Self-help and eating disorder treatment

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Human resolve can be a formidable force in any endeavor. Recovering from an eating disorder is no different. Self-help can be a valuable resource in eating disorder treatment. Tapping into an individual’s innate strengths can build resilience and pave the way to lasting peace from disordered eating.

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In this article

What Is self-help?

Self-help therapy is almost exactly what it sounds like: a form of therapy in which the person seeking help takes the lead role in their own recovery. The process often involves working methodically through a series of programs aimed at alleviating a person’s particular problems.

Forms of self-help have been around for decades, if not centuries, with people naturally taking interest in their own mental health. But more formalized self-help therapy techniques really began to take hold in the middle part of the last century.

Around that time, cognitive behavioral therapy (CBT) was developed. Aimed at changing people’s behaviors by changing their thought patterns, and teaching them healthier coping mechanisms, the system proved helpful for treating a number of disorders. And designed to be administered in pre-planned phases, as well as a number of take-home assignments, the method proved easily adaptable to self-help workbooks and at-home guides. 

The vast expansion of the internet and smartphone technology has made the concept even more accessible, with self-help therapy techniques more widely available now than ever.

How to treat eating disorders with self-help

Happily, self-help therapy has been found to be effective for people with a number of different eating disorders. (1) 

How are eating disorders treated with self-help?

When used to treat eating disorders, most self-help therapies follow a similar format to CBT. The ultimate goal is for the patient to recognize unhelpful thought patterns and replace them with better habits for their health. The program is typically divided into four parts: (2)

  • Self-monitoring thoughts and behavior, through exercises like daily journaling
  • Identifying any further problems or barriers to change
  • Addressing these issues directly, through methods like exposure therapy
  • Practicing new coping strategies and creating future recovery goals

For eating disorders, such as anorexia nervosa (AN), a number of more specific techniques are typically in play.

During the first stage of CBT-based self-help therapy, patients with anorexia may be instructed to begin a weekly weighing regimen, as well as establish a schedule of “regular eating,” which often eventually requires the consumption of three meals a day plus snacks. Weighing is not recommended for binge eating disorder (BED) or bulimia nervosa (BN). 

The second stage often involves the most robust therapy. It can include “assignments” like challenging a patient’s ordinary eating patterns—e.g., having a snack in the middle of the day—exposing a patient to feared foods or food groups, or having them make weekly meal plans.

And the coping strategies learned and practiced in the final stage can include anything from games and puzzles that help discard old thought or behavioral patterns or reinforce new ones, to mindfulness and meditation, used to help stay focused and balanced.

What to expect in self-help?

As its name implies, self-help is a take-home therapy, and is a part of the Within Health approach, as we treat eating disorders from your home, or on the go through our app. 

Guides can come in the form of books, apps, or other online programs. Most of these programs are structured, with assignments, projects, or other reading laid out in a pre-planned format. And though a patient can take as long as they’d like to complete these sections, a course of treatment typically has an anticipated timeframe.

While undergoing self-help treatment, a patient can expect, first and foremost, a lot of reading. The primary goal of this type of therapy is letting the patient become their own therapist, so they learn about different therapeutic techniques and approaches involved with eating disorders.

But equally as important is the actual doing, or the therapy itself. Patients using self-help will often be asked to perform a number of tasks, or “homework assignments,” focused on both undoing old and unhealthy thought and behavioral patterns and learning new ones.

Depending on the type of self-help a patient uses, there may also be another person involved, whether a trained therapist, other support person, or even an entire support group, to help a patient understand and adapt to these techniques.

Types of self-help

The most frequently used type of self-help is called guided self-help. Using this type of therapy, a patient has books or guides to work through on their own, but also gets help from an outside party. This can look like: (3)

  • Going to a limited number of therapy sessions while working on their own in between and afterward
  • Having a specific therapist or other support person on-call

Other types of self-help therapy include: (3)

  • Pure self-help: When a person works through a self-help guide or program entirely on their own.
  • Bibliotherapy: Where a primary care mental health worker will recommend or provide specific self-help books or programs for a patient.
  • Computerized self-help: A form of pure self-help that involves structured sessions that take place entirely online.
  • Management groups: A form of group self-help therapy where patients come together to talk about common symptoms or problems.
  • Activation groups: A form of group self-help therapy where patients participate in group activities to help increase meaningful activity and positive reinforcement in their lives. 

