Binge-Eating Disorder: Clinical Foundations and Treatment [ペーパーバック]

The book is another step in the clinical march of the CBT camp as it prolifically designs and field-tests problem-specific applications.

The volume introduces the CBT in application to Binge-Eating Disorder (BED) and offers a detailed, ready-to-use clinical curriculum for applying the CBT paradigm to this population. The curriculum is well suited for groups and individuals.

The approach sets primarily behavioral goals (reduce binge-eating behavior) and offers behavioral (relaxation, trigger/cue control, habit modification) strategies as well as cognitive strategies (ranging from classic reframing to emotional self-regulation), as well as elements of exposure/decensitization experiential exercises, coupled with skills training (stress mng, etc.).

The book offers a brief review of other approaches to BED (e.g. offers minimal coverage of DBT, Interpersonal, etc.). The volume summarizes efficacy research and positions CBT as the best empirically supported tx strategy for BED to date.

Well compiled, well designed, well presented, well priced - another CBT power tool (with the added benefit of being generalizable to other compulsive-spectrum clinical presentations).

Pavel Somov, Ph.D., author of "Eating the Moment: 141 Mindful Practices to Overcome Overeating One Meal at a Time" (New Harbinger, Nov. 2008)

I write this review as a person with what is probably a mild case of BED. I read the popular book on the subject by Christopher Fairburn, Overcoming Binge Eating, and came away from that book with a CBT plan that I felt would work. It made sense and progressed well. I also recognized that that book was written back in 1995 or so and figured that in the years since, advancements had been made.

Unfortunately, I was wrong, and it seems things have regressed. The problem is that this is a true manual. Of the same kin as something that would be used to fix a car engine, except for the crucial and often overlooked fact that people are not car engines. In fact, we are quite a bit more complex than that. I get the feeling that in order to create the CBT problem herein the authors (or whomever designed the program) drew a diagram, where certain "cues" led to certain "behaviors" and then declared "I know! If only we interrupt the cues!" Sounds good in theory, however, in practice I doubt the CBT manual here would provide anyone any good. Indeed, in the larger of two studies that used it, only 17% of people using it as self-help improved (compared with ~10% no-therapy control group). I'm cherry picking, as the other therapist-led groups did better, but I feel the number is telling, especially after reading the therapy itself.

The therapy is not bad, it's just utterly un-insightful. It is this: Any little thing that is determined to be a risk factor or cause of BED (low self-esteem, impulsiveness, etc, etc) has a worksheet. You do 3-4 worksheets a week, and that's it. Cured! One could go through this therapy spending 15 minutes a week reading the handout of the week, 15 minutes a week doing the worksheets of the week, and 5 minutes a day filling out the "self-monitoring worksheet" where one need not even record what they ate, but simply make marks throughout the day for when food was eaten. That's it! No change needs to happen. No assessment of "am I really following this" as there is nothing to follow. In Fairburn's outdated CBT manual one could not progress to the next step until some requirement was satisfied (e.g. eating at regular meal times throughout the day). In this program, eating regularly is a suggestion mentioned perhaps twice, oh, and of course you must fill out the meal planning worksheet, for "at least three days". That oughta do it.

Perhaps this CBT manual is a suggestion, and it's up to the therapist to actually make it good. But I doubt it. And I also want to mention that I am a fan of CBT. I have used it to great effect in the past, for social anxiety. I do not scoff at "changing your thoughts" type of activities, except when they are as unmotivated and un-insightful as they are here. I feel as though the authors have not actually conversed with patients with BED, and have not tried to see things from their perspective and ask them how they might make the therapy better. The only point of view they seem to acknowledge is the numbers that come out of clinical trials.

Being of the scientific persuasion myself, I am sympathetic to this viewpoint. But if it were the only method we allowed ourselves to gain understanding of psychological problems, I doubt this field would ever progress. On the other hand, the book does a good job of citing all it's references and playing devil's advocate to itself by covering all sides of everything.

I see Fairburn has his own more recent clinical manual on Amazon (except he calls it a "guide", a distinction I appreciate), that I may check out next.