An enhanced CBT Model: Eating disorder recovery within reach

Enhanced cognitive behavioral therapy (CBT-E) is CBT to treat eating disorders.

• A form of CBT called enhanced cognitive behavioral therapy (CBT-E) is an adaptation of CBT designed to treat eating disorders.

• CBT-E moves through four distinct stages of treatment over the course of 20 to 40 weeks via regular outpatient therapy sessions.

• Enhanced CBT is different from CBT. It’s important to ask providers about their training and ensure their training is in CBT-E.

Cognitive behavioral therapy (CBT) is a popular therapy modality with adaptations to treat a wide range of mental health conditions, including depression, anxiety, OCD, and more. Broadly, CBT focuses on identifying patterns of thoughts, emotions, and/or behaviors that negatively influence our lives. A form of CBT called enhanced cognitive behavioral therapy (“CBT-E”) is an adaptation of CBT designed to treat eating disorders.

An Overview of Enhanced Cognitive Behavioral Therapy

CBT-E is considered the first-line, evidence-based treatment for people with eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). Even though these conditions present different problematic behaviors, they share many of the same foundational features at their core. For example, people with AN, BN, and BED often experience extreme concern with weight and shape and/or difficulty coping with negative emotions.

These factors–“overvaluation” of shape and weight and mood intolerance–are common triggers to problematic eating behaviors like food restriction, binge eating, or purging.

While CBT-E is a manualized and structured treatment, it’s intended to fit the client “like a glove” with a focus on creating a personalized “formulation” or map of the client’s eating disorder and a customized plan for addressing their unique patterns and challenges.

The Four Stages of CBT-E

CBT-E consists of four stages. In Stage One, the emphasis is on gaining a comprehensive understanding of the factors that contribute to and sustain the individual's eating difficulties. At the outset, the therapist collaborates with the client to promote regular and consistent eating habits (which is indeed achievable). This stage also prioritizes increasing self-awareness and employing problem-solving techniques to identify why eating may occasionally become disordered. During this initial phase, which lasts about 4 to 8 weeks, it's recommended to have sessions twice a week to facilitate significant progress.

In the brief second stage, the therapist and client assess the progress made and develop a plan for Stage Three. Stage Three focuses on weekly sessions that delve into the ongoing factors perpetuating the eating struggles. This stage thoroughly addresses concerns related to weight and body shape, as well as issues surrounding dieting and excessive control over food. The therapist also assists the client in managing triggers related to events and emotions that may lead to disordered eating.

As Stage Three concludes and transitions into Stage Four, the focus shifts towards the future, specifically on strategies to minimize the risk of setbacks or relapse in the months and years to come. CBT-E is designed to be adaptable, ensuring it “fits like a glove” for each individual. While it follows a structured protocol with specific strategies, the approach is tailored to the unique needs of the client, emphasizing a deep understanding of their personal patterns and triggers.

Next steps for eating disorder recovery

If you’re interested in CBT-E, it’s crucial to seek out providers who adhere closely to its principles. Inconsistent application of CBT-E strategies can diminish the effectiveness of the treatment. Once you identify a provider who specializes in CBT-E, you can schedule an assessment to determine if it’s the right fit for you.

For those in the New York area, Columbus Park is one of the few places offering authentic CBT-E treatment. Our clinicians are intensively trained in the model, and we frequently utilize this approach due to its effectiveness and efficiency, making it suitable even for those with busy schedules.

Don’t hesitate to reach out to see if CBT-E could be the right option for you.

Read the rest of this post on Psychology Today under Essential Reads about Eating Disorders.