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Group Therapy and Eating Disorder Treatment

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Eating disorders affect everyone, with research estimating that nine percent of Americans will develop an eating disorder at some point in their lifetime. (1)

One standard treatment option many people with eating disorders find successful is group therapy. Used alone or alongside other treatment options, group therapy can help build community and confidence in someone with an eating disorder. It can also establish a support system and increase socialization through weekly meetings between friends, families, and others living with an eating disorder.

Group Therapy and Eating Disorder Treatment

What is Group Therapy?

Group therapy is a form of psychotherapy where people living with similar challenges gather to discuss their experiences under the supervision of a therapist. People attending group therapy for an eating disorder can find a group specific to their condition, such as one for orthorexia nervosa (OR), or may choose to join a more general meeting that is inclusive of all eating disorders. 

The purpose of group therapy is to help individuals build self-awareness and modify their behaviors. For individuals with anorexia nervosa (AN) or avoidant restrictive food intake disorder (ARFID), the sessions may focus on identifying why individuals avoid food and taking steps to change their approach to eating. Sessions for atypical bulimia nervosa (ABN) or binge eating disorder (BED) may explore the causes of a person’s binging and purging and work to build different eating habits. 

Group therapy can range in the number of people per session and may be offered virtually, through an app, or in person. Group therapy may be a stand-alone treatment or be used with other treatments, depending on your needs.

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How to Treat Eating Disorders with Group Therapy

Every group therapy session can differ, depending on who is monitoring the discussion. In most cases, group therapy sessions meet once a week, in-person or online, to discuss the challenges and progression of eating disorder treatment from the week before. The therapist supervising the group may act as a moderator to ensure the conversations stay productive and all participants are respectful. 

How are Eating Disorders Treated with Group Therapy 

For people living with a long-term eating disorder, group therapy may help them rebuild trust in themselves and others. Some people with an eating disorder have trouble trusting their body when it’s telling them it’s hungry. Someone with an eating disorder may also distrust others, especially friends and family, because they don’t feel understood by their loved ones. Talking to relatives and friends in family therapy can start to rebuild some of that trust.

Group therapy may also help individuals take charge of their narrative. Some people place a lot of their identity on their eating disorders. As a person continues to share their story and hear from others, they can separate their identity from their eating disorder. Building an identity separate from their disordered eating behavior may give the individual a better sense of control to make more beneficial decisions regarding their eating behaviors and health.

What to Expect in Group Therapy

A licensed therapist typically leads group therapy. Members may meet each week for one to two hours or longer, depending on the group. If the session is in-person, it’ll likely be in a quiet space with chairs arranged in a circle so everyone can easily interact with the group. 

At the start of the session, the therapist may set an intention for the session or remind participants of guidelines to keep everyone safe and comfortable. An intention for group therapy may include discussing self-care or self-love or improving eating habits. Other sessions may start with introductions and individual updates on their progress during their week. 

Some group therapy sessions may have lesson plans or group activities, and others may take on more of a free-form discussion style. In either case, the lead therapist will guide members through the session to ensure everyone is feeling heard and included.

If a therapist chooses a group activity, it may relate to the session’s intention. For example, suppose the focus of the session is finding one’s identity outside of an eating disorder. In that case, the activity could be writing a list of hobbies or interests to help participants see they are more than their eating disorder. 

After a group activity or discussion, a therapist may assign homework for the next session. The goal of the assignment is to encourage participants to work on their treatment outside of the sessions. For someone with bulimia nervosa or binge eating disorder, homework could include journaling their thoughts and feelings before and after a food binge or purge to help identify what pushes them to eat. Someone with a night eating disorder might have to eat a small snack every morning or cut off their food intake at a particular time of day to build more consistent eating habits throughout the day. 

Types of Group Therapy

There are a few different types of group therapy:

  • Family therapy: Family therapy is group therapy in which a person with an eating disorder attends therapy with their family. It’s a time for the family to learn about the challenges their loved one faces with their eating disorder. Families can also share concerns and learn how to help. 
  • Open group: Open group therapy means individuals can join the group at any time and come as little or as much as they want.
  • Closed group: Closed group therapy means all members join at once, and they are the only people who may attend the session. Closed group sessions typically run for a certain amount of time, and it’s expected that members attend each session.
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Evaluating Group Therapy as an Effective Eating Disorder Treatment

Everyone’s journey to recovery from an eating disorder is different. Group therapy as a treatment option provides some participants with wonderful benefits, but it also has limitations. 

