transition. While leaving the eating problem behind
might seem a long way away right now, it can be useful to have it in mind from
the beginning.
“I’m not sure that I’m ready to change”: a quick word about
motivation
We will talk more about motivation in the next chapter. However, in case your
motivation is already waning, this brief section is just to get you thinking about
your reasons for being scared of change, so that you can weigh up the pros and
cons of engaging in self-help.
Not everyone wants to change or to give up their eating disorder. This can be
for many reasons:
• for some people the eating disorder can feel like part of their identity, and
they fear what life would be like if they did not have this to focus on (e.g.,
“Who would I be if I were not ‘the thin one’?”)
• sometimes the eating disorder is like a good friend or a security blanket, which
you cannot imagine coping without
• sometimes the eating disorder helps you manage difficult emotions, and you
are fearful about how you might manage these emotions if you did not have
the eating disorder
• at other times it can be terrifying to think about eating normally again – fears
of losing control over your weight and shape are very common
• some people would like to get rid of the unpleasant side of the eating disorder
(e.g., binge-eating) while retaining other parts (e.g., not having to eat in a
healthy pattern or keeping your weight at too low a level), even though
experience tells us this is not possible
Not all people want to undertake change at the same rate, and recovery is a
journey of different lengths for different people. Therefore, we advise that you try
the journey, knowing that you can stop or turn back if you want to. Many
sufferers only start to develop optimism when they make their first behavioral
changes and find that they do not have the feared consequences (e.g., they find
they can eat breakfast without gaining weight). If you never start the journey,
you can never find out whether you have the strength to make it. However, if you
never start the journey, then you know that the future is likely to be unchanged.
3
How to use this book
Read it all
The first thing that you need to do is to gather information about the task that
faces you – so that you can decide if this is something that you want to do at
this point in your life. Therefore, you need to read the whole book now, even if
parts seem irrelevant at the moment. That will help you to find the helpful
parts when you need them. And read it all even if you do not believe that
change is possible. It might help you understand that change can happen, and
that it makes sense to be optimistic about your being able to get rid of the
eating problems.
If you are a sufferer
The key material about doing CBT for yourself is in Chapters 2 and 3. A lot of
the appendices will also be helpful to you. And remember that there are many
things that you will need to do if you want this to work – the “non-negotiables”
of therapy. You might hope that you will get well without having to do them.
However, there are no exceptions if you want to give yourself the best chance of
getting well and eating normally again.
If you are a carer
If you are a carer, a relative, a partner, or a friend who wants to help a sufferer,
then the key material for you is in Chapter 4. The appendices should be useful
for you, too.
15
Whoever you are
If it is time to think about getting more formal help, then the key material is in
Chapter 5. However, other sections will be helpful to give you an idea of what to
expect in formal care.
Section 2
For the sufferer
This section is written for the person who has the eating disorder. However, it is
also important to share this material with your carers in order to allow them to
understand what you will need to do. We will cover the following areas:
• whether you have a problem that deserves consideration
• your motivation to change or stay the same
• making your mind up whether now is the time to do therapy for your eating
disorder (balancing your motivation and your current life circumstances)
• getting started with therapy, including planning out what you will need to do
17
4
Am I making a fuss about nothing?
If you were not concerned about your eating, you would not be reading this
book. But do you really have a problem that needs help? Go back to Question-
naire 1a (Chapter 1). If your answers confirm your suspicions that you have a
problem with your eating, then read on. To help you with your understanding of
eating disorders, there are a number of definitions that it is useful to clarify and a
number of myths that it is useful to dispel, so let’s start there.
Some important definitions
Diagnosis. When people think about eating disorders among adults, they usually
think of either anorexia nervosa or bulimia nervosa. However, the majority of
people with an eating disorder do not fit neatly into these diagnoses, but are
described as “atypical” cases (also known as Eating Disorder Not Otherwise
Specified). This means that you may have some symptoms of either anorexia
nervosa or bulimia nervosa, but you do not meet all the criteria for severity, or
you may have a much more “mixed” presentation.
Diagnosis is a controversial subject. Some clinicians tend to focus on diagnosis as
an aid to communication. However, it is not particularly helpful or necessary to
know your exact diagnosis, as it has little link to the type of treatment that you need.
In recognition of the fact that very many sufferers (probably most) find themselves
in just this situation, we now focus on the thoughts, feelings, biology and behaviors
that people with eating disorders have in common, rather than on diagnosis.
Bingeing. Many people with eating disorders binge on food. A binge is when
you consume food in a frantic, impulsive way. During the binge itself, you feel
out of control, numb and detached. Your focus is narrowed to the food you are
eating, with all other experiences (especially negative ones) blocked out of
awareness for the duration of the binge.
Bingeing can be divided into two categories, that are determined by the
quantity of food that you consume in a single episode. Objective bingeing
19
20 Section 2: For the sufferer
involves the consumption of a very large amount of food (definitely more than
