Integrative Cognitive Affective Therapy (ICAT)
for Bulimia Nervosa and Binge Eating Disorder (BED)

ICAT has been developed by Stephen Wonderlich and Carol Peterson and a group of other collaborators in the US over a period of about 20 years. The treatment model is empirically based on studies and surveys evaluating the experience of many individuals suffering from bulimia nervosa and also BED. It was demonstrated that momentary, often very intense negative emotional states were strong predictors of a binge and/or purge episode.

ICAT is a structured short-term treatment delivered over 20 sessions. ICAT is emotion focussed, emphasising the functional relationship between emotion experience in the moment and bulimic behaviour. It involves meal planning, the introduction of regular normalised eating and the use of self-monitoring of eating and emotions.

The overarching clinical aim of ICAT is to assist the individual to enhance their awareness of momentary emotional factors and the development of skills to manage these emotion states and urges for bulimic behavior in the moment. ICAT also supports the person to identify the processes in their lives which generate periods of emotion dysregulation, like unrealistic high expectations, negative self-directed behaviours and/or interpersonal difficulties.

ICAT strongly focusses on building a strong collaborative therapeutic relationship and encourages non-judgmental observation and then the development of more functional skills and strategies.

ICAT has been tested in pilot studies and also in a randomised control trial, in which it was compared to Cognitive Behavior Therapy-Enhanced (CBT-E). The results of this trial revealed that ICAT-BN did not differ from CBT-E in its effectiveness and appeared to be even more effective with individuals with high levels of emotion regulation difficulties.

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