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Cognitive emotional behavioral therapy (CEBT) is a talk therapy treatment that can help with many mental health disorders, including a variety of eating disorders. The treatment may be especially helpful for those with eating disorders and concurring conditions, such as anxiety disorders.
For many people, CEBT is an important aspect of treating eating disorders, along with nutritional therapy, family therapy, meal planning, and other types of help.
What is cognitive emotional behavioral therapy (CEBT)?
Cognitive emotional behavioral therapy—sometimes just called cognitive emotional therapy—is a hybrid form of therapy used to treat eating disorders. It borrows methods and philosophies from both cognitive behavior therapy (CBT) and dialectical behavior therapy (DBT), which are both popular forms of treatment for a range of mental health issues.1
Cognitive emotional behavioral therapy works to help prepare patients for the more emotionally challenging aspects of therapy. At its core, CBT teaches patients about their emotions, using various techniques to help people gain more awareness of their feelings and learn to manage them better.
CEBT incorporates several strategies to help people restructure their behavioral patterns. Methods can include mindfulness meditations, experiential exercises, and other tactics to help instill motivation to change.1
The intention is to dig out the issue of disordered eating from the root while planting the seeds that will blossom into new, healthier eating behaviors. The potential for such a powerful transition is why cognitive emotional behavioral therapy is often engaged for deep-seated, difficult, and potentially dangerous cases like eating disorders.
How to treat eating disorders with cognitive emotional therapy
Since cognitive emotional behavioral therapy helps people get in touch with and understand their emotions and emotional responses to things, it can be used as a pre-treatment before other courses of therapy or as the primary treatment.
For individuals with eating disorders, this can be especially helpful, as it can also help them uncover and understand some of the underlying psychological disorders that may be helping to drive their eating disorder, such as anxiety, depression, or other types of emotional trauma.
Cognitive emotional therapy strives to help people understand their emotional reactions to food and eating. Much like CBT, it proposes that these responses are often the first signs of oncoming harmful behavior.
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The idea is that learning to first recognize, then eventually manage, these emotional responses in a healthier way will lead to healthier thoughts (cognitive) and actions (behavior).
But before people can regulate their reactions, they have to understand them. With that in mind, CEBT works to teach people struggling with eating disorders what these emotions might look like, how they might feel, and where they might come from.
When used to treat eating disorders, cognitive emotional behavioral therapy typically breaks those lessons down into four stages:2
Assessing background: Patients’ personal histories are taken into account first, and they’re also given a bigger-picture perspective on how their eating disorder may be perceived or stigmatized in society.
Self-awareness development: Patients will then explore their histories for behavioral patterns related to their eating disorder and the risks of disordered eating.
Emotional recognition: Once patients are familiar with their patterns, the work begins to help them recognize the emotions driving them. Patients also examine the relationship between emotions and eating behavior, body image, and self-esteem.
Initiating change: Once patients know the emotional mechanisms behind their condition, they’re given strategies to regulate them better.
This education is considered the foundational step toward sustainable change. The goal of CEBT is to give people struggling with eating disorders the tools to both recover from their condition and manage a lifelong recovery.
What to expect in cognitive emotional behavioral therapy (CEBT)
Like cognitive behavioral therapy, CEBT typically follows a more structured format. Patients start with a number of sessions over a period of time and with a fixed set of goals. The sessions can be one-on-one or take place in a group setting.
Also, like cognitive behavioral therapy, cognitive emotional behavioral therapy typically asks patients to bring some work home with them. These “homework” assignments involve practicing many of the methods patients are taught to recognize and regulate emotions, including journaling, meal planning, and exposure to feared foods.3
Aspects of other forms of therapy may also be included, such as:1
Dialectical behavior therapy (DBT): A method of treatment that asks patients to understand that they can love and respect themselves while needing to change certain thoughts or behaviors.
Acceptance and commitment therapy (ACT): A therapeutic modality that helps patients let go of negative thoughts by focusing instead on positive goals.
Mindfulness and meditation: Ancient practices that help people remain in the present moment, which can help foster a greater sense of acceptance and inner peace.
Patients are taught how to practice these lessons through role-playing exercises, participating in games or puzzles that might help reinforce new perspectives, breathing exercises, and other techniques.
Evaluating cognitive emotional therapy as an effective eating disorder treatment
No form of therapy is perfect, but there are several benefits to CEBT that patients may not get through other types of therapy.
Cognitive emotional behavioral therapy has been found to be one of the most potent tools for eating disorder recovery.
Having greater awareness of emotions and emotional reactions has been found to help with many mental health issues aside from eating disorders.4 This includes anxiety and depression, which often co-occur with and work to maintain eating disorders.5
Emotional awareness has also been linked to greater adaptive emotional responses in patients.2 This means patients can retain the CEBT strategies they’ve learned and apply them successfully in the future. This is especially important for people with eating disorders, as this type of mental illness has a particularly high risk for relapse.6
Plus, many people benefit from the structured format of cognitive emotional behavioral therapy. Clear expectations and a set timeline can make the process seem less overwhelming and more solution-driven.
While CEBT may be a great option for people who prefer a more structured and focused approach, the method might not be a great option for someone with a less reliable schedule or who can’t or won’t commit to the entire course of treatment. The “homework” assignments may also be tricky for people with unstable home environments.
Cognitive emotional behavioral therapy also embodies the old adage that says, you can bring a horse to water, but you can’t make them drink. While it’s possible to point out to patients the mechanics behind their emotional reactions and behavioral patterns, change will only happen if and when the patient is ready to embrace it.
This is why traditional “talk” therapy approaches may not work for some people. As its name suggests, CEBT is very cognitive in focus, emphasizing the mind, thinking, and talking.
But many other types of therapies focus on the body, senses, and feelings, which can be effective when talk therapy “hits a wall.” These include expressive arts therapy, dance, movement, or yoga therapy, eye-movement desensitization and reprocessing (EMDR), and somatic experiencing therapy. For those not responding well to CEBT, a hybrid treatment plan may be necessary.
The lion’s share of research on CEBT has been performed alongside examinations on cognitive behavioral therapy, which is currently the leading treatment for people struggling with eating disorders. These studies have yielded results including a 42% success rate for patients receiving different forms of CBT after a 5-month course of treatment, compared to 6% who received psychoanalytic psychotherapy during that time.7
One 2020 exam that focused exclusively on cognitive emotional behavioral therapy also found a high success rate for the method, as described by the patients themselves. More than 66% of participants—who were diagnosed with binge eating disorder—said they were somewhat or completely surprised by the efficacy of CEBT, with 63% reporting that the positive changes in their lives would not have happened without the therapy.2
While there’s no doubt far more work to be done on who CEBT can help and how the current outlook for the therapy is undoubtedly encouraging.
Cognitive emotional behavior therapy at Within Health
Within Health doesn’t offer CEBT at this time. However, we provide cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and many other treatment modalities.
All of our care programs include a trauma-informed approach to eating disorder treatment, as well as compassionate care tailored to our client’s individual needs.
To learn more about our remote care programs for eating disorders or wish to start treatment, call our team.
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.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
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