Setting treatment goals for bulimia nervosa
While there is no universal set of goals that will bring about healing from bulimia nervosa for every person, there is evidence that some frameworks for goal setting can be highly effective and increase the chances of achieving one’s goals. A study published in 2017 analyzed goal setting by breaking down health behavior goals into the components which proved most impactful for implementation and adherence. These consisted of: (1)
- Goal characteristics
- Action plans
- Coping plans
The publication emphasized that achieving a goal is not as easy as just writing any odd phrase on a white board and calling it a day. The methodology used to formulate a health behavior goal had an undeniable impact upon the individual’s ability to implement and maintain that behavior change. (1)
This article will explore the components of a goal that is optimized for bridging the gap between intention and behavior. At the bottom is a list of potential goals in areas often focussed upon in the treatment of bulimia nervosa. Regardless of the goal one has in mind, approaching goal setting and behavior change from a place of self-compassion and understanding can create a space for true progress.
Approach vs. avoidance goals for bulimia nervosa
Approach goals are those that aid the individual in moving toward a desired goal, whereas avoidance goals help one move away from an undesired outcome. An approach goal might look like: (2)
- I am going to honor my hunger by eating a satisfying meal or snack when I notice I am hungry.
Whereas an avoidance goal will look like:
- I will not binge and purge when I notice I am hungry.
These phrases present two sides of the same coin: responding to hunger without using eating disorder behaviors. The key difference is the feeling surrounding the two statements. Approach goals are associated with greater positive thoughts, emotions, and self-evaluations, while avoidance goals are linked more commonly with negative emotions and fewer positive thoughts. (2)
Performance vs. mastery goals for bulimia nervosa
Performance goals are those that judge and evaluate an individual’s ability. Mastery or learning goals increase existing abilities and learning new skills. Performance goals, on their own, have a higher potential for adverse results if not met.
Failure to achieve these types of goals can elicit feelings that the individual’s abilities were not enough, having a detrimental effect on self-esteem and affect in regards to future goals.
With mastery goals, “failures” transform into challenges. There will be speed bumps along the way, but mastery goals help one remember that those roadblocks are temporary and part of the learning process. They can help keep self-compassion at the forefront of one’s mind while experiencing a perceived setback, which is a vital companion on any healing journey. As the individual moves beyond the speed bumps there is an associated increase in self-efficacy, knowledge, and performance. (3)
For example, a performance goal might look like this:
- I will not use eating disorder behaviors at all this week.
Nothing inherently wrong with this statement and a great goal to achieve, but missing a day or more has the potential to bring feelings of shame and self doubt, taking the wind out of one’s sails before even leaving the dock. Instead, the suggested alternative would be to replace the performance goal with one or more mastery goals:
- I will notice when I am feeling the urge to engage in eating disorder behaviors and learn alternative skills to respond to these urges.
The active engagement and problem solving associated with mastery goals allows for the individual to see any missed goals not as a failing of their ability, but as a challenge to the method used. The goal is still attainable, its achievement just requires an approach from a different angle. (3)
Difficult vs. easy goals for bulimia nervosa
A 35 year summary of empirical research on goal setting discovered the ideal level of difficulty to ensure commitment to goals. The research demonstrated that challenging goals produce better results than easy goals, which are associated with decreased performance and low effort. In fact, the higher the difficulty of the goal the higher the resulting performance, as long as there was an accompanying level of commitment to the goal. (4)
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Action plans and coping plans
The last two components of an effectively set goal are most beneficial when used in tandem. Action plans are the steps one will take to accomplish a goal; they answer where, when, and how a goal will come to fruition. A 2013 publication states that the characteristics of a proper action plan should include: (5)
- Having a short duration (optimal timing was one week).
- Being conceived by the individual.
- Being shared with others.
- Confidence in completing the action plan.
Coping plans arise out of the inevitable appearance of barriers to existing action plans. They are plans to overcome these obstacles and shield action plans from derailment and distraction. (5)
I will follow my recovery meal plan every day this week.
If I miss a meal or snack during the day, I will have an extra supplement with my night snack.
Incorporating any type of change in one’s life will require patience, compassion, and commitment. There will be days that feel like nothing could possibly prevent a goal from being accomplished, but there will also be days that feel like a goal is completely insurmountable. In those faltering moments, it’s important to have a support system that is prepared to help make it through the final stretch. The multidisciplinary team at Within Health is ready to help design personalized goals around the healing journey.
Whether an individual finds solutions through the Partial hospitalization program, Intensive outpatient program, or Outpatient program, the Within Health team is there to make your healing journey with bulimia nervosa empowering and compassionate.
Goals for common healing areas in bulimia nervosa
Goal: Identifying distorted perceptions about food.
Action Plan: This week I will choose one challenging or scary food and incorporate it into at least 3 meals or snacks without compensating after.
Goal: Have a more positive body image.
Action Plan: This week I will dedicate 30 minutes to writing down some of the negative thoughts I have about my body and then identifying ways to challenge those thoughts.
Goal: Manage compulsive behaviors.
Action Plan: This week I will make a list of 10 ways to respond to a triggering situation without engaging in eating disorder behaviors. If a triggering event occurs, I will consult my list and try out at least one of the things on it, then write down whether it was helpful or not.