TL/DR:

• CBT-E is the gold-standard and first-line treatment for treating eating disorders in adults; it is also an evidence-based treatment that has consistently demonstrated good effects among adolescents as well.

• CBT-E is a highly personalized and customized intervention that focuses on addressing the specific factors that maintain a given person’s eating disorder symptoms over four distinct stages of treatment.

• CBT-E is designed to be short-term, fast-moving, and action-oriented.

• CBT-E is different than traditional CBT and requires clinicians to have specialized training in CBT-E to implement it well.

• Simply incorporating “some aspects of CBT-E” into treatment has been shown to be insufficient to ensure good outcomes. This would be similar to only taking a partial dose of your prescribed medication — at best, it’s likely to result in an weakened response and, at worst, it would be completely ineffective.

CBT-E: An Overview

CBT-E is the gold-standard evidence-based treatment for adults who suffer from eating disorders, including Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge Eating Disorder (BED), and Other Specified Feeding or Eating Disorder (OSFED). These disorders may seem very different on the surface but our best available evidence indicates that they share some core features. Recognizing this, CBT-E was designed to be transdiagnostic, meaning it can be used to efficiently treat a variety of eating disorders, because it targets the common features that cut across all eating disorders. Although the treatment was originally developed for adults, there’s a growing evidence base that indicates that CBT-E works well among adolescents as well.

Rather than focusing on what first caused your eating disorder, CBT-E is focused on understanding and disrupting the factors that are keeping you stuck in your eating disorder currently. You and your therapist work to first become experts on what’s keeping your eating disorder going by developing a personalized “formulation” of your disorder that helps to identify what to target in your treatment. Because CBT-E is designed to be tailored to your particular case, treatment should feel like it fits you like a glove.

Stages of CBT-E

CBT-E includes four stages that are implemented over the course of 20 to 40 sessions (with the longer treatment duration typically required for individuals who need to restore weight). There is an emphasis on building momentum at the start of treatment, so the standard protocol involves twice weekly sessions for 4-8 weeks to start; this then reduces to 50-minute sessions once weekly.

The focus of this initial stage is for the therapist and patient to develop a shared understanding of the patient’s eating disorder and how it’s being maintained (i.e., what’s keeping the individual stuck in eating disordered thinking and behaviors). Your therapist also helps you start to develop a regular and consistent pattern of eating, provides you with tailored psychoeducation about your symptoms, and helps you start to address concerns about weight.

Stage 1: Starting Well