Psychological counseling is a very important part of recovery from anorexia nervosa. Individual counseling is frequently required for up to a year and may take as many as 5 to 6 years to provide full relief from the psychological characteristics of the condition.⁸ Psychological counseling usually is not started until after the person is out of a nutritional crisis, because the person may temporarily lack the skills of reasoning or understanding. Types of psychological counseling that are effective in treating anorexia include:

• Individual counseling. Therapies such as cognitive-behavioral therapy (CBT) may be used to treat anorexia. CBT teaches people how to change attitudes and behaviors about eating, weight gain, and recovery. While it is proven effective in treating other eating disorders (such as bulimia), research is ongoing to confirm its effectiveness in treating anorexia. Usual CBT treatment consists of 20 counseling sessions over several months, although with anorexia, the need for treatment may continue for years rather than months.
• Group counseling. Working with other people who have anorexia can be very helpful. People who have the disorder can share their triumphs and setbacks, offer encouragement, and make meaningful comments that might be helpful. But it is important for the person to continue individual psychological counseling in addition to attending group counseling.
• Family therapy. Family members can be very helpful in their loved one's recovery. Family therapy informs you about anorexia and helps you find ways to aid with recovery. Initially, it can help the person with anorexia achieve a healthy weight. Eventually, family therapy focuses on working on other family issues. This includes meeting the needs of other family members. Studies have found that one type of family therapy where parents take control of their teen's food intake (re-feeding) is effective in the short and long term.¹⁰
• Nutritional counseling. Your doctor may ask you to see a registered dietitian. The dietitian tries to shift the focus from counting calories to eating foods the person likes, in a relaxed and enjoyable setting. People who have this illness need to gain weight each week until they reach a healthy weight for their height. Then it is important for them to stay at a comfortable weight. To help with weight gain, liquid food supplements such as Ensure or Sustacal may be used.

Stress management techniques. Although not part of the treatment of anorexia, relieving stress can help you recover, improve your quality of life, and stay healthy. Techniques for managing stress include:

• Exercising. Regular, moderate physical activity helps relieve physical and mental stress. But this should be closely supervised in people whose overexercising is a symptom of their anorexia.
• Writing. Expressing yourself in writing may help reduce your stress level.
• Expressing your feelings. Talking, laughing, crying, and expressing anger are normal parts of the emotional healing process.
• Doing something you enjoy. A hobby or other healthy leisure activity that is meaningful to you can help you relax. Volunteer work or work that helps others can be a powerful stress-buster.
• Doing body-centered relaxation. You can build a healthy relationship with your body through breathing exercises, muscle relaxation exercises, massage, aromatherapy, yoga, or the traditional Chinese relaxation exercises of tai chi and qi gong.
• Doing mindfulness activities. You can learn how to relax your body with self-hypnosis, meditation, or imagery exercises and through listening to relaxing music or using humor to reduce stress.

For more information on stress reduction, see the topic Stress Management.