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Section 9
CBT Techniques in Restoring Self-Esteem

Question 9 | Test | Table of Contents

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In the last section, we discussed three concepts related to boredom and loneliness with regards to binge eating.  These three concepts related to boredom and loneliness with regards to binge eating included:  providing occupation; providing companionship; and feelings of inadequacy. 

In this section, we will examine three Cognitive Behavior Therapy techniques that can be helpful in restoring confidence in clients with bulimia.  These three confidence boosting techniques include:  Beauty is the Beholder; Overcoming the Approval Trap; and Relabel Problems.

3 CBT Confidence Boosting Techniques

♦ Technique #1- Beauty is the Beholder, 6 Steps
The first confidence boosting CBT techniques is "Beauty is the Beholder." Megan, age 20, had been told since an early age that if she did not lose weight, she would be alone for the rest of her life.  Because of this, she had internalized the belief that if beauty brings you men, and she was not able to find a man, she must not be beautiful. One of her automatic thoughts was "I need to be skinny!" which she repeated over and over. To counteract this belief, I asked Megan to try the "Beauty is the Beholder" exercise in order to replace this internalized automatic thought. 

I gave Megan the following list of instructions to follow:

  1. Set aside twenty minutes and make sure you will not be disturbed.
  2. Turn off your phone and stand nude or seminude in front of a full-length mirror.
  3. Breathe deeply, stand erect with your shoulders back, and now with conviction declare, "I am beautiful."  Allow whatever resistances you have to come up and then repeat.
  4. Look at each part of your body and tell yourself with enthusiasm, "I am beautiful."  Notice how different it feels to be affirming your looks rather than finding fault.  If negative comments and judgments come to mind, just notice them and go back to affirming, "I am beautiful."
  5. Give repeated doses of "I am beautiful" to the parts of your body of which you have been the most critical.
  6. To complete the exercise, give yourself a kiss on the back of the hand as you look in the mirror and say, "I am beautiful."  Don’t be embarrassed.  It’s no crime to feel good about yourself; to the contrary, it’s harmful not to.  Remember that feeling beautiful allows you to stop obsessing over your looks and to start putting your energy into more important activities.

The object of this exercise is to replace such automatic thoughts as "I am fat" or "I need to be skinny" with a more general and affirming automatic thought.  Think of your Megan.  Does he or she need to replace his or her automatic thoughts with more affirmations?

♦ Technique #2 - Overcoming the Approval Trap
The second confidence boosting CBT technique is "Overcoming the Approval Trap."  Jennifer, age 23, was finding it difficult to balance being a diligent master’s student and making time for her family at home. Since an early age, Jennifer and her mother, Dorothy, had had a close and intimate relationship. When Jennifer decided to travel 2,000 miles for college, Dorothy felt abandoned and rejected. 

She began to take out her frustrations on Jennifer, heaping criticism after criticism in an attempt to bring her daughter back home. When Jennifer had decided to stay in school and get her master’s, Dorothy stated, "No man really wants a wife who makes more than him! You have enough problems with dating as it is. If only you’d lose a bit of weight." 

Jennifer stated, "I call my mom every evening and we talk for hours, but she’s still not satisfied! I really don’t know what she wants from me! I started binging and purging about my second year into college and I know it’s because of her whining. I order my day around her, and I’ve never been able to say, ‘Let me run my life!’"

I stated to Jennifer, "We all want unconditional love, to be appreciated free of demands or expectations.  Yet all growth involves the integration of seemingly opposite values—the paradox of unconditional love is accepting that we all have conditions.  No matter how much you do for others, some people will still criticize, complain, or take out their negative emotions on you."

To help Jennifer release the aggravation she had accumulated, I asked her to try a role playing game called "Overcoming the Approval Trap" in which I played Dorothy and Jennifer allowed herself a tirade. At first, she was reluctant, but after some coaxing, Jennifer finally let loose. Jennifer stated, "I hate it when you criticize me!  You’re always breathing down my neck and finding fault, never letting me run my own life!  Why can’t you just support me in my biggest decisions?"  Think of your Jennifer.  Who is he or she trying to gain unconditional love from?