others would eat over that space of time). For example, many people binge on
2000–4000 kilocalories1 in a single sitting, usually in private. In contrast,
subjective bingeing involves eating far fewer kilocalories (e.g., maybe a single
biscuit or a normal meal), while still feeling out of control. In either case, we
know that it is the sense of loss of control that matters, and that is central to how
you react emotionally and behave (e.g., restricting food, vomiting, exercising).
Therefore, we do not treat either form of bingeing as more important, but they
will obviously have different effects on issues such as weight gain.
Obesity. Although simple obesity (in the absence of behaviors such as binge-
eating) is a serious and distressing problem, it is not treated as part of the constella-
tion of eating disorders. This is because the factors that lead to the development
and maintenance of obesity are different from those that lead to an eating disorder,
so that treatment for obesity needs to be different too. If you are obese but do not
binge or have any of the other behavioral patterns that we talk about here, this
book is not for you. There are many resources for helping you with obesity, but it is
vital that you focus on one that gives the prospect of slow, long-term change
(rather than any kind of “miracle cure” that promises fast results). While you
should talk with your doctor about your physical wellbeing, we recommend that
you should consider a CBT self-help book focused on weight problems. The book
by Gauntlett-Gilbert and Grace (2005) in the references is worth considering.
Myths to dispel
You have to be thin to have an eating disorder. A low weight is only one of many
possible symptoms of an eating disorder. Remember that the great majority of
people with an eating disorder are in the normal weight range or above. In
addition, many of the risk factors to your physical and psychological health are
unrelated to low weight. Finally, most individuals with eating disorders tend to
see themselves as bigger than they actually are, making your judgement about
your size rather questionable anyway (women in general are particularly poor at
judging their own size).
Only women have eating disorders. It is true that the majority of those suffering
from an eating disorder are women. There are about 20–35 females for every one
male with an eating disorder. However, men certainly do experience the same
eating problems as women. Women probably experience these disorders more
because of society’s definitions of “acceptable” appearance and ways for women
to deal with emotions (e.g., women using food, men using alcohol or aggres-
sion). Such stereotypes can make it particularly hard for men to access help.
1
Please note that one kilocalorie (kcal) is the correct technical term for what most people refer
to as one calorie. So, for example, when someone says that they are on a 1500 calories per day diet,
the correct term should be 1500 kilocalories. Some countries use joules rather than calories, but we
have retained the more common unit in common language.
Chapter 4: Am I making a fuss about nothing? 21
I must be disturbed to think this way about my eating and my body. Unfortu-
nately, in today’s climate it seems to be normal for women to be dissatisfied with
the way they look. Dissatisfaction with your body exists on a continuum, but if
you have an eating disorder your dissatisfaction goes beyond a simple desire to
look slightly different. If you have an eating disorder, the way your body looks
can influence every thought and feeling that you have, every decision that you
make, and every action that you take. Most importantly, it influences your sense
of self-worth, and you start to ignore other ways of evaluating yourself (e.g.,
career, family, friends, intimate relationships).
Eating disorders are entirely negative. Eating disorders are commonly described
in terms of the damage they do and their uncontrollable nature. However, that is
not the whole picture, by any means. If eating disorders were entirely negative,
then far more sufferers would simply eat normally and leave the problem behind.
It is critical to understand the function of the eating disorder. Eating behaviors
act as a form of coping strategy – providing a way of dealing with the difficult
things that life throws at you by “blocking” them out of awareness. Sometimes
sufferers do this by focusing on a long-term pattern of behaviors (e.g., restricting
eating, over-exercise, checking your weight all the time), and others do it more
impulsively (e.g., binge-eating or vomiting when distressed). Finally, a lot of
sufferers use both methods at different times. In the short term, this strategy
helps by protecting you from distress, but in the long term it creates more
difficulties as the problems that are generating the distress are not resolved but
instead are left to get worse. The question then is: do I take a short-term risk (and
undertake some very hard, emotionally distressing work) by trying to overcome
my eating disorder, or do I play safe in the short term by keeping the eating
problem (and putting up with the associated long-term pain and inconveni-
ence)? The cinema analogy (below) is worth bearing in mind:
The cinema analogy (Part 1)
Imagine going to the cinema. The film you are watching represents your life.
Sometimes it is challenging to watch, frightening or even upsetting. So when
someone comes and sits in front of you wearing a large hat you are quite
relieved that they have blocked your view. This person represents your eating
disorder blocking out difficult thoughts and feelings. However, you still have
a partial view of the screen and can still hear the soundtrack clearly, so you
know that you are missing what has the potential to be a really good film. Part
of you wants the person in front to move, but another part is afraid of what
you might see, and feels safer continuing to hide. The longer you sit there,
however, watching those around you engrossed in and enjoying the film, the
more you feel like you are missing out on something.
Are your attitudes towards eating, shape, and weight serving to protect you
from the difficult aspects of your life, but preventing you from achieving your
potential? Is your eating disorder blocking your view of the film?
Table 4.1
Disadvantages (cons) of my eating disorder

