Enhanced Cognitive Behavioral Therapy (CBT-E) for Adolescents
The guidelines set forth by the National Institute for Health and Clinical Excellence (NICE), inform that Enhanced Cognitive Behavioral Therapy (CBT-E) is the most appropriate alternative to Family Based Treatment (FBT) (typically considered the gold standard) for young people with anorexia nervosa or bulimia nervosa. For adolescents with binge eating disorder, CBT-E is recommended as the first line.
At Columbus Park, we regularly use CBT-E with our younger patients when FBT is not indicated. Typically, this means that CBT-E is the treatment of choice for:
most young patients with binge eating disorder
adolescents with bulimia who are highly motivated to recover
adolescents in early stages of anorexia nervosa who show high motivation and capacity to engage in treatment and recover
older teens who anticipate moving away from home (i.e. seniors planning for college) in the near future
Evidence-Based Treatment
There have been numerous encouraging studies on the efficacy of CBT-E in teens with anorexia nervosa (Calugi, Dalle Grave, Sartirana, & Fairburn, 2015; Dalle Grave, Calugi, Doll, & Fairburn, 2013) and in eating disorders that do not involve weight suppression (Dalle Grave, Calugi, Sartirana, & Fairburn, 2015), such as binge eating disorder.
CBT-E for adolescents is a well-considered, flexible and personalized treatment (Dalle Grave & Calugi, 2020) that addresses eating-disorder psychopathology. CBT-E is highly collaborative and focused on building motivation and fully engaging the patient in the process of recovery. Patients drive the treatment, including the decision to engage in a more regular eating schedule, address body concerns, and restore weight if necessary.
CBT-E in three steps
The first step is about systematically targeting the factors that keep the individual locked into their eating struggle. With a clear understanding of the processes that drive disordered eating, the patient is able to begin disrupting some of these processes with the guidance and support of both their therapist and parents. Regular eating and self-monitoring to increase awareness are key features of this first step of treatment.
The second step is focusing on concerns with weight and shape because preoccupation with weight, shape, and food control are viewed as central to the eating disorder. As this focus is addressed, manifestations like binge eating, purging, driven exercise, and dietary restraint are targeted and extinguished.
The third step in CBT-E is about finishing well with a clear plan and targeted skills for preventing relapse.
Parents as a powerful resource
When an adolescent undergoes treatment for an eating disorder, responsible treatment will almost always involve parents or caregivers.
At the very start of treatment, parents will meet with a Columbus Park provider to share observations, concerns, and more general history in relation to their child. A follow-up meeting involves direct contact between the patient and provider, followed by parents joining in for a collective discussion. Parents and the patient will be given important information about the condition and the recommended treatment course.
When CBT-E is the treatment recommendation, parents are engaged periodically throughout the course. They will be asked to join sessions on occasion and may be given some feedback around ways they can support their child’s progress at home.
