Preventing Relapse

Step Three of cognitive behaviour therapy (CBT) for binge-eating disorder (BED) lasts 48 weeks, with 12 sessions delivered at 4-week intervals in patients who addressed the Healthy Weight Loss module in Step Two of the tretment, that are reduced to 12 weeks, with 3 sessions every 4 weeks, in all the other patients. The focus of the sessions is on assessing both the eating-disorder psychopathology and progress in weight maintenance over the last 4 weeks. The session begins by reviewing how the patient has implemented the maintenance plan, to identify the features of BED and difficulties in weight maintenance that the patient will need to tackle. The need for weekly weighing should be reiterated. In this phase, it is essential to emphasize to the patient that their attitude toward any setback is crucial in determining what will happen next. Specifically, they are encouraged not to view any setback (e.g., a binge episode) as a “relapse.” They are also helped to identify and address situations that increase the risk of weight regain and implement an action plan that promptly addresses it. For a patient who wants to lose weight in the future, the therapist should suggest careful consideration of their reasons, and the potential risks involved. Finally, at the conclusion of Step Three, the patient should be explicitly educated on self-efficacy, and reassured of the fact that they now have all the tools they need to maintain weight on their own and deal with any situation that might otherwise lead to relapse.