Eating Disorder Group Therapy: How It Works & Who It’s Right For

What Is Group Therapy?

Group therapy involves the simultaneous treatment of several clients experiencing similar issues. One or more mental health professionals facilitate these programs, which can occur in various settings, like schools, treatment facilities, private practice offices, and hospitals. Sessions can vary in length and frequency, but typically take place weekly or monthly.¹

Group Therapy Vs. Eating Disorder Support Groups

Group therapy refers to groups specifically facilitated by trained therapists with a master’s-level or doctoral degree and relevant licensing in their state. These facilitators are trained to provide safety and cohesion within a group. Some adhere to a specific curriculum, whereas others implement a process group where they allow group members to share current feelings and needs. These groups typically cost money, and members are pre-screened.

Eating disorder support groups are commonly peer-led, which means that facilitators are not necessarily mental health professionals. Instead, these groups might be run by people in recovery. 12-Step groups, including EDA, ABA, and OA fall under the category of being eating disorder support groups. These groups are free and open to anyone who wishes to recover from their eating disorder.

Does Eating Disorder Group Therapy Work?

Eating disorders often fester in secrecy and isolation. Patients tend to conceal their struggles and avoid disclosing their eating disorder symptoms with others. Group therapy, in many ways, acts as an antidote for this behavior.

Some of the benefits of group therapy for eating disorders include:

• Identifying faulty thinking patterns
• Learning new coping skills for eating disorders to replace problematic ones
• Receiving peer support and guidance
• Practicing vulnerability with others
• Building confidence in your recovery
• Enhancing your self-esteem
• Managing other comorbid symptoms (like depression, anxiety, or trauma)
• Learning that you are not alone in your struggles
• Having a sense of accountability for your recovery

Should Group Therapy Be Part of a Larger Treatment Plan?

Depending on the individual, the status of their eating disorder, and their current medical needs, group therapy could be used by itself or in tandem with other forms of treatment. In more severe cases, for instance, a client may need acute care, like inpatient eating disorder treatment and psychological support.² That said, many healthcare providers do recommend group therapy, as well as individual or family therapy.

Types of Group Therapy for Eating Disorders

Finding the right group is important, and knowing which type will best suit your needs can help you choose the best fit. Finding success within recovery requires a person to develop a sense of safety and support. Likewise, facilitators must be competent and well-trained in eating disorders for a group to be successful.

There are several different group therapy options for eating disorder treatment, including:

• Psychoeducational groups: Psychoeducation is a relatively broad term for any education intended to improve your mental health. When it comes to eating disorders, psychoeducation can range from understanding symptom management to learning about the impact a disorder can have on one’s brain chemistry.
• Process groups: Process groups generally do not follow a specific format. Instead, facilitators encourage group members to share their candid thoughts and feelings freely. Members will then provide appropriate feedback and support.³
• CBT groups: Cognitive behavioral therapy groups can help clients challenge the unhelpful thinking patterns associated with their eating disorders. CBT groups also introduce alternative coping skills to help clients eliminate or avoid disordered habits.
• DBT groups: Dialectical behavior therapy is rooted in mindfulness, emotional regulation, and distress tolerance, which represent crucial components of a healthy recovery. DBT groups for eating disorders will introduce these skills and encourage members to practice them regularly.
• Experiential therapy groups: Art, dance, equine, and yoga are popular experiential therapy groups. These settings allow clients to express themselves without direct communication.
• Nutrition groups: Learning about nutrition can help clients with meal planning and other food-related concerns. Registered dieticians or nurses often facilitate these groups, and a therapist may also be present.
• Family-based groups: Families can be an influential part of the recovery process. Facilitators may lead family-based groups to help loved ones offer support and guidance to members.
• 12-step groups: 12-step groups like Overeaters Anonymous (OA), Eating Disorders Anonymous (EDA), and Anorexics and Bulimics Anonymous (ABA) offer free, confidential support for anyone who wants to recover. These groups are peer-led and considered support groups, not group therapy.

Common Eating Disorder Group Therapy Activities

Group therapy activities vary, but talking about struggles and growth represent key components of any successful group. Most facilitators encourage members to be honest with one another, with the idea that peer support can cultivate insight and motivate change. Furthermore, most groups emphasize developing new skills. Eating disorder recovery entails overhauling how you perceive and eat food, but it also requires you to reexamine how you cope with stress, set boundaries, and value yourself.

