Fairburn therapy: characteristics, operation and phases

Bulimia nervosa is an eating disorder in which the patient binges where she consumes large amounts of food. After them, she feels regret, shame and guilt and, to reduce these negative emotions and "correct" the situation, she carries out purgative behaviors such as vomiting or using laxatives.

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

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

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What is Fairburn Cognitive Behavioral Therapy?

Bulimia nervosa is an eating disorder in which the patient has frequent bouts of binge eating, followed by compensatory behaviors which usually involve vomiting or using laxatives.

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

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

The fear of gaining weight by losing control of what you eat It 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 they are very poorly nutritious diets, hunger does not take long to appear, which increases 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 such an effective method that it has become one of the most common in clinical practice. in the context of cognitive behavioral therapy, in addition to 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 around five months. The procedure is semi-structured, problem-oriented and focused primarily on the present and the future of the patient, more than in her past. This therapy consists of three differentiated stages, the priority objectives of which are focused on the acquisition of control by the patient about feeding her, modify her cognitions about weight, silhouette and body image and that the changes are maintained in the weather.

The therapy places the responsibility for the change in the patient, granting him an active role in his improvement and overcoming of bulimia nervosa. The therapist has the role of motivating, supporting and providing the information and guidance that the patient needs throughout the therapy.

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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 therapy lasts approximately 8 weeks (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, you will have to stretch the duration of this stage a little more, performing more than one weekly session in case pertoque.

The first step is to know the personal history of the patient and identify the main points of interest to design the treatment. After that, we go on to explain what is the cognitive model of bulimia nervosa on which the therapy is based, based on the idea that the disorder works through a vicious cycle of dieting, bingeing, and purging behaviors.

The crucial factor in bulimia nervosa is the ideation of weight and body silhouette, ideas that lead the patient to try to lose weight through the most extreme methods in order to acquire her ideal weight and silhouette. To do this, the patient has followed low-calorie diets, with few nutrients and, as a general rule, very little varied (p. eg, the diet of pineapple, grapefruit, maple syrup ...)

Following this type of diet has the collateral effect of increasing binge eating since, being not very nutritious and not very varied, the patient feels very hungry and, furthermore, as her food is monotonous and repetitive, it bores her and increases her desire to eat food more "Prohibited" (p. eg, chocolate, hamburgers, candies, ice cream, pizza ...). This situation is untenable, arriving at the moment when she cannot take it anymore and she binges, eating huge amounts of hypercaloric, greasy and hyperpalatable food.

After the binge comes negative feelings, especially guilt and shame. To try to reduce them and, also, avoid gaining weight due to the huge amount of calories that she has just consumed, the patient does purgatory behaviors such as vomiting or taking laxatives, believing that this way you will not absorb the fats from all the food you have just eaten eat. After a while, after releasing her negative emotions, the patient tries again to be on a diet until the next binge occurs and, later, purges.

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

• Dissatisfaction with one's own body silhouette.
• Overrated ideas about weight and shape.

During this early stage of Fairburn's therapy It is also necessary for the patient to monitor her intake, noting in a diary what meals she takes, the time of intake and their quantity. The idea behind self-registration is to make the patient more aware of her problem and thus identify what precipitates her bingeing. The food records must be meticulously analyzed session by session, and it is necessary for the patient to connect with how she felt and what she did before carrying out the binge.

There are cases of patients who never weigh themselves, who do not want to know what they really weigh (avoidance behavior) while others are able weighing herself 7 or more times a week, wanting to control at all times the slightest change that may have occurred in her weight (behavior of reinsurance). 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 behavior pattern, for which 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 stimulation control. Some guidelines that are advised are: do not do any activity while she is eating, always eat in the same place, leave some food on the plate and limit exposure to foods that are “tempting and dangerous ”.

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

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Stage 2

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

The patient is recommended to start eating those tempting foods, which she sees as forbidden and dangerous. These foods avoided will be ranked according to the degree of rejection, classified into 4 groups of increasing difficulty. Each week, the psychotherapist will indicate to the patient that she should take one of those forbidden foods, starting with the easiest group.

After putting these techniques into practice, cognitive therapy itself begins. As in the first stage the patient already identified those negative thoughts about weight and body silhouette, it is time to teach her about the different cognitive distortions that exist, discovering and analyzing which ones she feels most about identified.

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

To facilitate the process of identifying thoughts and thus having the opportunity to work on them, the psychotherapist can propose different experiments behavioral tasks or send homework such as looking in the mirror, wearing tight clothes, drawing on paper the silhouette you think you have and comparing it with the one you really have...

From these tasks, the patient You will have to write down what goes through your head, to take it to the session with the psychologist and analyze its veracity, coherence and the advisability of thinking like this.

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Stage 3

The third and final phase of Fairburn therapy is performed in 3 sessions every two weeks.. This last section of the intervention focuses on the objective of preventing relapses.

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

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

Instead, a relapse implies returning to the starting point, with follow-up of restrictive diets, binges and purgative behaviors, all behaviors that should be controlled and avoided. Given the severity of relapses, it is necessary that before the end of Fairburn therapy the patient has a plan strategic personal and in writing that specifies what she will do in case of identifying a relapse, and thus prevent her from going to plus.

Today, 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, in which it also has great results.