Cognitive Behavioural Therapy for Eating Disorders

What is Cognitive Behavioural Therapy for Eating Disorders?

Cognitive Behavioural Therapy (CBT), as the name suggests, combines both cognitive therapy and behaviour therapy. It is a treatment modality used to treat many different psychological illnesses such as mood and anxiety disorders. CBT has been adapted for the treatment of eating disorders. The use of CBT for the treatment of adolescents and adults with Bulimia Nervosa and Binge Eating Disorder is supported by clinical evidence and best practice guidelines (Brownley et al, 2007; Byrne et al, 2011; Byrne et al, 2017; Hay, 2013; Hay et al, 2009; Hay et al, 2014; National Collaborating Centre for Mental Health, 2004).

CBT is a structured and time-limited treatment. CBT consists of 20 sessions over 20 weeks, however treatment length will be modified by an experienced CBT practitioner to match the individual’s illness presentation and needs. CBT focuses on skill acquisition and reducing illness behaviours. It involves understanding the individual and their eating disorder, setting up a formulation to inform treatment, addressing the factors that maintain the eating disorder (addressing body image, dietary restraint, events, and mood), maintaining changes, and managing setbacks.

The strategy underpinning CBT is to construct a formulation of the processes that are maintaining the person’s psychopathology and use this to identify the features that need to be targeted in treatment.

Cognitive Behavioural Therapy Enhanced (CBT-E)

CBT-E is an outpatient treatment for adults with eating disorders and is a transdiagnostic treatment (treating all eating disorders). CBT-E was developed by Christopher Fairburn and his colleagues at the Centre for Research on Eating Disorders Oxford. It is a manualised treatment model that has been developed into a treatment guide:

Cognitive Behaviour Therapy and Eating Disorders by Christopher Fairburn. Guilford Publications 2008.

Evidence supporting CBT-E over and above CBT is still emerging. There is some evidence to suggest this version of CBT may lead to positive results for people with Anorexia Nervosa (NICE, 2017).Although CBT-E performs equally to Specialist Supportive Clinical Management (SSCM) and Maudsley Model of AN Treatment for Adults (MANTRA), it has been shown to increase weight more quickly (Shapiro, 2007).

Cognitive Behavioural Therapy training

InsideOut has a range of eLearning programs for health professionals, including ‘Cognitive Behavioural Therapy: The Basics’. Check out our eLearning page for more information.

Brownley, K. A., Berkman, N. D., Sedway, J. A., Lohr, K. N., & Bulik, C. M. (2007). Binge Eating Disorder Treatment: A Systematic Review of Randomized Controlled Trials. International Journal of Eating Disorders, 40(4), 337-348. doi: 10.1002/eat.20370

Byrne, S. M., Fursland, A., Allen, K. L., & Watson, H. (2011). The Effectiveness of Enhanced Cognitive Behavioural Therapy for Eating Disorders: An Open Trial. Behaviour Research and Therapy, 49(4), 219-226. doi: 10.1016/j.brat.2011.01.006

Byrne, S., Wade, T., Hay, P., Touyz, S., Fairburn, C. G., Treasure, J., Schmidt, U., McIntosh, V., Allen, K., Fursland, A., & Crosby, R. D. (2017). A Randomised Controlled Trial of Three Psychological Treatments for Anorexia Nervosa. Psychological Medicine, 1-11. doi: 10.1017/S0033291717001349

Hay, P. (2013). A Systematic Review of Evidence for Psychological Treatments in Eating Disorders: 2005–2012. International Journal of Eating Disorders, 46(5), 462-469. doi: 10.1002/eat.22103

Hay, P. P., Bacaltchuk, J., Stefano, S., & Kashyap, P. (2009). Psychological Treatments for Bulimia Nervosa and Binging. The Cochrane Library, 4(1), 1-94. doi: 10.1002/14651858.CD000562.pub3

Hay, P., Chinn, D., Forbes, D., Madden, S., Newton, R., Sugenor, L., Ward, W., & Royal Australian and New Zealand College of Psychiatrists. (2014). Royal Australian and New Zealand College of Psychiatrists Clinical Practice Guidelines for the Treatment of Eating Disorders. Australian & New Zealand Journal of Psychiatry, 48(11), 977- 1008. doi: 10.1177/0004867414555814

National Collaborating Centre for Mental Health. (2004). Eating Disorders: Core interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. British Psychological Society (UK).

National Institute for Health and Care Excellence (NICE). (2017). Eating Disorders: Recognition and Treatment. NICE Guideline.

Shapiro, J. R., Berkman, N. D., Brownley, K. A., Sedway, J. A., Lohr, K. N., & Bulik, C. M. (2007). Bulimia Nervosa Treatment: A Systematic Review of Randomized Controlled Trials. International Journal of Eating Disorders, 40(4), 321-336. doi: 10.1002/eat.20372