Support, in these cases, can also be delivered in a number of ways, including phone, email, or text.

Evaluating self-help as an effective eating disorder treatment

Therapy is not a one-size-fits-all phenomenon. Self-help may be helpful for treating some types of eating disorders, but not others, and prove beneficial or limited—or both—in any situation.

What are the benefits of self-help?

One of the most obvious benefits of self-help therapy is its accessibility. The method is easily and widely available and can be used by people who can’t afford more traditional therapy or may have trouble working that routine into their schedules.

Guided self-help, in particular, can be a great way for a person to learn new skills and coping mechanisms, which can help heal eating disorders and maintain a greater sense of balance and peace. (4) And the practice can be a good way to prepare for other more intensive forms of therapy, especially CBT. 

When used in this way, self-help therapy is considered part of a “stepped care” approach, which means a patient should be involved in the least intensive and least restrictive form of therapy possible. (3) Self-help is often considered the first step on this journey, and, if the method doesn’t prove fruitful, a patient can then “step up” to seeing a trained mental health worker or therapist on a more regular basis. Typically, the recommendation is to “step up” if no improvement is seen after four weeks of self-help. (3)

Overall, self-help has been found to be the most helpful for treating bulimia nervosa (BN) and binge eating disorder (BED). Although, the method is not recommended for severe cases of any disorder, or for people struggling with anorexia nervosa, due to the additional medical needs they may have. (2)

What are the limitations of self-help?

Like all forms of self-help, self-help therapy has a number of limitations to accompany its benefits.

The method is only recommended for mild or moderate cases of any disorder, including eating disorders. That’s mostly due to the immense amount of self-discipline the technique involves. Even the strongest person can feel tired, or have enough “off” days to quit. And a person who’s struggling badly may not even have the energy to start, let alone maintain, self-help.

Similarly, self-help is only as perceptive as the person practicing it. Though the technique’s aim is to teach patients how to identify their own problematic thoughts and behaviors, it can be easy for a person to fall back on patterns of denial, or get so lost in their own view they fail to see an issue.

Pure self-help therapy is especially prone to this potential pitfall. Part of the purpose of seeing a therapist is to have them not just evaluate, but also extract negative emotions and behaviors that a person may not even be aware of. And lack of outside accountability or clarity could lead to stifle progress. 

Efficacy of self-help in healing eating disorders

Self-help has been tested in a number of randomized controlled trials and controlled clinical trials. (5) In many cases, different forms of the therapy have been found effective.

One two-year study that started in 2013 followed a group of 38 students, diagnosed with either bulimia or binge eating disorder, through a 12-week guided therapy program. (4) At the end of the session, 42% of participants were no longer experiencing binging episodes, and 63% no longer met the official criteria for an eating disorder.

A more expansive study, which followed 160 patients struggling with binge eating disorder through a session of guided self-help, found the method to be a “robust treatment,” with 35% of participants found to be in remission from their disorder a year after their session. (6)

More than a dozen other studies brought back similar results, whether the guided self-help was offered online, or in-person, though nearly all studies have focused on the relationship between self-help and bulimia or binge eating disorder. (1, 7, 8)

Like all forms of therapy, the limitations—as well as benefits—of self-help should be considered before starting a regimen. And it’s important to tailor a comprehensive eating disorder treatment plan to each individual’s needs.

Self help at within health

At Within Health, your clinical care team will work with you to find the best treatment process for your particular needs. Our program includes elements of self-help, such as our reflective opportunities sessions, where clients are given a list of reflective and experiential opportunities. You may be asked to reflect in a journal, or through an artistic prompt. At Within Health we want patients to take ownership of their treatment, so eating disorder treatment is not something that simply happens to our patients, but is something the patients actively participate in. Call our admissions team today to learn more about our virtual care program for eating disorders.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

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