Physical health/wellbeing
Psychological health/wellbeing (e.g., mood, stress, happiness, ability to think, plan and
concentrate)
Family
Friends
Intimate relationships
Personal development (e.g., self-esteem, hobbies/leisure, career, education, future dreams)
We will come back to the cinema analogy later on, when considering the process
of deciding whether it is time to change (see Chapter 6).
Ultimately, the best way to determine whether you have an eating disorder
that needs addressing is to decide if your attitudes to eating, shape and weight are
getting in the way of you living your life the way you want to live it – affecting
your thoughts, your emotions, your behaviors, your relationships and your
physical wellbeing. To get a clear picture of this possibility, think about each of
the following aspects of life and consider whether your eating problems are
currently having a negative impact on them. Write the negative aspects (cons)
down on the chart above in Table 4.1 (Disadvantages of my eating disorder). It
can be very telling if you ask your family, friends or loved ones to complete the
same sheet. Often, they can see patterns in your life that are harder for you to see.
5
Motivating yourself to treat

your eating disorder
Given that you are reading this book, you will probably have noticed that you
have two contradictory ways of thinking about your eating disorder. One part
of you has had enough of the fact that every decision you make is influenced by
what you eat and/or what you weigh, and would like to get rid of the eating
disorder as soon as possible. This part of you is probably what motivated you
to read this book in the first place. However, there will be another part of you
that would rather not be thinking about this at all. This second part of you may
be afraid that you will be asked to make changes that are scary to contemplate
(e.g., eating differently, gaining weight, dealing with emotions differently).
These two conflicting ways of thinking about your eating disorder can feel
confusing, and will make the decision to change very hard to make. Since you
are reading this book, it is likely that you have felt “frozen,” and unable to get
on with your life.
Motivational states
Your motivation to change will fluctuate from one day to another, or even
one minute to another. Therefore, there is no point in deciding, “I am ready”
or “I just want to be left alone” and expecting to feel the same way the
next time you think about it. The next box lists a commonly defined set of
“states” in the motivation of sufferers, giving the labels, definitions, and ways in
which this book can help you move towards recovery. Because people tend to
fluctuate across these patterns of motivation in very individual ways, we tend to
think of them as “states” rather than “stages” (where there is an implication
that you will pass through them in a predictable order). Remember that you
can move between these states, and do not be disappointed if you feel that your
progress is not always maintained. To be effective, the treatment that you are
undertaking needs to match the motivational state that you are in. If it does
23
Motivational states that are common in eating disorders
Anti-contemplation (e.g., “There is nothing wrong – how dare you suggest

