Eating disorders are notoriously complex and can be difficult to treat, but group therapy can be an effective method for helping a person cope. Structured curriculums, peer support, full disclosure, and vulnerability can promote sustainable recovery. Groups can be used as a standalone treatment or be included in a more comprehensive treatment approach.
How Does Group Therapy Work?
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 including schools, treatment facilities, private practice offices, and hospitals. Sessions can vary in length and frequency, but typically take place weekly or monthly.1
Why Is Group Therapy a Good Option for Those With Disordered Eating?
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 include:
- Identifying faulty thinking patterns
- Learning new coping skills 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 (depression, anxiety, 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 hospitalization and psychological support.2 That said, many healthcare providers do recommend group therapy, as well as individual or family therapy. However, finding the right group is important. 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.
Types of Group Therapy for Eating Disorders
There are several different group therapy options for eating disorder treatment. Here are some common types:
- 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 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.
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. It also requires you to reexamine how you cope with stress, set boundaries, and value yourself.
Group Therapy Examples
Facilitators sometimes organize groups based on specific criteria or diagnoses. This is not always the case (as people sometimes oscillate between different symptoms), but 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 themselves4.
Groups for anorexia nervosa 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 bingeing 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 bingeing 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 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 is popular 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.
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. 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.
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 follow up study, members who completed a CBT group therapy program showed significant improvements in self-esteem and depressive symptoms.5
- 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.6
- 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.7
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 include:8
- 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
Criticism of Group Therapy
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.
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.
Final Thoughts on Group Therapy for Eating Disorders
Eating disorders can be life-threatening, but recovery is possible. Group therapy provides a supportive and accessible option if you are struggling. Subsequently, groups can offer a defined path to hope and healing.