Enhanced Cognitive Behaviour Therapy
Enhanced Cognitive Behaviour Therapy (CBT-E) is a psychological treatment for eating disorders, and is a type cognitive behavioural therapy.
CBT-E is a transdiagnostic treatment, i.e., it can be used for all forms of eating disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder and other similar states. The transdiagnostic view is based on the observation that the main maintaining processes for eating disorder are likely to be largely the same across different diagnoses.[1].
Therefore, if these maintaining processes can be disrupted in one eating disorder, it should be possible to disrupt them in other eating disorders. However, the treatment is tailored to an individual’s eating disorder rather than being one-size-fits-all.
What the Treatment Involves[edit]
CBT-E is an individualised treatment, where the therapist adapts treatment to match the eating problem of the person receiving treatment. It generally involves an initial assessment appointment followed by 20 treatment sessions over 20 weeks [2].
When working with people who are significantly underweight, treatment needs to be longer, often involving around 40 sessions over 40 weeks. Weight regain is integrated with addressing other eating disorder features. The goal in CBT-E is that patients themselves decide to regain weight rather than having this decision imposed upon them.
CBT-E can be delivered in two forms: (i) a “focused” form, which exclusively addresses the eating disorder features; or (ii) a “broad” form, which also addresses one or more of the following external maintaining mechanisms: clinical perfectionism, core low self-esteem, marked interpersonal difficulties. The focused form is recommended for most patients, and should be viewed as the default version. The broad form should be reserved for patients who (i) have a pronounced form of one of the external maintaining mechanisms and (ii) where this mechanism appears to be contributing to the maintenance of the eating disorder.
Stages of the Treatment[edit]
CBT-E uses a modular approach, where some modules are used across all patients, some are used in the majority of cases, and some are used in a subgroup, if needed.
Stage One: The focus is on gaining a mutual understanding of the person’s eating problem and helping them to modify and stabilise their pattern of eating. There is also emphasis on personalised education and addressing concerns about weight.
Stage Two: In this brief stage, progress is reviewed and plans are made for the main body of treatment (Stage Three).
Stage Three: This consists of sessions focused on the processes that are maintaining the person’s eating problem. Usually, this involves addressing concerns about shape and eating; enhancing the ability to deal with day-to-day events and moods; and the addressing of extreme dietary restraint. Towards the end of this stage the emphasis shifts onto the future.
Stage Four: The emphasis fully shifts onto the future. There is a focus on dealing with setbacks and maintaining the changes that have been obtained.
Evidence for Effectiveness[edit]
CBT-E has been subject to a number of research studies [3][4][5][6][7][8][9][10]. If one focuses on studies in which CBT-E was delivered well, the evidence suggests that with patients who are not significantly underweight (the great majority of adult cases) about two-thirds of those who start treatment make a full recovery. This recovery appears to be well-maintained. Many of the remainder also improve, but not to this extent.
In 2015, NHS England and the Chief Medical Officer recommended that this treatment be made available for all patients with an eating disorder, whatever their eating disorder diagnosis and whatever their age [11][12], and in 2017 it was endorsed by the National Institute for Health and Care Excellence (NICE).
Developers of CBT-E and Training in its use[edit]
CBT-E was initially developed by Professors Christopher Fairburn, Zafra Cooper and Roz Shafran [1] at the Centre for Research on Eating Disorders at Oxford (CREDO), which is a part of the Department of Psychiatry at the University of Oxford. Professor Christopher Fairburn and colleagues have written a comprehensive practical guide to the implementation of CBT-E for therapists[2].
CBT-E was originally conceived of as an outpatient treatment for adults. However, since then, Riccardo Dalle Grave at Villa Garda Hospital has developed an intensive version for day patients and inpatients [13] and a version for younger people [14]. Riccardo Dalle Grave and Simona Calugi have produced a practical guide book for therapists to implement CBT-E with adolescents[15].
The Centre for Research on Eating Disorders at Oxford (CREDO) currently provides free online training in CBT-E for eligible therapists [16]. A wider network of colleagues, the CBT-E Training Group, offer additional regular workshops [17]
References[edit]
- ↑ Fairburn, Christopher G; Cooper, Zafra; Shafran, Roz (May 2003). "Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment". Behaviour Research and Therapy. 41 (5): 509–528. doi:10.1016/s0005-7967(02)00088-8.