Benefits of Group Therapy

Group therapy for someone living with an eating disorder can provide various benefits, such as creating a community and building a support system. Here are a few notable benefits of attending group therapy for eating disorder treatment: 

  • Building a community: When a person is living with an eating disorder, they may feel alone in their struggles. Group therapy gives individuals a sense of community and lets them know they’re not alone in their journey. 
  • Establishing a support system: Individuals receive support and offer support to their peers through group therapy. Getting support can build a therapeutic alliance and trust among peers. Giving support provides personal growth when individuals take what they’ve learned through their own experiences and help someone else. 
  • Increasing socialization: A symptom of many eating disorders is self-isolation. Group therapy helps participants work on their socialization and communication skills to become more confident interacting with others. 

Limitations of Group Therapy 

While group therapy can be an excellent option for someone living with an eating disorder, here are some limitations to consider before joining a group therapy session. 

  • Limited confidentiality: There is confidentiality within the group, meaning members can’t discuss what other people have shared outside the session. However, since group therapy is about sharing experiences with peers, individuals have to talk about their eating disorders with other people. 
  • Less personal: Depending on the size of the group and the time allocated to the session, not everyone may have the opportunity to share and receive guidance each session. There’s also limited time for individuals to unfold their personal challenges the way they may in an individual therapy session.
  • Social anxiety: While group therapy can help individuals with socialization skills, starting in group therapy may cause social anxiety to those who are uncomfortable in group settings. 

Efficacy of Group Therapy in Healing Eating Disorders

Group therapy may not heal everyone with an eating disorder. Still, research finds group therapy a successful treatment option for those experiencing bulimia nervosa or a binge eating disorder. (2) People living with BN or BED tend to have similar tendencies around restricting or purging food. Changing these behavioral habits is what group therapy sessions address. Individuals can learn from one another how to identify restrictive and purging tendencies and how to change them.

Research also finds group therapy less successful for those living with anorexia nervosa. A symptom of AN includes a distorted perception of their sizes. Sometimes, being around people can trigger that symptom, and the person may start comparing their bodies to those around them. In a group therapy setting specific for eating disorders, this can be incredibly triggering, as there are typically many individuals with lower weights and smaller body frames. Likewise, people with BED may find being in a group with people in smaller bodies may also trigger feelings of shame and internalized weight stigma.

While group therapy presents challenges for some eating disorders, it’s generally a successful option for those living with eating disorders. Group therapy can help individuals build self-awareness and change food and eating-related behaviors when used alongside other treatments.

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Group Therapy at Within Health

Group therapy at Within Health incorporates all of the core modalities, including acceptance and commitment therapy groups (ACT), dialectical behavior therapy groups (DBT), and cognitive behavioral therapy groups (CBT), among many others. Our clinical care team at Within Health wanted to be intentional about creating a group feel in a virtual space. It is for this reason that some of our group sessions may include group meals, or activities, in a shared virtual space. Each of our groups are kept fairly small, as we believe it is important to keep sizes manageable, to help promote client accountability. Call our admissions team today to learn more about the first steps when it comes to treating your eating disorder.

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Resources

  1. Report: Economic costs of eating disorders. Harvard School of Public Health. (2021, September 27). Retrieved April 4, 2022, from https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/ 
  2. Grenon, R., Schwartze, D., Hammond, N., Ivanova, I., Mcquaid, N., Proulx, G., & Tasca, G. A. (2017). Group psychotherapy for eating disorders: A meta-analysis. International Journal of Eating Disorders, 50(9), 997–1013. https://doi.org/10.1002/eat.22744 
  3. Mayo Foundation for Medical Education and Research. (2018, February 20). Anorexia nervosa. Mayo Clinic. Retrieved April 4, 2022, from https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/symptoms-causes/syc-20353591 
  4. American Psychological Association. (n.d.). Psychotherapy: Understanding group therapy. American Psychological Association. Retrieved April 4, 2022, from https://www.apa.org/topics/psychotherapy/group-therapy 
  5. Mayo Foundation for Medical Education and Research. (2018, May 10). Bulimia nervosa. Mayo Clinic. Retrieved April 4, 2022, from https://www.mayoclinic.org/diseases-conditions/bulimia/symptoms-causes/syc-20353615 
  6. Mayo Foundation for Medical Education and Research. (2018, May 5). Binge-eating disorder. Mayo Clinic. Retrieved April 4, 2022, from https://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/syc-20353627
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