When bullying targets weight, trauma-focused CBT is a promising treatment, research finds

Researchers at Yale School of Medicine (YSM) have tested the first psychotherapeutic treatment of any kind for bullying, specifically weight-related bullying. It’s important work because there are currently no evidence-based treatments in use that target young people who experience bullying, the researchers said.

Bullying can lead to a number of harmful outcomes, including social and academic problems, anxiety, depression, self-harm, and suicide. Bullying related to weight, in particular, can be a precursor to eating disorders, weight gain, and obesity. Yet, efforts to date have focused on reducing bullying rather than treating its victims.

“Most of the research has focused on preventing bullying or helping schools manage the effects of bullying, but there’s really nothing done for the individual patient, which is bizarre because we know that bullying has all these serious consequences,” says Janet Lydecker, Ph.D., assistant professor of psychiatry at YSM and first author of a study published in the International Journal of Eating Disorders on July 15th.

Lydecker and her team used trauma-focused cognitive behavioral therapy (TF-CBT) in combination with CBT for eating disorders to treat youth experiencing weight-related bullying. They called this therapy “TF-CBT-WB” (trauma-focused CBT for weight bullying). They tested its feasibility in 30 adolescents.

The study found that the treatment improved symptoms such as traumatic stress, eating disorder severity, and body image concerns. Lydecker hopes to expand on these promising results in future studies.

A trauma-focused approach

Historically, TF-CBT has been used to treat youth who have experienced traumatic events such as abuse or near-death experiences, but researchers are beginning to expand the definition of what is considered trauma. Bullying in particular has been shown to cause clinical levels of traumatic stress in children. Because bullying occurs as discrete events that leave children feeling unsafe and distressed, it meets the criteria for TF-CBT treatment.

People will say [bullying] is a “small T” trauma, meaning it is not the official trauma that the DSM prescribes [Diagnostic and Statistical Manual of Mental Disorders] “I can talk about it,” Lydecker says. “But it still functions as a trauma, especially among adolescents whose whole world revolves around their peers and their peer relationships.”

Although not clinically tested, a standard CBT approach to treating bullying can frame it as a stressor and help patients learn coping strategies. By treating bullying as a trauma, Lydecker’s approach requires patients to create a story by recounting the bullying experiences, then reading back through the story and identifying distorted thoughts and emotions.

Lydecker says she expected that TF-CBT-WB for appearance-related bullying would help prevent later development of eating disorders, rather than treating existing eating disorders. That’s why she was surprised to find a high initial rate of serious eating disorder psychopathology among participants.

After three months of weekly treatment sessions, she and her team compared participants’ eating disorder symptoms before and after TF-CBT-WB treatment and saw clinically significant reductions in eating disorder severity, body image and eating problems, and in binge eating.

Lydecker believes that these results demonstrate that TF-CBT-WB may hold promise not only for the treatment of bullying, but also for the treatment of eating disorders.

“In the area of ​​eating disorders, we need more treatment,” she says. “This could be a way to address some of that underlying self-concept and stress that comes from these appearance-related bullying experiences. This could be another option for people with eating disorders, and we really need that flexibility.”

The Future of TF-CBT-WB

Although the results are promising, more research is needed to learn more about the effectiveness of the treatment.

First, it was difficult to comprehensively measure the success of TF-CBT-WB because no other treatment was being tested. For ethical reasons, the study did not have an inactive control group (such as a waitlist), and because there is no evidence-based treatment for bullying, there was no standard of care to use as a comparison—something Lydecker hopes future studies will address.

Lydecker has already begun planning studies with larger cohorts and longer follow-up periods to see how long the effects of the treatment last. She is also interested in finding a way to assess whether a patient would benefit more from TF-CBT or standard CBT.

She also wants to determine whether there are differences in outcomes for youth who are “bully victims,” ​​children who both bully and are bullied. Lydecker hopes the study will spark interest, both among scientists and patients.

“The goal is to get it to the doctors and patients who need it as quickly as possible,” she says.

“If kids have been bullied, they don’t have to deal with it alone. Bullying may be common, but it’s not a normal part of childhood development that you can ignore. It really does require working with a mental health professional if there’s any kind of stress going on.”