♦ Technique #3 - Relabel Problems
In addition to Beauty is the Beholder and Overcoming the Approval Trap, the third confidence boosting CBT technique is "Relabel Problems." Nancy, age 18, had begun to blame herself for not being able to stop binging on her own. Nancy stated, "I used to have such will power! I was the captain of the volleyball team, mainly because I stayed after and practiced for an hour every night. But now I can’t even keep myself from eating a chocolate bar! I’m such an idiot!" 

To help Nancy understand that she really had no control over her eating habits, I asked her to try the "Relabel Problems" exercise. I asked that she look blamelessly at what she may have done to bring about the situation she was in.

I stated to Nancy, "The lesson you learn from adversity helps you to prevent its happening again. The lesson is usually something crucial to your development. If you don’t learn it now, the problem will reappear until you learn what you need to know. Suppose you have a bad day at school and you go home and consume three jars of peanut butter. What have you learned? That framing what happens to you negatively will bring on a binge."

Nancy stated, "So I may not have control over my eating directly, but I do have control over the feelings that cause it! My problem is not my eating, but the negativity that precludes it." Think of your Nancy. Would he or she gain a new perspective through "Relabeling Problems?"

In this section, we discussed three techniques that can be helpful in restoring confidence in clients with bulimia.  These three confidence boosting techniques included:  Beauty is the Beholder; Overcoming the Approval Trap; and Relabel Problems.

In the next section, we will examine three different levels of overeating.  These three different levels of overeating include:  food users; food abusers; and food addicts.

Evidence-Based Practices in Outpatient Treatment for Eating Disorders

- Schaffner, A. D. and Buchanan, L. P. Evidence-Based Practices in Outpatient Treatment for Eating Disorders. IJBCT, 6(1). p. 35-44.
Reviewed 2023

Peer-Reviewed Journal Article References:
Gallagher, M. E., Tasca, G. A., Ritchie, K., Balfour, L., Maxwell, H., & Bissada, H. (2014). Interpersonal learning is associated with improved self-esteem in group psychotherapy for women with binge eating disorder. Psychotherapy, 51(1), 66–77.

Glasofer, D. R., & Devlin, M. J. (2013). Cognitive behavioral therapy for bulimia nervosa. Psychotherapy, 50(4), 537–542.

Olivardia, R., Pope, H. G., Jr., Borowiecki, J. J. III, & Cohane, G. H. (2004). Biceps and Body Image: The Relationship Between Muscularity and Self-Esteem, Depression, and Eating Disorder Symptoms. Psychology of Men & Masculinity, 5(2), 112–120. 

Pearl, R. L., Wadden, T. A., Bach, C., Gruber, K., Leonard, S., Walsh, O. A., Tronieri, J. S., & Berkowitz, R. I. (2020). Effects of a cognitivebehavioral intervention targeting weight stigma: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 88(5), 470–480.

Radin, R. M., Epel, E. S., Daubenmier, J., Moran, P., Schleicher, S., Kristeller, J., Hecht, F. M., & Mason, A. E. (2020). Do stress eating or compulsive eating influence metabolic health in a mindfulnessbased weight loss intervention? Health Psychology, 39(2), 147–158.

Schaefer, L. M., Smith, K. E., Anderson, L. M., Cao, L., Crosby, R. D., Engel, S. G., Crow, S. J., Peterson, C. B., & Wonderlich, S. A. (2020). The role of affect in the maintenance of binge-eating disorder: Evidence from an ecological momentary assessment study. Journal of Abnormal Psychology, 129(4), 387–396.

QUESTION 9
What are three CBT techniques that can be helpful in restoring confidence in clients with bulimia? To select and enter your answer go to Test.

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