ABSTRACT

In our model instrumental beliefs or metacognitions have a key role, in combination with general negative self beliefs, in the development and maintenance of bulimia nervosa. These beliefs or metacognitions include both negative and positive beliefs about eating and eating-related control processes. This chapter introduces negative beliefs about eating, including beliefs about the uncontrollability of eating and the negative consequences of eating behaviour. It describes strategies to identify key negative beliefs, and outlines ways to deal with them, including strategies involving verbal reattribution using a modi®ed dysfunctional thought record (DTR). Behavioural experiments, including behavioural experiments to test lack of control thoughts, ideas for building up a sense of control over eating and tips on helping patients devise their own experiments, including follow-on experiments, are presented. The idea of realistic and unrealistic beliefs is introduced, and the chapter ends with some tips for troubleshooting, and a discussion of the time scale over which experiments may be planned.