Fairburn therapy: characteristics, functioning and phases

This is the Fairburn cognitive-behavioral therapy, widely used to treat bulimia.

Bulimia nervosa is a disorder of eating behavior in which the patient carries out binge eating in which she consumes huge amounts of food. After binge eating, she feels regret, shame and guilt and, in order to reduce these negative emotions and "correct" the situation, she engages in purgative behaviors such as vomiting or using laxatives.

Among the interventions to help people with this disorder, the one that is considered to be the most effective is Fairburn therapy, a three-phase approach that takes about 5 months to treat..

Below we will discover what is done in these stages and how it works to improve the lives of people with bulimia nervosa.

What is Fairburn cognitive-behavioral therapy?

Bulimia nervosa is an eating disorder in which the patient engages in frequent episodes of binge eating, followed by compensatory behaviors, usually involving vomiting or the use of laxatives. usually involving vomiting or the use of laxatives.

These behaviors occur in response to the patient's great anxiety about having eaten huge amounts of food, feeling shame and guilt and, in an attempt to "fix" what she has done, she purges all the food she has eaten or exercises excessively.

It is a disorder in a feminine key, since although men can also suffer from it, it is much more common in women, pressured by the canons of beauty where thin girls are glorified and those who are fat are demonized.

Fear of getting fat by losing control of what you eat. is a key aspect of the disorder, which is why patients follow very restrictive diets in order to achieve the ideal weight and body shape. However, because these diets are very low in nutrition, hunger soon sets in, increasing the risk of binge eating.

The most effective treatment for bulimia nervosa is considered to be Fairburn therapy, an intervention created by Christopher G. Fairburn specifically to treat this eating disorder. It is a method so effective that it has become one of the most common in clinical practice in the context of cognitive-behavioral therapy, as well as being extrapolated to other disorders related to binge eating episodes and anxiety-reducing behaviors.

Treatment with the Fairburn method is done in an individual format, with a duration of about five months. The procedure is semi-structured, problem-oriented and focused primarily on the patient's present and future, rather than her past. rather than on the patient's past. This therapy consists of three differentiated stages, whose priority objectives are focused on the patient gaining control over his or her diet, modifying his or her cognitions about weight, silhouette and body image, and ensuring that the changes are maintained over time.

The therapy places the responsibility for change on the patient, giving them an active role in their improvement and overcoming bulimia nervosa. The therapist has the role of motivating, supporting and providing the information and guidance needed by the patient throughout the therapy.

The stages of Fairburn therapy

The stages of Fairburn therapy for bulimia nervosa are mainly the following three.

Stage 1

The first stage of Fairburn's therapy lasts approximately 8 weeks (2 months) and is carried out with weekly interviews. (2 months) and is carried out with weekly interviews. In those cases in which the patient shows a great lack of control in her eating behaviors, the duration of this stage will have to be extended a little more, with more than one weekly session if necessary.

The first step is to know the patient's personal history and identify the main points of interest to design the treatment.. After that, the cognitive model of bulimia nervosa on which the therapy is based is explained, based on the idea that the disorder works through a vicious circle of dieting, binge eating and purging behaviors.

The crucial factor in bulimia nervosa is ideation of body weight and body shapeThese ideas lead the patient to try to lose weight by the most extreme methods in order to achieve her ideal weight and silhouette. To this end, the patient has followed low-calorie diets, with few nutrients and, as a rule, very little variety (e.g., pineapple diet, grapefruit diet, maple syrup diet, etc.).

Following this type of diet has the collateral effect of increasing binge eating since, being low in nutrients and lacking in variety, the patient feels very hungry and, in addition, as her food is monotonous and repetitive, it bores her and increases her desire to eat "forbidden" foods (e.g., chocolate, hamburgers, candy, ice cream, pizza, etc.). This situation is unsustainable, reaching the point where he cannot stand it any longer and goes on a binge, eating huge amounts of hypercaloric, fatty and hyperpalatable food.

After the binge comes the negative feelings, especially guilt and shame.. To try to reduce them and also to avoid gaining weight from the huge amount of calories she has just consumed, the patient engages in purging behaviors such as vomiting or taking laxatives, believing that she will not absorb the fats from all the food she has just eaten. After a while, after releasing her negative emotions, the patient goes back to trying to diet until the next binge and then purging.

