Integrative Cognitive-Affective Therapy (ICAT): An Emerging Evidence-Based Treatment

Integrative Cognitive-Affective Therapy (ICAT) is a new individual psychotherapy that has been developed for the treatment of bulimia nervosa (ICAT-BN) and binge eating disorder (ICAT-BED).  ICAT was developed to retain key components (e.g., self-monitoring and prescribed eating patterns) of previously established evidence-based treatments, particularly cognitive-behavioral therapy.  However, ICAT has been developed to specifically target “momentary” precipitants of eating disorder symptoms that have been identified as potential maintenance factors in previous empirical studies.  As a result of these findings, ICAT is an emotion-focused treatment that emphasizes the primary role of emotions in maintaining eating disorder symptoms as well as the importance of targeting emotion regulation.  ICAT has four phases of treatment:  an initial phase that focuses on motivational interviewing; a second phase that implements meal planning and adaptive coping skills; a third phase that identifies interpersonal and intrapersonal precipitants of negative emotions that contribute to eating disorder behaviors; and a fourth phase that focuses on relapse prevention.  Several pilot studies and a larger randomized controlled trial have supported the initial efficacy of ICAT as a treatment for bulimic symptoms, as well as its comparable outcomes to cognitive-behavioral therapy.  Pilot data have also indicated that ICAT is helpful for treating binge eating disorder.  Further research is underway to examine principles and techniques of ICAT in the  treatment of other types of eating disorders, including anorexia nervosa.