there is!”)
• Sufferers in this state are not able to think about even having a problem.
This can be the case even where there is very substantial damage and
risk (both physically and psychologically). If the individual recognizes
that she or he has a problem of any sort (e.g., being substantially under-
weight), she or he may spend a long, fruitless time seeking other causes
(e.g., physical causes such as food allergies, thyroid problems) and
resisting any suggestion that there is an eating disorder per se. Because
those around the sufferer can see a problem and often express strong
concerns, arguments can ensue. This is the state that can be the most
frustrating for carers.
• This book is highly unlikely to be read by a sufferer who is regularly in this
state. However, it is more likely to be used by a carer who is trying to find
ways of helping the sufferer (see Section 4 p. 95).
Pre-contemplation (e.g., “I’m not ready to change”)
• In this state, you are not ready to contemplate a change at present, though
you can see that it might be necessary in the future. Your reluctance to
move now might be owing to your lack of knowledge about the detrimental
impact of your eating disorder on your physical and psychological health.
Alternatively, you might feel that your life circumstances are too chaotic,
unstable or challenging for you to be able to consider changing what feels
like your only coping strategy.
• If you are pre-contemplative, this book might be useful in considering
if now is the time to move on towards change. It will provide you with
important information about keeping yourself as safe as possible, both
physically and psychologically.
Contemplation (e.g., “I’m thinking about change”)
• In this state, you are ready to take in more information about the
possibility of change, and you are likely to be more interested in the idea
of change in general. This often manifests as considering possible plans
(e.g., thinking what you would like to have different in your life over the
next six months), but without acting to make them possible (e.g., think-
ing that you might like children in the future, but not making any firm
decision). You are more aware of the disadvantages of your eating dis-
order and the advantages of resolving it, but another part of you is still
very afraid of this.
• This book can help you to start thinking about why your eating disorder
has developed, why it has not resolved itself, the longer-term consequences
on your life if it continues, and what you could do in the future to
resolve it.
Chapter 5: Motivating yourself to treat your eating disorder 25
Preparation (e.g., “I’m getting ready for change”)

• If you are in this state, you have made the decision to change and intend to
act shortly (e.g., in the next month). In this state you will be developing a
plan of action (e.g., devising a regular eating plan, recruiting friends
and family for support, getting a referral for treatment). Good
planning at this point will optimize your chances of successful recovery
(see Chapter 8).
• This book can help you to gather the knowledge and take the steps to
maximize your chances of successfully resolving your eating disorder.
Action (e.g., “I’m starting to change”)
• This is the state where you begin to make changes. However, it is important
to remember that this is not the first step in the process of change, but that
other things (particularly contemplation and planning) must come first.
The most common mistake that people can make in the change process is
jumping to take action before they are ready.
• This book can guide you through a self-help program to recovery. You can
get the most benefit by reading on from here.
Maintenance (e.g., “I’m making changes and hanging in there”)
• This is the state where you are working to consolidate changes, prevent
relapse and continue your personal development.
• This book can help you to consolidate your recovery, guard against relapse
and move you forward in your personal development.
not, the treatment will make you feel anxious, frustrated and more stuck.
Take a look at the definitions, and consider how they each relate to your
current state (and what you might do about it, using this book). Remember,
you might see different parts of yourself as being in different states at the
same time.
The pros and cons of having an eating disorder
At the end of Chapter 4, we considered the disadvantages of having your

