CBT‑E (Enhanced Cognitive Behavioural Therapy) is a transdiagnostic, evidence‑based psychological treatment for eating disorders. It was adapted from CBT for bulimia to treat the core maintaining processes that are common across eating‑disorder presentations. CBT-E is suited to individuals with clinically significant eating-disorder psychopathology who can be safely managed as outpatients and are able to engage in a timelimited, fairly intensive programme.
The main mechanisms targeted in CBT-E include:
- Overvaluation of shape and weight: Addressing the excessive importance placed on body image and weight in self-evaluation, which contributes to distorted body perceptions and preoccupation.
- Control over eating behaviours: Targeting patterns such as restrictive eating, binge eating, and purging that serve as coping strategies for emotional distress.
- Dietary restraint: Challenging chronic dieting and strict food rules that maintain disordered eating patterns.
- Event- and mood-related eating changes: Recognising and managing emotional triggers and social situations that lead to emotional eating, binge eating, or food avoidance.
- Body checking and avoidance behaviours: Reducing behaviours like frequent body checking, mirror avoidance, or excessive exercise that reinforce body image anxiety.
- Perfectionism: Addressing high standards and self-criticism that contribute to rigid eating and exercise behaviours.
- Low self-esteem: Working on negative self-perceptions linked to body dissatisfaction and eating behaviours.
- Interpersonal difficulties: Improving communication, assertiveness, and conflict resolution skills that impact emotional wellbeing and eating patterns.
By targeting these mechanisms, CBT-E aims to disrupt maladaptive cycles, promote healthier coping strategies, and support a balanced, positive relationship with food, body, and self-esteem.
What would a multi-disciplinary approach involve when treating an eating disorder?
A multi-disciplinary approach to treating an eating disorder involves coordinated care from various health professionals to address the complex physical, psychological, and behavioural aspects of the condition. This holistic, collaborative model recognises eating disorders as multifaceted conditions requiring comprehensive care to optimize recovery outcomes.
Key elements include:
- Medical Monitoring: Regular medical assessments to monitor physical health, manage complications such as electrolyte imbalances or nutritional deficiencies, and ensure client safety, including weight and BMI tracking.
- Psychological therapy: Evidence-based psychological treatments like Cognitive Behavioural Therapy for Eating Disorders (CBT-E), which target the core mechanisms maintaining the disorder, address distorted thoughts about body image and eating, and provide relapse prevention strategies.
- Nutritional Support: Involvement of dietitians to develop and supervise healthy eating plans, reinforce accurate nutritional information, and assist with food monitoring and meal planning.
- Allied health interventions: Exercise physiologists may be involved to promote healthy physical activity and coping behaviours, tailored to the individual’s needs.
What treatment outcomes can you expect for someone who has completed CBT-E?
For someone who has completed CBT-E (Enhanced Cognitive-Behavioural Therapy) for an eating disorder, the expected treatment outcomes include:
- Establishment of more regular eating patterns and reduction in disordered eating behaviours such as binge eating, purging, and excessive dietary restraint.
- Improved awareness and understanding of the cognitive and emotional mechanisms that maintain the eating disorder, such as distorted thoughts about weight, shape, and food.
- Development of healthier coping strategies to manage emotional triggers, perfectionism, low self-esteem, and interpersonal difficulties that contribute to the disorder.
- Reduction in overvaluation of body shape and weight, leading to less preoccupation and distress related to body image.
- Greater ability to manage setbacks and relapse triggers through personalised relapse prevention planning.
- While complete elimination of all disordered behaviours may not be immediate, significant improvements in eating habits, psychological wellbeing, and functioning are anticipated.
- Long-term maintenance of gains with periodic review, typically including a follow-up appointment around 20 weeks after treatment completion.
It is also important to note that treatment success depends on many factors such as the individual’s physical health stability, comorbid conditions being addressed (e.g., depression, substance misuse), and consistent engagement with therapy sessions. Overall, CBT-E aims to promote recovery and a more balanced relationship with food and body image.
If you or someone you know could benefit from CBT-E, contact ORS today.
