This book describes the application of cognitive behavioural principles to patients with a wide range of eating disorders - it covers those with straightforward problems and those with more complex conditions or co-morbid states. The book takes a highly pragmatic view. It is based on the published evidence, but stresses the importance of individualized, principle-based clinical work. It describes the techniques within the widest clinical context, for use across the age range and from referral to discharge. Throughout the text, the links between theory and practice are highlighted in order to stress the importance of the flexible application of skills to each new situation. Case studies and sample dialogs are employed to demonstrate the principles in action and the book concludes with a set of useful handouts for patients and other tools. This book will be essential reading for all those working with eating-disordered patients including psychologists, psychiatrists, nurses, counsellors, dieticians, and occupational therapists. This book describes the application of cognitive behavioral principles to patients with a wide range of eating disorders. Case studies and sample dialogues are employed throughout the text to demonstrate the principles in action and the book concludes with a set of useful patient-handouts and other tools. Preface xxiii Section I Introduction The philosophical and theoretical stance behind CBT 3(10) The importance of evidence 3(1) Dealing with the whole person in treatment 4(1) Clinician stance: the curious clinician 4(2) Collaborative working relationships 5(1) The transdiagnostic approach 6(1) Using the transdiagnostic model in practice 7(1) Themes in the process of treatment 7(4) Short-term discomfort in order to achieve long-term gain 8(1) The patient becoming his or her own therapist 9(1) Continuum thinking 10(1) Goal-setting 10(1) The value of case formulation 11(1) The importance of behavioral experiments 11(2) Broad stages in CBT and format of delivery 13(3) Broad stages in CBT for the eating disorders 13(1) Duration of treatment and when to expect change 14(1) Format of treatment 15(1) What the clinician needs to establish before starting 16(15) Medical safety 16(1) Risk assessment in eating disorders 17(1) Who is at medical risk? 17(1) Assessing acute risk at the beginning of treatment 18(3) Recent weight changes 19(1) Non invasive tests for muscle strength: the sit up, squat, stand (SUSS) test 20(1) Care planning in response to the baseline physical tests 21(1) Assessing chronic risk 21(1) Monitoring risk during treatment 22(1) When to stop CBT because medical risk is the priority 22(1) The value of a multidisciplinary working environment 23(2) Preparing the physical environment 25(1) Trouble-shooting: realistic expectations of CBT 25(6) Summary 27(4) Section II Core clinical skills for use in CBT with the eating disorders Assessment 31(11) Areas covered in interview 31(8) Demographic information 32(1) Eating behaviors 32(1) Measuring the patient's height and weight 33(1) Psychosexual functioning and history 34(1) Central cognitive elements 34(1) Body concept/dissatisfaction 34(1) Body percept 35(1) Fear of fatness and weight gain 35(1) Eating disorder diagnosis 36(1) General health 37(1) Comorbid behaviors and psychological disturbances 37(1) Risk assessment 38(1) Treatment history 38(1) Family structure 38(1) Life history 38(1) Client's motivation and goals for treatment 39(1) Treatment preferences 39(1) Additional assessment of cognitions, emotions and behaviors 39(1) Trouble-shooting in the assessment phase 39(3) Extended assessment 40(1) Therapy-interfering behaviors 40(1) Address the patient's refusal to be weighed 40(2) Preparing the patient for treatment 42(2) Motivation 44(24) Context for motivation: understanding the patient and building a relationship 44(6) Understanding the patient's position 44(1) The clinician's position 45(1) Clinician and patient investment 46(1) Stages of change 47(1) Precontemplation (``not ready'') 47(1) Contemplation (``thinking about it'') 48(1) Preparation (``getting ready for change'') 48(1) Action (``ready, set, go'') 48(1) Maintenance (``hanging in there'') 48(1) Willingness and resources: two components of change 49(1) Assessing motivation for change 50(5) Questionnaire and interview measures 50(1) Pros and cons lists 50(1) The ``miracle question'' 51(4) Motivation as a moving target 55(1) Tools and techniques to enhance motivation 55(6) Friend or foe letters 56(1) Life plans 57(1) Writing to oneself in the future 58(1) Pros and cons of change 59(1) Problems and goals 60(1) Developing and using a summary flashcard 61(1) Trouble-shooting: common problems in motivational analysis and enhancement 61(7) Addressing fluctuations in motivation 61(1) Pros and cons of the change process 62(2) Letting go of the eating disorder 64(2) When the patient is not ready to change 66(2) A guide to important dietary and nutritional issues 68(28) What food is used for in the eating disorders 68(1) A beginner's guide to nutrition: what clinicians and patients need to know 69(2) What should a basic meal plan look like? 71(10) Meals 76(1) Snacks 76(1) Calcium-rich foods 77(1) Fruit and vegetables 78(1) Traditional desserts/fun foods 79(1) Fluid requirements 79(2) Food planning versus counting calories 81(1) Helping patients to improve diet: getting started 82(3) Planning changes in diet 83(1) Timing of eating 84(1) Content 84(1) Working with patients who are underweight or overweight 85(9) Managing weight gain in underweight patients 85(1) How much extra does the patient need to eat to gain weight? 85(1) Changes in metabolic rate/energy needs during weight gain 86(1) How to practically manage weight gain in low-weight patients 87(1) Patients who are overweight or obese 87(1) Vegetarianism and veganism 88(2) Vitamin and miner