Rethinking OCD and Eating Disorder Treatment: Why Traditional CBT Falls Short—and What Actually Helps

As a therapist who specializes in OCD and eating disorders, I often work with clients who feel tormented by relentless, intrusive thoughts. Whether it’s fears about food, weight, morality, health, or control, these thoughts are sticky, repetitive, and emotionally charged. Many of these clients have been through therapy before—usually CBT—and come in frustrated that, despite all their efforts to “reframe” or “challenge” their thoughts, nothing has really changed.

In some cases, they feel even more stuck.

If this sounds familiar, you’re not alone. And you’re not doing anything wrong. The problem may be with the approach itself.

Why Traditional CBT Doesn’t Work for OCD and Eating Disorders

Cognitive Behavioral Therapy has long been considered the gold standard for anxiety-related conditions. And for many, it’s incredibly helpful. But when it comes to OCD and eating disorders, especially those that involve intrusive thoughts and internal compulsions, traditional CBT techniques can backfire.

CBT often teaches clients to:

• Challenge distorted thinking

• Replace negative thoughts with rational ones

• Use logic to argue against intrusive fears

While this may seem helpful on the surface, for someone with OCD or an eating disorder, it often fuels the cycle.

Here’s why: the more we try to “talk back” to an intrusive thought, the more important and threatening the brain assumes it is. Instead of weakening the thought, we reinforce its significance. Thought-challenging, in this context, becomes a compulsion—just another way to try to gain certainty or control.

And that keeps the loop going.

Thought-Stopping: But Not the Way You Think

When I say “thought-stopping,” I don’t mean forcefully trying to erase thoughts from your mind. That kind of effort only backfires. What I mean is stopping the engagement—not getting into a debate, not analyzing the thought, not proving it right or wrong.

This form of thought-stopping is about disengagement. It’s about noticing a thought, recognizing that it’s not helpful or meaningful, and choosing not to give it your attention. It’s like seeing someone wave you into a pointless argument—and choosing not to step into the ring.

Rather than endlessly analyzing, rewording, or reframing, we simply let the thought float by. No reaction. No interpretation. Just a pause—and then a redirection of our focus back to the present moment.

This approach is powerful, especially for clients who are exhausted from trying to “fix” their thoughts or do therapy homework that feels like a mental gymnastics routine.

How This Applies to OCD and Eating Disorders

Many clients with eating disorders also struggle with OCD-like thinking patterns: rigid rules, intrusive guilt, compulsive mental checking, or black-and-white beliefs about food and body image. Traditional CBT methods often try to “correct” these thoughts—but that correction becomes its own ritual.

Instead, we work on tolerating discomfort, allowing uncertainty, and choosing not to engage.

For example:

• “What if I gain weight?” doesn’t need a counterargument. It needs a pause.

• “This food is bad” doesn’t need a debate. It needs space.

• “Did I eat too much?” doesn’t need a review. It needs a shift in attention.

When we stop engaging with the thoughts, they lose their power. Not immediately—but consistently, over time. What’s left is mental clarity, emotional flexibility, and room to reconnect with your values and your life.

If you’ve tried CBT and felt like you were failing—or that the approach wasn’t helping—you’re not alone. There’s a reason it didn’t work. You don’t need to challenge every thought or prove your fears wrong.

Sometimes the most powerful thing you can do is nothing at all.

Let’s work together to unlearn the noise and make space for healing.

Warmly,

Allison Summer

LPC | OCD & Eating Disorder Specialist

A Brighter Day Wellness