ABSTRACT
Our model proposes that bulimia nervosa is in effect a strategy for dealing with the activation of negative beliefs, thoughts and feelings. In this perspective the metacognitive appraisal and regulation of inner experiences is a central feature of the problem. It follows from this that metacognitive therapy principles (Wells 2000) could be applied in the treatment of BN. We have found that enabling patients to develop alternative strategies for relating to inner events is useful in increasing ¯exibility and subjective sense of control. One speci®c strategy is the use of detached mindfulness (DM) techniques. This chapter outlines the nature of detached mindfulness (Wells 2000, 2006), its role in the treatment of BN and example strategies for presenting its rationale to patients. A range of DM strategies, including metacognitive guidance, free association and the tiger task, that can be applied in practice are described, and their speci®c practical application is discussed.
