By Jana Keith-Jennings, LMSW
Eating disorders are officially classified as psychiatric disorders, but the behaviors can lead to catastrophic physical problems and can be fatal. Given the prevalence and risk of eating disorders, there’s been increased focus on establishing effective treatments. There are a range of choices in treatment, both in terms of therapeutic interventions and physical settings for care.
Treatment settings are generally organized into levels of care that correspond to the level of medical and/or psychiatric severity of the eating disorder. Levels of care from most intensive to least are inpatient, residential, partial hospitalization, intensive outpatient, and outpatient, all of which vary in length of treatment as well from days to weeks to months.
All eating disorders are treated with some form of psychotherapy.
According to NEDA, the most common types of psychotherapy used to treat eating disorders are Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), Enhanced Cognitive Behavioral Therapy (CBT-E), Cognitive Remediation Therapy (CRT), Dialectical Behavioral Therapy (DBT), Family-Based Treatment (FBT), Interpersonal Psychotherapy (IPT), and Psychodynamic Psychotherapy.
Though all of these modalities (and more) may be used to treat eating disorders, not all of them were designed specifically for eating disorders, nor have they all been shown to be consistently effective as interventions for EDs. Therefore, it is generally recommended to prioritize evidence-based treatments as the initial course for most eating disorders.
Enhanced Cognitive Behavioral Therapy, referred to as CBT-E, is the leading evidence-based treatment for adults with almost any form of disordered eating, including anorexia, bulimia, and binge eating disorder.
CBT-E was originally developed by Professor Christopher Fairburn as a treatment for bulimia nervosa, and then expanded to also treat binge eating disorder. In the early 2000s, it was modified further as a “transdiagnostic model” and appropriate for anorexia nervosa as well.
Fairburn’s transdiagnostic model takes the view that all eating disorders operate in a similar way, with the same factors – or psychopathology – at their core. Fairburn reinforces that the different eating disorders share a preoccupation and over-valuation (or extreme importance) of weight, shape, and/or their control. The transdiagnostic approach maintains that if maintaining processes can be disrupted in one eating disorder, it should be possible to disrupt them in other eating disorders.
CBT-E takes the form of a time-limited, structured, one-to-one talk therapy that focuses on the factors that keep people stuck in their eating disorders.
These factors include things like body preoccupation, irregular eating, dieting, and more. The CBT-E model is designed to be customizable and applicable to individual needs while still targeting the common core issues and challenges to recovery across EDs.
CBT-E has been tested and used in treatment in studies from the UK, Australia, Denmark, Italy, and the USA. Response rates differ across studies, due to differences in patient samples as well as the quality of treatment administered. Even so, the studies in which CBT-E was delivered well by clinicians fully trained in CBT-E showed that patients who are not significantly underweight (about two-thirds) make a full recovery that is well-maintained over time. The remainder of patients also show improvement, but not to this same extent. The response and completion rate are found to be lower in patients who are significantly underweight.
Research findings* may be summarized as follows:
- CBT-E has been shown to be suitable for all forms of EDs in adults (not true of any other treatment).
- CBT-E has been shown to be effective in the treatment of younger patients and may be a suitable course for teens as well.
- CBT-E may be used in inpatient and day-patient settings.
- In comparison to Interpersonal Psychotherapy in adults, CBT-E was found to be more potent.
- CBT-E has been found to be more effective than 100 sessions of psychoanalytic psychotherapy delivered over two years.
*summarized from https://www.cbte.co/what-is-cbte/current-status-cbte/
Given its potency as a treatment for disordered eating, CBT-E should be prioritized as the first line for individuals embarking on treatment. To get the best results, it’s important to work with a therapist who is well trained in CBT-E and offers the treatment with fidelity to the model. Here is a helpful blog about how to find a CBT-E provider.
Columbus Park is committed to expert delivery of evidence-based treatment for eating disorders. We offer CBT-E as our first line to patients who we believe will benefit. For those who don’t meet the criteria for CBT-E, we offer potent second-line treatments. For information about whether our setting might be right for you or someone you love, please arrange a complimentary call with one of our team members.