eating problem. While there are obviously lots of such disadvantages (the cons)
to having an eating disorder (emotional problems, physical risk, social with-
drawal, etc.), it is important to remember that there will also be good points
to the “problem” (the pros). In fact, many people with eating disorders see the
eating disorder as a solution, rather than a problem. So let’s think about a couple
of the biggest pros:
• Feeling in control. An eating disorder can help you feel as if you are in control in
at least one area of your life. Even if you are bingeing, vomiting or using other
behaviors that make you feel out of control, resolving to re-start your diet
again gives you a short-term sense of calm and control (and the promise
of longer-term control and happiness, if you can just manage to stick to it this
time and lose some weight).
• Sense of achievement. If you manage to lose some weight, an eating disorder
can also provide you with a short-term sense of achievement, and may feel
like the only thing you have managed or can achieve. People with eating
disorders often say that they feel worthless, but at least they feel thin and
worthless.
Such pros are why part of you does not want to give up your eating disorder. It is
important to be clear about the pros of your eating disorder, so that you know
exactly what you will be giving up if you decide to change, what gaps will need
to be filled, and what coping strategies will need to be replaced. The next step is
to expand on the previous list, to consider the pros as well as the cons of your
disorder. Think about what is positive and what is negative about your eating
disorder, and fill in Table 5.1.
It is quite likely that you found more “cons” than “pros” in your list.
However, rather than just saying: “Well, why can’t I stop doing this?” it is
important to consider just how powerful those pros must be. Often, the pros
are about short-term benefits, and you hold on to them in order to deal with
the panicky feelings that you get when thinking about giving them up. For
example, you might feel calmer after checking yourself in the mirror, even
though you know that you end up feeling more worried about your weight long
term, but the fear about what would happen to your weight if you stopped this
checking is too strong.
Table 5.1
Cons of my eating
Pros of my eating disorder (see earlier
Area of my life disorder table)
Physical health/wellbeing
Psychological health/wellbeing (e.g., mood,
stress, memory, concentration)
Family
Friends
(e.g., sex life, having children)
Personal development
(e.g., self-esteem, hobbies/leisure, career,
education)
Chapter 5: Motivating yourself to treat your eating disorder 27
In short, it is often the case that people with eating disorders trade
the short-term comfort of not having to change for the long-term frustration
of staying stuck with the eating disorder. This way of looking at and respond-
ing to things will come up in the next section under the label of “safety
behaviors.” What is needed is a clear idea of what you would gain long term
by facing your anxieties about change. This is by no means an easy thing
to implement.
Therefore, to get that bigger picture, the next step is to take the pros and
cons that you have outlined in the previous table (Table 5.1), and to divide
them up into short- and long-term pros and cons. You can do that in the
next table (Table 5.2). For example, if you restrict your food intake and
you put “Feeling happier” into the “advantages pros” box, then consider
whether the restriction makes you feel happier in the short term, but leaves
you feeling more miserable and fearful long term. Likewise, you might feel
that a good point about bulimia in the short term is that it means that you do
not have to let anyone get close and find the “real” you, but long term you
have no chance to develop a supportive relationship. Do this for all the
pros and cons that you identified above, and add others if you think of them
as you go along.
What do you notice about the distribution of advantages and disadvantages
across time? Very often, we find that sufferers have a lot of short-term pros and
lots of long-term cons (lots of entries in the top left part of the table and in the
bottom right part, but fewer in the top right and bottom left). If this is how
Table 5.2
Advantages of
my eating Disadvantages
disorder of my eating
Area of my life (pros) disorder (cons)
Short term Physical health/wellbeing
(minutes/hours/ Psychological health/wellbeing
days/ weeks) Family
Friends
Long term Physical health/wellbeing
(months/years) Psychological health/wellbeing
