Although there is strong evidence that CBT is effective in a proportion of individuals (about 40% of people with bulimia nervosa), there is naturally interest in trying to find methods to help the group that fails to find any benefit. This is the group that responds poorly in the beginning phase of standard CBT-BN and does not appear to benefit from the educational and self-monitoring elements. Often individuals who respond poorly have additional co-morbidity and have experienced significant trauma in their lives. Cooper and colleagues have a different cognitive model than more standard approaches in that they include the positive impact that bingeing may have for the individual. This model is clinically useful as it opens up an investigation into the unmet needs for which food is being used as a substitute. In many cases this is a problem with emotional regulation. The metacognitive strategies described in this book can be particularly helpful for guiding individuals to develop more adaptive strategies to manage emotions. The use of imagery (starting with the tiger test) to work with emotions is illustrated. This book includes many clinical illustrations and has an appendix packed with resources and is therefore an invaluable mine of information for those in clinical practice who need a variety of tools to match the needs of their patients.