Common eating disorder group therapy activities include:

• Identifying triggers for eating disorders
• Sharing stories about body image and your relationship to food over time
• Learning information about eating disorders
• Practicing healthy coping skills
• Examining thoughts, feelings, and behaviors related to eating disorders

The Structure of Eating Disorder Therapy Group Sessions

Eating disorder therapy group sessions all generally start with the facilitator reviewing the rules and agenda for the group. Groups may range from 1-2 hours and members often sit in a circle. Psychoeducational groups, however, may be set up to resemble that of a lecture with the facilitator sitting or standing in front. People are encouraged to speak one at a time. Some groups will start with an opening icebreaker, and some facilitators may also assign homework for members to complete between sessions.

It’s essential for group members to speak respectfully and maintain consistent respect throughout the group. If someone is being unruly, other group members may be encouraged to address the behavior. However, in most cases, the facilitator will intervene.

The Benefits of Group Therapy for Eating Disorders

Research shows that group therapy is just as effective as individual psychotherapy in treating eating disorders.⁴ While the benefits of group therapy are many, valuable peer support is one asset that cannot be experienced in individual treatment.

Group Therapy Helps People Reduce Feelings of Isolation

Peer support in a group therapy setting is beneficial in reducing feelings of isolation. Spending time with others who are experiencing similar struggles in a supportive environment can reduce stigma and feelings of shame and loneliness.

Group Therapy Offers Community & a Support System

Eating disorders can be secretive and isolating. Many people feel like they are completely alone in their struggles, and they might worry that nobody can understand what they’re experiencing. Group therapy can unpack some of this shame. Building support with people who truly get it can be an invaluable part of the recovery process.

Group Therapy Offers Exposure Opportunities

Group therapy may encourage people to step out of their comfort zone. For example, sharing about a lapse may be brand new to you, but doing so can be an important step in your recovery. Likewise, some group facilitators will encourage people to bring a feared food to eat in group as a way to gain support and expose themselves to their discomfort.

Group Therapy Can Help Someone Overcome Social Anxiety

Group therapy has been shown to be effective in helping people overcome social anxiety, particularly when CBT is implemented.⁵ It creates an opportunity for new, supportive relationships and offers a chance to practice social skills in a safe environment.

Group Therapy Can Provide New Perspectives for Folks Stuck in Cycles

Group therapy can help a person recognize maladaptive patterns in their thoughts, feelings and behaviors and provide a safe, supportive space to explore ways to break free from these cycles. Group members can work together, with the facilitator, to identify ways to build healthier patterns.

Limitations of Group Therapy for Eating Disorders

Despite the many benefits of group therapy for eating disorders, there are some limitations, like a general lack of confidentiality, a less personal experience than one-on-one therapy (as the facilitator must attend to all group members), and it cannot help someone going through a more acute crisis.

Here are the potential limitations of group therapy for eating disorders:

• Limited confidentiality: Instead of sharing your story with a licensed therapist alone, in a group setting you are disclosing to the entire group. While confidentiality is important in group therapy, there is no guarantee of privacy.
• Less personal experience: While you will have plenty of opportunities to be heard in group therapy, there will be lots of time spent listening to other group members. Though this is a valuable aspect of group therapy, learning from one another’s perspectives and experiences, it may feel less personal than individual therapy.
• Can be difficult for someone with severe social anxiety: Navigating a group therapy setting may be difficult for someone with social anxiety. Anxiety may impede the person’s ability to get the most of the eating disorder group.
• Not appropriate for people in crisis: Group therapy is not a good fit for a client in crisis. If someone is struggling with suicidal thoughts, for example, individual therapy and possible hospitalization would be indicated.

Group Therapy Examples

Facilitators sometimes organize groups based on specific criteria or diagnoses, like anorexia or binge eating disorder. This is not always the case, however, and some people find it beneficial to be with folks with other issues, while others oscillate between symptoms.

Here are some standard group therapy formats you can expect:

Group Therapy for Anorexia Nervosa

Anorexia nervosa creates an emotional obsession with food, weight, and body image. People with anorexia typically struggle with control; they may believe that controlling their food intake or body weight will help them feel better about themselves.⁶

Group therapy for anorexia nervosa should aim to help clients identify healthier relationships with food and their bodies. This may include a combination of self-esteem and psychoeducational activities, along with processing their current struggles and fears. Open groups allow new members to join anytime, while closed groups allow admittance only during certain periods.

Bulimia Group Therapy

Bulimia also involves an emotional obsession with food, weight, and image. Along with (or instead of) restricting food, those with bulimia also engage in binging and purging behaviors.