Family
Friends
Exploring the Variety of Random
Documents with Different Content
Viszont világos, hogy miután a világegyetem egészében véve
végtelen idő óta áll fenn a maihoz hasonló viszonyok között, tehát
életnek is kellett mindig lennie, bármily távoli multra is gondolunk.
Ezen utolsó fejezetben igyekeztünk bebizonyítani, hogy még
mielőtt a természettudományok alapvető törvényeiket (az energia-
és anyagmegmaradásának törvényeit) formulázhatták volna, ezen
törvények többé-kevésbé tudatosan alapul szolgáltak a filozófusok
világmagyarázatainak. Tán azt lehetne mondani, hogy sokkal
észszerűbb lett volna minden további nélkül elfogadni a filozófusok
felfogását és nem várni a természetkutatók megokolására. Ez tán
meg is történt volna, ha e filozófusok tanaival egyidejüleg nem
hirdettek volna más gondolkodók határozottan ellentmondó
nézeteket. A természettudományi vizsgálat tehát nélkülözhetetlen
volt.
Továbbá nagy különbség van azon filozófiai elmélkedések és az
utóbbiakból levezetett természettudományi törvények között. Ha
például Empedoklesz és Demokritosz azt tanították kortársaik
általános felfogásával ellentétben, hogy az anyag megmarad, az
teljesen más, mint Lavoisier bizonyítása, hogy ha a fém oxigént vesz
a levegőből és azáltal nehezebbé lesz, a súlynövekedés teljesen
megfelel a fém által lekötött oxigén súlyának. E kisérlet csak egyike
ama bizonyításoknak, amelyeket a kémikusok minden nap adnak és
amelyek azt mutatják, hogy az anyag megmaradásának elvéből
levont következtetések sohasem vezetnek félre bennünket.
Hasonlókép áll a dolog Descartes, Leibnitz és Kant filozófiai
elmélkedéseinél a nap fokozatos kiégéséről, amelyekben már
homályosan benne rejlik az az eszme, hogy az energia nem
keletkezhet semmiből. Azonban csak Mayer és Joule kisérleti
bizonyításai után, amelyek megmutatták, hogy amint egy bizonyos
energiamennyiség (pl. munka alakjában) eltünt, a megfelelő
mennyiség mindig föllép más alakban (pl. hő alakjában) – csak ezek
után lehetett teljes bizonyossággal állítani, hogy a nap felhalmozott
energiamennyisége a kisugárzás következtében mindinkább
csökken, míg végül egészen el kell fogynia, ha csak egyik-másik
módon nem pótolja valami. Azelőtt a legkiválóbb férfiak, mint
Laplace és Herschel is, nem találtak ellentmondást azon
föltevésben, hogy a nap sugárzása csökkenés nélkül örökké tart, ez
a mindennapi tapasztalaton alapuló általános felfogás ma is fennáll.
Kant felfogása a világfolyamat mindig visszatérő megújhodásáról –
bár csak általánosságokat említ – igen nevezetes, de
ellentmondásba jut a kivitelben az energia megmaradásának
elvével. Ugyanaz áll Du Prel kisérletére is.
Kantnál a világfolyamat megismétlődésének eszméje etikai elven
alapul. «Jóleső érzéssel» fogadja azon gondolatot, hogy a világon
továbbra is lesz szerves élet. Azonkívül szerinte ellentmond az isteni
tökéletességnek, hogy a napok örökre kialudjanak. Spencer
tárgyilagosabb szempontból indul ki, amikor azt mondja, hogy a
világegyetem fejlődésében bizonyos törvényszerűség érvényesül. Ő
azon modern állásponton van, hogy a világ végtelen idő óta áll fenn
és nem is lesz vége, míg Kant azt hitte, hogy a világ teremtés által
jött létre. Spencer szerint az anyag összehúzódásának és
szétszóródásának korszakai váltakoznak, ami az indus nyugalmi és
fejlődési periódusokra emlékeztet. A naprendszer, mondja Spencer,
mozgó egyensúlyi helyzetben lévő rendszer, amely végül úgy oszlik
el, hogy megint megritkult anyaggá válik, mint aminőből keletkezett.
De hogyan történjék az ily szétszóródás, amikor csak vonzó erő
ismeretes, aminő Newton gravitációja, az érthetetlen. Jóllehet
Spencer megemlékezik az égitestek közötti összeütközés
lehetőségéről, azonban a szétszóródás folyamatában nem tulajdonít
annak szerepet. De ha taszító erők nem volnának, akkor minden
koncentrálódnék a világegyetemben.
A világegyetem örök ciklikus fejlődésének eszméjét – amelyről az
indus filozófusok a mult szürkületében álmodoztak – csak úgy
dolgozhatjuk ki, ha megalkotjuk a sugárzási nyomás fogalmát és
bebizonyítjuk, hogy az entropia bizonyos körülmények között
csökkenhet is.
Az eszmékkel úgy vagyunk, mint az élő szervezettel. Sok magvat
hintenek el, de csak kis mennyiség indul csirázásnak; és a belőlük
kifejlett élőlények közül a legtöbben a létért való küzdelemben
elpusztulnak, úgy hogy csak kevés marad életben. Hasonló
kiválasztásnak vannak alávetve a természettudomány tanai, a
természetnek leginkább megfelelőket szemelik ki közülök. Gyakran
halljuk, hogy hasztalan foglalkozunk elméletekkel, mert azokat
mindig megdöntik. Aki azonban így beszél, az nem látja tisztán a
