Integrative Cognitive-Affective Therapy (ICAT) and Eating Disorders

Integrative Cognitive Affective Therapy (ICAT) is an individual, outpatient treatment, with preliminary empirical support for bulimia nervosa and binge eating disorder. ICAT’s comprehensive treatment approach spans several therapeutic orientations and integrates impactful elements of existing treatments, such as a focus on emotional, cognitive, and interpersonal functioning, psychoeducation, and use of behavioral interventions (e.g., self-monitoring, skill-use) for ceasing maladaptive behaviors. ICAT consists of a minimum of 21 sessions, over four treatment phases. Phase I focuses on establishing rapport, providing education, and increasing motivation for change. In Phase II, patients begin to learn skills for making and following plans for normalized eating, and for managing urges for eating disorder behaviors. Phase III, which is the longest phase, focuses on identifying and modifying the proximal situational and affective precipitants leading to maladaptive eating behaviors. Finally, in Phase IV, treatment gains are consolidated and stabilized, and treatment is terminated. Throughout all phases of ICAT, the therapeutic relationship is considered an important element of treatment. Clinicians should be both attuned to and responsive to patients’ emotions in the moment and further, should strive to create an honest, collaborative relationship that promotes adaptive aspects of the patient’s functioning. Clinicians delivering ICAT are advised to predominantly employ active and directive styles, but to incorporate a reflective and patient-led style as well at times. A final important element of ICAT is its utilization of patient handouts and monitoring assignments to teach and practice skills which facilitate change. Overall, the foundation of ICAT is a strong focus on the momentary affective and interpersonal processes that maintain ED behaviors. By understanding these processes and developing alternative methods of coping with difficult life situations and emotions, patients can be helped to live healthier, more meaningful lives free of eating disorder behaviors.