Groups for bulimia focus on cultivating a sense of balance and distress tolerance, often to teach one how to avoid and reduce binging and purging behaviors. They also integrate components of self-esteem, self-compassion, and personal accountability.

How Much Does Group Therapy for Eating Disorders Cost?

The cost of group therapy varies, although groups are typically cheaper than individual or family sessions. Your location, type of group, and the facilitator’s level of experience will largely influence the rates. With that in mind, a group may cost anywhere from $10-$50 per session.

If your mental health insurance authorizes this specific mode of treatment, they may subsidize some or all of these costs. Depending on your plan, you may need to reach your deductible before insurance takes over. Alternatively, some facilitators offer sliding scales or pro bono services for clients. Likewise, community-based support groups and 12-step programs run on donations.

How to Find Group Therapy Near You

Group therapy can be found both in-person and online. If you intend to use your insurance to subsidize treatment costs, consider asking your provider for a list of in-network facilities. If you know someone who has completed eating disorder treatment, you can ask them for a referral, too. If you’re currently attending individual therapy, your therapist may also be able to offer some options. You could also use an online platform like Equip Health, which offers therapy groups as part of a larger treatment plan.

Who Is Able to Offer Group Therapy for Eating Disorders?

There are no official standards for group therapy facilitation. Psychologists, psychiatrists, professional counselors, licensed therapists, and mental health interns can run groups. Most settings require that facilitators have training in eating disorders, and some facilitators may be in recovery themselves.

If you’re interested in trying a particular group, ask the facilitator about their credentials and experience. Keep in mind that CEDS (certified eating disorder specialist) is the most common type of certification.

Can Online Eating Disorder Group Therapy Work, Too?

Research supports the use of online therapy, including online group therapy. However, some aspects of online group therapy differ from in-person groups. For example, studies suggest that group cohesion develops slower in an online group therapy setting, requiring more time for the intervention to be effective.⁷

On the other hand, some people benefit more from online groups than in-person. Though certain elements like body-language are often lost in the online setting, some people may feel safer attending an online group from home. Finding an online group that is led by a licensed therapist in a secure online platform can offer a viable alternative to in-person group therapy for eating disorders.

Is Eating Disorder Group Therapy Effective?

Research shows that eating disorder group therapy appears to be effective. In addition, its lower costs offer greater accessibility to people who need support.

• In a 10-year study, members who completed a CBT group therapy program showed significant improvements in self-esteem and depressive symptoms.⁸
• While treatment drop-out rates tend to be high for any eating disorder, another meta-analysis indicated that a combination of CBT and family support tends to positively boost recovery efforts.⁹
• The American Psychological Association (APA) stated that more than 50 clinical trials have shown that group therapy is just as effective as individual therapy. Researchers have stated that effective groups allow attendees to create a shared sense of purpose and identity.¹⁰

Risks of Group Therapy

No therapy can be performed without possible risks. Because of this, it’s important to understand what these potential variables are before beginning treatment. Group facilitators must review these risks thoroughly during the informed consent process with clients. If you have additional concerns, feel free to address them with the therapist directly.

According to research, some of the common risks of group therapy  for eating disorders include:¹¹

• Lack of therapist skill or competence
• Clashing leadership styles
• Selection errors (mismatch between therapeutic interventions and a client’s symptoms)
• Differing personalities among members
• Confidentiality concerns

Potential to Pick Up Negative Peer Influence

In the case of eating disorder group therapy, peer influence can sometimes be insidious and competitive. For instance, members may “learn new tricks” on how to manage food or body weight from other attendees. They may also feel pressured to look or act a certain way to fit in with the group.

Possibility for Mismanagement

Likewise, groups need to be well-managed to be effective. It is not appropriate for one person to monopolize the conversation or dominate a therapist’s attention. Moreover, some members hesitate to open up in groups, because they fear shame or judgment. Trained facilitators understand these risks and work to mitigate them appropriately. That said, there is no perfect group, and it is crucial to be aware of these factors.

If You or a Loved One Has an Eating Disorder, Seek Help Immediately

Eating disorders can become life-threatening if left untreated. The more severe and long-lasting the disorder, the more likely it is to cause serious complications, including serious health problems, suicidal thoughts or behavior, depression and anxiety, problems with growth and development, social challenges, issues at work and school, substance use disorders, and even death.¹²

If you or someone you love exhibits symptoms that could be related to an eating disorder, seek help immediately. Contact your doctor for treatment recommendations. In the event of a mental health emergency, call the 988 Suicide and Crisis Line or go to your nearest Emergency Room.