Appetite-focused cognitive-behavioral therapy in the treatment of binge eating with purging Original Research Article

The first-line treatment for bulimia nervosa (BN), cognitive-behavioral therapy (CBT), uses food-based self-monitoring. Six young women presenting with BN or significant purging behavior were treated with a modification, Appetite-Focused CBT (CBT-AF), in which self-monitoring is based on appetite cues and food monitoring is proscribed. This change was designed to direct attention away from the typically excessive focus on type of food. Reinstating “moderate hunger” as the cue to eat and “moderate fullness” as the cue to stop discourages both severe restriction and overeating. Clients are encouraged to eat what they want (defined as what feels good internally) to prevent feelings of deprivation. The appetite monitoring component effectively targeted binge eating, essentially eliminating purging to compensate for binges, but purging that served other functions required additional interventions. Appetite monitoring was highly preferred compared to prior experiences with food monitoring. The results suggest that appetite monitoring is likely a viable alternative to food monitoring that may make CBT more acceptable for some individuals who binge and purge.