So Bill it sounds like we’ve done pretty well with confronting some of the cues about your binge eating You know I was actually really surprised that just looking at pictures of donuts or watching videos of Dunkin Donuts commercials would raise my anxiety the way it did So the fact you’ve experienced these strong cravings means that we’re on the right track What we need though is to have repeated experience with the cravings in the absence of any binging of any type That’s definitely what I’m hoping will happen I know I can’t just keep on going on binging So I know we’ve made some nice progress with the things that are on the hierarchy with your binging queues Today I’d like to move ahead with something a little bit more challenging on the hierarchy This will be an opportunity to show yourself that you can experience the cravings without giving in to the binging And in the long run that should help the cravings go down Yeah So let’s figure out how to start When you binge it on donuts in the past how did it happen exactly Well, I’d often keep a box of Krispy Kremes at my apartment That’s where I’d often do the binging and it would happen more often when I was really stressed out So it sounds like then an exposure to a whole box of donuts would spark those urges and those cravings So how strong do you think the cravings would be on a 0 to 7 scale Pretty strong I’m gonna say like a 3 or 4 How about we start there and Then as we move along we can figure out ways to make the cravings even stronger Okay Let’s do it In this bag I’ve got a box of donuts So whenever you’re ready you can take them out and we can get started Okay Okay so Bill Let’s try to review what we’re going to do here We want you to practice accepting the cravings So try not to distract yourself or take yourself away from the feeling of the cravings Let’s just try to see where your cravings are at can you tell me that? They’re definitely up there. I mean it feels Kind of like the anxiety I would feel if I was home Perfect that’s what we want to do we want to simulate exactly what you’re experiencing at home How are you doing I think I’m doing pretty well The cravings are definitely there, but It’s not like I feel like I’m gonna lose control and just start binging Okay Well then where would you rate your anxiety at Nothing too scary Alright then let’s keep going All right good work Bill Everything seems to be going well Can you tell me about your experience with the cravings You know I’m really genuinely surprised by this My cravings have definitely gone down It’s a really good sign that the cravings are going down Now to make this really work even better it would be good to try to do something to increase the cravings even more right now Well, I guess I’d have to say if I open the box and smell the donuts That would be really hard I mean if I did that in my apartment It would be binge time All right let’s go for it Give it a shot and let’s see what happens Okay So on a 0 to 7 scale how anxious are you right now I guess I’m gonna say about a 4 This is exactly how I would feel when I would open up the box and smell them Okay good Well let’s keep going So tell me where we’re at right now on a number scale Okay The cravings are still there but I think my anxiety has dropped maybe Maybe it’s a 2 or 3 All right so Bill I know I’m pointing out the obvious here but You haven’t binged so what do you make of that I guess I’m kind of unsure I You know I I think that if you weren’t here It would be a whole lot more difficult I know that I would never binge in front of somebody I’m glad you shared that with me Bill Now you know we want to remove any barrier from you getting the absolute maximum out of this exposure work so I’m going to step out of the room and leave you here for about the next 10 minutes to keep working on this on your own All right hang in there Sounds good All right well how did that go for you Bill Pretty well I I really wasn’t sure how I was gonna go when you walked out of the room, but I I didn’t binge so I guess I’m pretty happy about that You know we really accomplished what we wanted here today We paired one of your binge eating cues with the absence of actual binging so we did exactly what we wanted I’m anxious to see how well I can do doing this on my own

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