Adapted from Cooper (2009) and Fairburn (2013)

To overcome BN or BED, one must give up the idea of dieting.

ELIMINATING DIETING GUIDELINES - GENERAL

Do not attempt to deal with dieting until a regular eating plan has been established and it has had a significant

impact on normalising eating habits (this could take anywhere between a couple of weeks to a few months).

Ask for assistance to determine how much food is required as this may be difficult to identify if fasting or

restricting has been a habit for a long time. Remember, this should be a rough guide rather than an exact

formula.

It is important to gradually reintroduce foods that have been avoided, so that ultimately a rational choice can

be made about whether to eat it or not. If these foods continue to be avoided, then when they are consumed,

they will more likely lead to a binge.

ELIMINATING DIETING GUIDELINES - SPECIFIC

Draw up a list of foods that have been avoided either because they were “too fattening” or they often triggered

binges. Having a look around the supermarket can help to fill up this list.

Organise the list into a specific hierarchy, with the items which present the least difficulty (i.e. the least

threatening), down to those that are most difficult.

Divide the hierarchy into three groups of difficulty: minor, moderate, and extreme.

Beginning with foods which present the least difficulty, incorporate one of these items into the meal plan every

second or third day. Plan this for a time that is particularly safe, for example, when you are eating with a friend

and it would be impossible to then purchase additional food.

Stick with foods from the ‘minor difficulty’ group until all the foods are able to be eaten without difficulty & the

foods are no longer identified as being avoided. Then move to the ‘moderate difficulty’ group & repeat this

process.

Roughly decide on how often these foods should be eaten and in what quantity – remember not to avoid.

REVIEWING THE PLAN

Remember to proceed with caution, and not move onto foods that are too challenging before feeling ready.

Step 5: Eliminating Dieting

Systematically widening the range of foods you eat

before moving to Step 6...

- Make any changes necessary to eat an adequate amount of food

- Identify feared foods and start to systematically reintroduce these to meal plan

- Practiced managing a range of difficult situations for eating

- Able to eat in a controlled way, in reasonable quantities, enjoyed foods

Helping people to overcome Bulimia Nervosa and Binge-Eating Disorder using

Cognitive Behavioural Techniques

MINOR DIFFICULTY

MODERATE DIFFICULTY

EXTREME DIFFICULTY

Helping people to overcome Bulimia Nervosa and Binge-Eating Disorder using

Cognitive Behavioural Techniques

Hierarchy of Difficult Foods – Step 5

Adapted from Cooper (2009) and Fairburn (2013)

TIPS

List all the situations you know you would find eating difficult.

Practice coping with these situations in safe environments, starting with the least threatening

and gradually moving on until you feel confident to manage any situation you may be in.

Take some notes about how you coped with that situation. You may like to think of

relaxation/calming strategies or other practical things that you did at the time.

Situation Notes

Helping people to overcome Bulimia Nervosa and Binge-Eating Disorder using

Cognitive Behavioural Techniques

Difficult Situations – Step 5