Enhanced CBT for eating disorders

Domain II · Behavioural & cognitive · Christopher Fairburn · 2008 · Oxford

What it is

Enhanced cognitive behaviour therapy (CBT-E) is a transdiagnostic, individualised psychological treatment for eating disorders. It covers anorexia nervosa, bulimia nervosa, binge eating disorder and other eating disorders. It was developed at the Centre for Research on Eating Disorders at Oxford…

Format

• Format. Individual outpatient sessions of about 50 minutes, preceded by assessment. CBT-E for adults was designed for outpatients. There are intensive day-patient and inpatient versions (Dalle Grave 2012) and a version for younger people.
• Not significantly underweight (adult BMI roughly 18.5 to 39.9): 20 sessions over 20 weeks.

Who practises it, and how they are trained or regulated

• Measures: the Eating Disorder Examination interview and the EDE-Q, plus the Clinical Impairment Assessment (CIA). These are licensed instruments reproduced in the manual's appendices; do not copy items.

Evidence status, as the guide reports it

• Goals: a systematic review of progress (re-administering the EDE-Q and CIA is the usual way to do this). Identify barriers to change and revise the formulation. Decide between focused and broad CBT-E. Design Stage Three.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the exercise turning into more checking. Keep it brief and structured.
• self-harm. Assess risk using standard practice and act on it (see Section 5).
• physical symptoms (dizziness, palpitations, fainting). Refer for urgent medical review.
• fewer, briefer episodes. It is working when the patient can name the underlying state themselves.
• sessions drifting into extended exploration of the past. Keep it brief and linked to the present.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.