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Enhanced Cognitive Behavioral Therapy (CBT-E)

Cognitive behavior therapy (CBT) is a short-term, evidence-based therapy oriented to treating symptoms (a transdiagnostic treatment) by focusing on beliefs, values and cognitive processes that maintain the disordered behavior. Averaging between 15 and 20 sessions, treatment length depends on severity of symptoms.

Enhanced CBT (CBT-E) aims for clients to decide to normalize their eating and/or gain weight, rather than having this decision imposed on them. Treatment usually lasts 20 weeks, though for underweight clients it may need to take as long as 40 weeks. 

CBT-E is often used in treating anorexia nervosa

    • Establishes a positive environment to incentivize weight gain, decrease disordered thinking and provide access to pleasurable activities that reward weight gain. As the person gains weight, the family can help him/her return to a normal social life and practice behaviors that aid the process.
    • Research shows 3/4 of those with anorexia treated with CBT-E gain a reasonable amount of weight and return to reasonably normal activities. 
    • CBT-E doesn’t necessarily work for everyone—some may relapse and need to be (re)hospitalized.

CBT-E is also helpful in overcoming bulimia nervosa. 

Treatment consists of careful recordkeeping to track behavior change:

    • Eating three or more balanced meals each day
    • Delaying and then stopping purging
    • Looking at and changing false beliefs about food, dieting and body shape
    • Learning there’s more than body shape to developing a good self-image

By the end of treatment, most people have increased self-control of binge eating and purging, with 2/3 of those treated able to return to normal eating patterns. There’s usually no or little weight gain after treatment ends.

CBT-E’s four stages: 

Gaining mutual understanding of the eating problem, addressing concerns about weight and helping to modify and stabilize eating patterns. Clients and therapists consider reasons for and against change.

Reviewing progress and revising plans for treatment.

Focusing on processes that maintain eating problems: addressing concerns about shape and eating, the ability to deal with day-to-day events and moods and extreme dietary restraints. 

Shifting emphasis to the future, dealing with setbacks and maintaining positive change. Underweight clients become accomplished at maintaining weight. A final session months after treatment provides an opportunity to review progress and address remaining or new problems.


Learn more about Evidence-Based Treatments for Eating Disorders offered at CFI…



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