fejlődést. A ma uralkodó elméletek, amint az eddigiekből láthattuk, a
legrégibb kor felfogására vezethetők vissza. Homályos sejtésekből
kiindulva mind nagyobb világosságra és érvényességre tettek szert.
Például Descartes örvényelméletét elhagyták, amint Newton
meggyőzően kimutatta, hogy a világűrben nem lehet jelentős
mennyiségben anyag; de Descartesnak több eszméje életképes
maradt, ilyen például nézete a ködfolt forgásáról, amiből a
naprendszer fejlődött ki. Épúgy felismerjük nézetét a bolygóknak az
űrből a naprendszerbe való bevándorlásáról Laplace azon tanában,
hogy bevándorolt üstökösök részt vettek a bolygók képződésében és
befolyásolták mozgásukat, valamint a fentemlített észrevételben,
hogy a vonzási középpontok, amelyek körül a napködfoltban a
bolygók képződtek, kivülről jöttek.
Mi sem tévesebb tehát, mint azon felfogás, hogy az elméleti
munka kozmogóniai kérdésekben hasztalan, vagy hogy nem
juthatunk tovább, mint az ókor filozófusai, mert néhány általuk
hirdetett felfogás igen közel járt az igazsághoz és azért föltaláljuk
azokat modern kozmogóniáinkban is. E téren a fejlődés a legutóbbi
idő folyamán gyorsabban haladt előre, mint bármely előbbi időben,
ami a természettudományok jelen virágzó korának köszönhető,
amellyel még megközelítőleg sem versenyezhet egy megelőző
korszak sem.
Örvendetes tény az is, hogy az évszázadok folyamán
mindjobban haladt az emberszeretet, amire fentebb nem kevés
példát soroltunk föl. Nagyjában véve tagadhatatlan, hogy a mindent
átölelő természet, a szabadság és az emberi érték fogalmai mindig
egyidejüleg fejlődtek, avagy megállottak, aminek kétségkívül az az
alapja, hogy ha az emberiség előre halad, a különböző művelődési
területek mind kibővülnek. Mi azt találjuk, hogy a természettudósok
minden korban szót emeltek az emberszeretet érdekében.
Aki éber szemmel kiséri a természet fejlődésének lehetőségeit,
és annak végtelen változatosságát, irtózik a csalárdságtól és
megveti a más rovására való boldogulást.
Lábjegyzetek.
1) A bunurongok igen alacsony fokon álló törzse az ausztráliai
tengerparton, azt mondja, hogy a sas alakú Bun-jel isten
teremtette a világot. Miből, nem mondják.
2) Alkalmas magyar fordítása nincs.
3) A szinodikus vagy holdhónap ujholdtól ujholdig tart.
4) Pontosabban 60·27 földsugár.
5) Jelenleg 23° 27′ 26″.
6) Ez az érték a valószinű eredője a Nap és a ködfolt relativ
sebességének. Úgy a Nap, mint a ködfoltok környezetükhöz
képest 20 km/sec. sebességgel mozognak.
7) Excentricitás alatt értjük a gyujtópontnak az ellipszis
középpontjától való távolságát viszonyítva a fél nagytengely
hosszához.
8) Mert 0·235:1=2·35:x, amiből x=10.
9) Ezen ú. n. izotermális réteg az egyenlítő közelében több, mint
20 km magasságban fekszik, Közép-Európában 11–12 km, és a
70° szélesség alatt 8 km magasságban.
10) Miután az előbbi számítások szerint földünkön a légköri
hőmérséklet emelkedése km-enként 10°-ra volna tehető.
11) 274:42·5=6·44.
12) 1200 km-nek.
13) Ekholm még alacsonyabb értéket nyer, 5·4 millió fokot.
14) Fábián Gábor fordítása.
15) Spinoza, a nagy filozófus 1632-ben született Amsterdamban;
1677-ben Hágában halt meg. Sorsa igazolja, mennyire haladt
azóta a civilizáció, azért közöljük itt röviden. Szülei portugáliai
zsidók voltak, kik az inkvizició üldözései elől menekültek
Hollandiába. A rendkivül tehetséges ifjú kora vallási dogmáiban
való kételkedését nem tudta leküzdeni, ezért hitsorsosai üldözték.
Végül igyekeztek rábeszélni, hogy nagy jutalom ellenében ismerje
el a zsidó vallást. Megvetéssel utasította vissza az ajánlatot. Erre
élete ellen törtek és kizárták a zsidó közösségből. Azután optikai
lencsék csiszolásával foglalkozva, szűkösen tartotta el magát és
nagyszerű filozófiai műveket írt.
TARTALOMJEGYZÉK.
A szerző előszava 5
I. A primitiv népek mondái a világ
keletkezéséről 11
II. Az ősidők kulturnépeinek teremtési mondái
27
III. A legszebb és legmélyebb teremtési mondák
45
IV. A régi filozófusok világmagyarázatai 61
V. Az újkor kezdete: a lakott világok
sokaságának tana 89
VI. Newtontól Laplaceig. A naprendszer
mechanikája és kozmogóniája 117
VII. Újabb csillagászati felfedezések 139
VIII. Az energia fogalma a kozmogóniában 171
IX. A végtelenség fogalma a kozmogóniában 197
Javítások.
Az eredeti szöveg helyesírásán nem változtattunk.
A nyomdai hibákat javítottuk. Ezek listája:
33 Dclitsch Delitsch
73 Kr. e. 611–547 között) (Kr. e. 611–547 között)
79 270 körül 270 körül)
102 végnélk ülinek végnélkülinek
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Buy ebook Beating Your Eating Disorder A Cognitive Behavioral Self Help Guide for Adult Sufferers and their Carers 1st Edition Glenn Waller cheap price