According to this therapy, the fundamental cognitive factor in bulimia nervosa lies in basing self-esteem on body image, which is considered a key aspect of the disorder. The cognitive disturbance typical of bulimia nervosa has two main aspects:

• Dissatisfaction with one's own body shape.
• Overvalued ideas about weight and figure.

During this first stage of Fairburn's therapy it is also necessary for the patient to monitor her intake, noting in a diary what meals she eats, the time and amount of food she eats.. The idea behind self-reporting is to make the patient more aware of her problem and thus identify what precipitates her binge eating. Food records should be meticulously analyzed session by session, and it is necessary for the patient to connect with how she felt and what she was doing before binge eating.

There are cases of patients who never weigh themselves, who do not want to know what they really weigh (avoidance behavior) while others are capable of weighing themselves 7 or more times a week, wanting to control at all times the slightest change in their weight (reassurance behavior). It is considered advisable for the patient to start weighing herself only once a week.

To try to make her eating habits healthy, the patient is prescribed a regular pattern of behavior, whereby she should preferably eat 5 meals a day and in moderate quantities.. If this is achieved, the patient will avoid hunger, a physiological sensation that predisposes to binge eating.

Finally, at this stage, the patient is trained to carry out a stimulus control. Some guidelines that are advised are: not to do any activity while eating, to always eat in the same place, to leave some food on the plate and to limit exposure to "tempting and dangerous" foods.

Among other strategies that are carried out during the initial stage are: information and psychoeducation on eating patterns, compensatory behaviors such as the use of laxatives or Diuretics or the adverse health effects of extreme diets.

Stage 2

The second stage focuses on the cognitive part, This is the moment in which restructuring is applied as the main technique.. The duration is also 8 weeks, with one session each week. In this period the priority is focused on the total elimination of the diet, since hunger and the food monotony it causes predisposes and facilitates binge eating. That is why it is key to stop dieting.

The patient is advised to start eating those tempting foods, which she sees as forbidden and dangerous.. These avoided foods will be ranked according to the degree of rejection, being classified in 4 groups of increasing difficulty. Each week, the psychotherapist will instruct the patient to eat one of these forbidden foods, starting with those in the easiest group.

Once these techniques have been put into practice, the cognitive therapy itself begins. As in the first stage the patient has already identified those negative thoughts about weight and body shape, it is time to teach her the different cognitive distortions that exist, discovering and analyzing which are the ones with which she feels more identified.

Once this step has been passed, the patient is taught to ask herself a Socratic dialogue. Through various questions, the patient will discover that her negative thoughts about her weight and body shape are totally unrealistic or exaggerated, and that she will have to modify them.

To facilitate the process of identifying her thoughts and, thus, to have the opportunity to work on them, the psychotherapist can propose different behavioral experiments or send home tasks such as looking in the mirror, wearing tight-fitting clothes, drawing on a piece of paper the silhouette she thinks she has and comparing it with the one she really has...

From these tasks, the patient should write down should write down what is going on in her head, to take it to the session with the psychologist and analyze its veracity, coherence and the convenience of thinking this way.

Stage 3

The third and last stage of Fairburn's therapy is carried out in 3 sessions every two weeks.. This last stage of the intervention focuses on the goal of relapse prevention.

It is expected that, at the end of the treatment, patients are much better, although most of them still have some cognitive symptoms. In this sense, the patient is trained to differentiate between falls and relapses.

We can define a fall as a small stumble or slip on the road to recovery and overcoming the disorder.. These are incidents that are part of the process, and should be seen as something normal, something that does not spoil it and that, even if they occur, should be continued.

On the other hand, a relapse implies going back to the initial pointThe patient should be seen as a normal person, with restrictive diets, binge eating and purgative behaviors, all behaviors that should be controlled and avoided. Given the seriousness of relapses, it is necessary that before the end of Fairburn therapy the patient has a personal written strategic plan specifying what she will do if a relapse is identified, to avoid further relapse.

Currently, Fairburn therapy for bulimia nervosa is considered one of the most empirically supported treatments. Given its great efficacy with bulimia, this intervention has been extended to other eating disorders such as binge eating disorder, where it also has great results.