Incorporating Meta-Emotions in Integrative Cognitive-Affective Therapy to Treat Comorbid Bulimia Nervosa and Substance Use Disorders in a Latina American

Abstract

Individuals with co-occurring eating and substance use disorders have poorer psychosocial adjustment than those with only eating pathology or substance misuse patterns; these complex cases are often challenging to treat in clinical settings. Eating and substance use disorders share personality, affective, and cognitive etiologic factors, suggesting the importance and opportunities to treat them simultaneously in an integrative intervention approach. The integrative cognitive-affective therapy (ICAT) validated to treat bulimia nervosa follows an evidence-based conceptual framework; it addresses many shared risk factors that underlie eating and substance use disorders. A Latina American with comorbid bulimia nervosa, alcohol and cocaine use disorders, and bipolar I disorder was treated using ICAT; therapy was augmented with an explicit examination of, and cognitive restructuring surrounding, negative meta-emotions. ICAT and treatment around meta-emotions were delivered in the context of an intensive outpatient program. Over the course of 15 individual sessions and at 1-month follow-up, the patient reported a decrease in dietary restraint, binge eating episodes, body dissatisfaction, and negative attitudes toward obesity and alcohol and cocaine abuse, and maintained a stable weight. The patient also saw improvements in depression- and anxiety-related symptoms, and self-evaluation. This case supports the flexibility and benefits of examining meta-emotion philosophy in the context of ICAT for the treatment of co-occurring eating and substance use disorders for adults in a clinical setting.