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Cognitive Behavioral Therapy for Eating Disorders A

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Cognitive Behavioral Therapy for Bipolar Disorder Second

Cognitive Behavioral Therapy for Social Anxiety Disorder

A Cognitive Behavioral Treatment Program for Overcoming

Maths A Student s Survival Guide A Self Help Workbook for

Eating Disorder in Males 1st Edition Renata Strumia

Re Entry A Guide for Nurses Dealing with Substance Use

Emma Gray (née Corstorphine)

Cambridge University Press

This publication is in copyright. Subject to statutory exception and to the

ISBN-13 978-0-511-90948-1 eBook (NetLibrary)

Cambridge University Press has no responsibility for the persistence or accuracy

“Decades of clinical experience come to light in this plain-speaking self-help

“Comprehensive and thorough. The information is provided in an approachable

“The writers communicate in a clear, direct, compassionate and honest voice,

Preface: read this bit first page xi

Section 1 Getting started 1

1 Who is this book for? 3

2 The key elements of cognitive behavioral therapy

3 How to use this book 15

Section 2 For the sufferer 17

4 Am I making a fuss about nothing? 19

5 Motivating yourself to treat your eating disorder 23

6 Is now the time to act? 29

7 Getting started with CBT 33

Section 3 The CBT self-help program 45

8 Start here: how to use this program 47

9 The practical steps of CBT for your eating disorder 58

Section 4 For carers 95

11 What can I do to support the sufferer? 99

Section 5 Transitions into more formal help 109

12 Thinking about getting more formal

13 Starting the process of getting therapeutic help 114

14 What to look for in a good CBT practitioner 120

15 The role of carers in the transition to more formal help 124

Section 6 Letting go of the eating disorder 127

17 Relapse prevention 136

18 Have I done myself permanent damage? 142

19 Carers need to move on too 145

Conclusion: eating normally again 147

Who is this book for?

What is this book about?

The self-help approach outlined here is based on the strongest evidence-based

Final points before starting

Who are the authors of this book?

We would like to dedicate this book to our families.

Emma Gray (née Corstorphine) was Consultant Clinical Psychologist/Clinical

First things first: staying physically safe and well enough

Who is this book for?

Question one: “Do I have an eating disorder?”

Table 1.1 Questionnaire 1a: Do I have a problem with my eating?

Most of the time

All of the time

I spend time worrying about whether I have put on weight

Question two: “Does my eating problem really deserve

Question three: “What can I do if I care for or live