Tackling avoided foods, one step at a time
Build an ordered set of steps towards avoided foods with your treating team. Compare your predictions with what happens and what you learn.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Tackling avoided foods, one step at a time
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Agree the ladder with your treating team
Keep regular eating and medical care in place. Order steps from more manageable to harder. Repeat or revise together; calm is not required for learning.
Step 1
Step 2
Step 3
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When to use ‘Tackling avoided foods, one step at a time’
‘Tackling avoided foods, one step at a time’ is an interactive cognitive behavioural therapy (CBT) worksheet, most often used in CBT for eating disorders.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist introduces it, works through it collaboratively, and helps make sense of what it surfaces. You can preview the full worksheet above, then assign it digitally for clients to complete between sessions on any device or download it as a print-ready PDF.
How it works
Most people work through it in around 20 minutes. It moves through four short steps:
- Agree the ladder with your treating team: Keep regular eating and medical care in place. Order steps from more manageable to harder. Repeat or revise together; calm is not required…
- Step 1
- Step 2
- Step 3
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, ‘Tackling avoided foods, one step at a time’ works by gradually and safely facing avoided situations so anxiety can subside (exposure). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This worksheet is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Fairburn, C. G. (2008). Cognitive Behavior Therapy and Eating Disorders. Guilford Press.
- National Institute for Health and Care Excellence (2017). Eating disorders: recognition and treatment. NICE guideline NG69.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
More Eating Disorders worksheets
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A formulation based on Fairburn's enhanced cognitive-behavioural model — mapping over-evaluation of eating, shape, and weight alongside maintaining mechanisms.
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Record what you eat and drink as you go, where you were and how you felt. Tick eating that felt out of control, being sick or using laxatives, skipped meals and exercise. Based on the real-time monitoring record in Fairburn (2008): adds ticks for skipped meals and exercise, and a daily reflection.
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Plan and track a pattern of regular eating, with three meals and two to three snacks, to build a predictable structure that makes binge urges less likely. Simplified from Fairburn (2008): planned and actual eating times, binges and context, without the vomiting and laxative column, and with an added flexibility rating.
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Self-evaluation pie chart
Examine what determines your self-worth, and how much of it is dominated by eating, shape, weight and controlling them, compared with other areas of life. Based on Fairburn (2008): a pie of what your self-worth rests on, with a preferred pie and a first step added; the discussion of the problems this causes is left out.
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Body checking and avoidance diary
Log body checking and body avoidance behaviours, what set them off, what you hoped they would do, what you concluded, and your mood afterwards, to spot patterns. Based on Fairburn (2008): recording body checking as it happens; avoidance, the trigger, its purpose, thoughts and mood columns are added.
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Dietary rule testing worksheet
Pick a strict eating rule, say what you think will happen if you break it, test it, and see what you learn. Based on Fairburn (2008): breaking a dietary rule as a planned experiment; belief ratings, a plan for urges to make up for it, a flexible guideline and next steps are added.
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