Tag Archives: bulimia

ICAT as a new therapy model?


Take any psychotherapies class and you will get your usual dose of the classic models built on grand schemes attempting to explain the meaning of life and human behavior: psychoanalysis (and later versions of object relations), humanist/client-centered, behaviorism, cognitive (and later combinations of the two), and various forms of family systems models. Students in advanced courses may learn a bit about various combinations of these models but usually such classes leave learners picking and choosing a theoretical home–or becoming eclectic by trying to take parts of each model.

But nowadays, models are built not to explain the meaning of life but to show “what works” in therapy. Sometimes model builders stumble onto a technique and then attempt to provide evidence how and why such interventions work. For example, I would classify Les Greenberg’s EFT, Francine Shapiro’s EMDR and Marsha Linehan’s DBT (though DBT has much more robust evidence supporting and has validity whereas Shapiro’s techniques have reliability but lack validity in my mind) as these kinds of models.

Now comes another model to try to capitalize on a number of proven techniques: Integrative Cognitive Affective Therapy. Right now, it seems to be used and studied for the treatment of Bulimia. But, I expect to see it grow over the years to any number of problems (just as DBT is not just used for Borderline Personality Disorder anymore).

What is ICAT? It is an attempt to improve upon the weaknesses of Cognitive-Behavioral Therapy (CBT) while maintaining the robust empirical power of the model. What are CBT’s weaknesses? Stephen Wonderlich says they are “1) a limited view of emotional responding; 2) inadequate consideration of interpersonal factors; 3) insufficient attention to therapist-client relationship; and 4) overemphasis on conscious-controlled cognitive processing.”*

ICAT attempts to improve on CBT by paying very careful attention to emotion, mindfulness, and other aspects of a person’s experience of self and world. Again, Wonderlich describes ICAT as “a collection of interventions drawn from an array of cognitive behavioral and emotion-focused therapies and based on a testable theoretical model…”

ICAT for Bulimia exists in a 21 session form as of now. It focuses on experiencing and identifying key emotions involved in the Bulimic process, making initial changes to eating habits, developing alternative coping mechanisms to deal with distressing emotions, dealing properly with desires, practicing self-regulation and challenging discrepancies between ideal and actual self. What makes it different from CBT is its focus on emotion and collaborative work between patient and counselor.

In many ways, it seems to adapt other model’s focus on validation, affect, mindfulness, and distress tolerance. Over and over it appears that understanding and addressing subtle emotional interpretations of life are the building blocks to changing pathological behaviors.This is not the first attempt to build an affective version of CBT. Some attempted to talk about constructivist CBT but that did not take hold. I suspect this model has a better chance at catching on.

*Wonderlich, Stephen (Summer, 2009). “An introduction to Integrative Cognitive Affective Therapy for Bulimia Nervosa” Perspectives: A Professional Journal of the Renfrew Center Foundation, pp 1-5.

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Physiology Phriday: Your brain and your food


We all love certain kinds of foods and when we eat them, our pleasure quotients increase dramatically. Some recent work in brain imaging suggests that women with propensity for bulimia show “greater activation of key reward regions of the brain” after tasting a chocolate milkshake. These same individuals may also experience decreased activity in parts of the brain that control self-regulation and impulse control (as reported in the April 2009 Monitor on Psychology, pp. 48-49).

This area of research is new and so the results need replication plus interpretation. Does the brain function this way after years of bulimic behavior. Or, does the brain instigate or tempt such behavior (strong reward response plus increased impulsivity) with it’s prior functioning?

Of course, the individual struggling with bulimia cares only a little about the why. They really concern themselves with the what. How do I eat with moderation? How do I not eat for emotional reasons? Unlike alcoholics who can always avoid alcohol, everyone has to eat, and eat everyday.  So, what to do when your brain responds the way it does to food? Here’s a couple of practical ideas to start you down the right path:

1. Get a “coach” or counselor who you will be completely honest with. This coach will help you construct an eating schedule and an array of responses to eating or purging temptations.

2. Construct a realistic eating schedule that avoids avoiding food. Keep a food journal. Be honest. Keep troubleshooting with your coach until you find something that works best for you. Remember to check out your schedule (times and foods allowed) with a nutritionist.

3. Construct and use an array of behavioral responses to eating temptations. These include distractions, connections with others, ways to make the moment better, crisis call opportunities.

4. Develop mindful techniques to focus on eating, on stopping eating, on other forms of pleasure God has given you–even on the difficult emotions that you feel.

5. Identify controlling automatic thoughts and lies in your “script” that drive you in particular emotional and behavioral directions. These can be about your body image, about your relationships, etc. Begin responding to them with truth from God’s point of view. Make sure your coach and others know what truthes you are trying hard to believe.

6. As you recognize triggers, temptations, etc., also identify “ways of escape” offered you by God.

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