Dietary Restraint Module
摘要
This module addresses dietary restraint within intensive CBT-E. Assisted eating enables patients to discontinue dietary restriction, normalize eating patterns, consume appropriate portions, and reintroduce many avoided foods. However, residual dietary rules often persist once patients begin eating unassisted, requiring specific therapeutic intervention. Persistence, extreme goals, and rigid dietary rules characterize strict dieting. Although patients usually perceive it positively, as a source of control, competence, or social approval, it is harmful, increasing food preoccupation, emotional stress, and social impairment while also maintaining the eating disorder. The module helps patients recognize strict dieting as problematic by exploring its negative physical, psychological, and relational consequences. Key methods include pros-and-cons exercises, structured discussion, and real-time monitoring. The intervention focuses on adopting flexible, healthy eating guidelines, including planning meals, eating at regular intervals (no more than 4 h apart), using normal portions, reintroducing previously avoided foods, and practicing eating in social contexts. Patients are also taught to manage lapses constructively, without engaging in catastrophic thinking or compensatory behaviours. Specific strategies target residual dietary rules, dysfunctional food checking (e.g., calorie counting and meticulous weighing), and intermittent caloric restriction, which can increase the risk of binge eating and weight loss. In addition, the chapter discusses addressing the over-evaluation of eating control, often linked to gastrointestinal symptoms or perfectionistic control needs, by broadening self-evaluation domains and reducing its behavioural expressions.