Exploring the processes of change in individual cognitive behavioural therapy for bulimia nervosa from the patients’ perspectives : a grounded theory study

The aim of this study is to explore how individuals with bulimia nervosa (BN) understand processes of change in individual cognitive behavioural therapy (CBT). The treatment of individuals with BN remains a major challenge and research suggests that treatment only helps a modest number of individuals. The rationale for this investigation is to learn more about the factors that influence change, which might contribute to or shed further light on the body of research that already exists in this area. A qualitative research method is chosen and used from a critical realist framework. The in-depth interviews of eight participants’ experiences of change in CBT for BN are analysed using a grounded theory methodology. The data analysis includes initial open coding, categorisation and linking the categories to construct a theory that is grounded in the data. The findings indicate that healing from BN is a complex and painful continual process of personal transition, which involves ‘a journey towards de-fusion of the sense of self and the BN’. Participants described how BN gradually became part of self and how bodily sensations and attributes affected cognitions and emotions. The overall finding demonstrates an immediate connection between the participants’ physical and psychological realities. This symbolic communication via the body, however, was not experienced as metaphors but rather as actual reality, which affected the change processes in several ways. The processes of de-fusion of the sense of self and therapeutic change in the BN seemed to have an interactional relationship that was central to the experiences of change at all stages of CBT for BN. The main findings are linked to the wider context and the possible implications are discussed. A critical evaluation of the study is offered followed by recommendations for future research and practice in the field of counselling psychology and beyond. In particular, mentalization-based therapy is explored as a possible framework for conceptualising BN, which might help grasp some basic limitations and difficulties in psychotherapy and treatment in general