- ↑ 2.0 2.1 Fairburn, Christopher G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press. ISBN 978-1593857097. Search this book on
- ↑ Fairburn, Christopher G.; Bailey-Straebler, Suzanne; Basden, Shawnee; Doll, Helen A.; Jones, Rebecca; Murphy, Rebecca; O'Connor, Marianne E.; Cooper, Zafra (July 2015). "A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders". Behaviour Research and Therapy. 70: 64–71. doi:10.1016/j.brat.2015.04.010.
- ↑ Poulsen, Stig; Lunn, Susanne; Daniel, Sarah I. F.; Folke, Sofie; Mathiesen, Birgit Bork; Katznelson, Hannah; Fairburn, Christopher G. (January 2014). "A Randomized Controlled Trial of Psychoanalytic Psychotherapy or Cognitive-Behavioral Therapy for Bulimia Nervosa". American Journal of Psychiatry. 171 (1): 109–116. doi:10.1176/appi.ajp.2013.12121511.
- ↑ Wonderlich, S. A.; Peterson, C. B.; Crosby, R. D.; Smith, T. L.; Klein, M. H.; Mitchell, J. E.; Crow, S. J. (23 May 2013). "A randomized controlled comparison of integrative cognitive-affective therapy (ICAT) and enhanced cognitive-behavioral therapy (CBT-E) for bulimia nervosa". Psychological Medicine. 44 (3): 543–553. doi:10.1017/s0033291713001098.
- ↑ Zipfel, Stephan; Wild, Beate; Groß, Gaby; Friederich, Hans-Christoph; Teufel, Martin; Schellberg, Dieter; Giel, Katrin E; de Zwaan, Martina; Dinkel, Andreas; Herpertz, Stephan; Burgmer, Markus; Löwe, Bernd; Tagay, Sefik; von Wietersheim, Jörn; Zeeck, Almut; Schade-Brittinger, Carmen; Schauenburg, Henning; Herzog, Wolfgang (January 2014). "Focal psychodynamic therapy, cognitive behaviour therapy, and optimised treatment as usual in outpatients with anorexia nervosa (ANTOP study): randomised controlled trial". The Lancet. 383 (9912): 127–137. doi:10.1016/s0140-6736(13)61746-8.
- ↑ Dalle Grave, Riccardo; Calugi, Simona; Conti, Maddalena; Doll, Helen; Fairburn, Christopher G. (2013). "Inpatient Cognitive Behaviour Therapy for Anorexia Nervosa: A Randomized Controlled Trial". Psychotherapy and Psychosomatics. 82 (6): 390–398. doi:10.1159/000350058.
- ↑ Fairburn, Christopher G.; Cooper, Zafra; Doll, Helen A.; O'Connor, Marianne E.; Palmer, Robert L.; Dalle Grave, Riccardo (January 2013). "Enhanced cognitive behaviour therapy for adults with anorexia nervosa: A UK–Italy study". Behaviour Research and Therapy. 51 (1): R2–R8. doi:10.1016/j.brat.2012.09.010.
- ↑ Byrne, Susan M.; Fursland, Anthea; Allen, Karina L.; Watson, Hunna (April 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.
- ↑ Fairburn, Christopher G.; Cooper, Zafra; Doll, Helen A.; O’Connor, Marianne E.; Bohn, Kristin; Hawker, Deborah M.; Wales, Jackie A.; Palmer, Robert L. (March 2009). "Transdiagnostic Cognitive-Behavioral Therapy for Patients With Eating Disorders: A Two-Site Trial With 60-Week Follow-Up". American Journal of Psychiatry. 166 (3): 311–319. doi:10.1176/appi.ajp.2008.08040608.
- ↑ National Collaborating Centre for Mental Health (2015). Eating Disorders: Access and Waiting Time Standard for Children and Young People with an Eating Disorder. London: NHS England. p. 25. Search this book on
- ↑ Annual Report of the Chief Medical Officer (2014). The Health of the 51%: Women. London: Department of Health. p. 11. Search this book on
- ↑ Dalle Grave, Riccardo (2013). Multistep cognitive behavioral therapy for eating disorders : theory, practice, and clinical cases. New York: Jason Aronson. ISBN 978-0765709271. Search this book on
- ↑ Dalle Grave, R. (2019). Cognitive-behavioral therapy in adolescent eating disorders. In J. Hebebrand & B. Herpertz-Dahlmann (Eds.), Eating disorders and obesity in children and adolescents (pp. 111-116). Philadelphia: Elsevier
- ↑ Dalle Grave, Riccardo; Calugi, Simona (2020). Cognitive behavior therapy for adolescents with eating disorders. New York: Guilford Press. ISBN 9781462542734. Search this book on
- ↑ "Training, Supervision and Competence". CBT-E.
- ↑ "News and Events". CBT-E.
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