CBT for binge-eating disorder

Domain II · Behavioural & cognitive · Christopher Fairburn

What it is

CBT for BED is not a separate therapy invented for BED. It is the CBT for bulimia nervosa adapted to binge eating without compensatory behaviour, and since 2008 it is usually delivered as transdiagnostic CBT-E, which targets the processes maintaining the eating problem rather than the diagnosis.…

Format

• Nine modules: Getting Ready; Starting Well; Regular Eating; Alternatives to Binge Eating; Problem Solving; Taking Stock; Dieting; Body Image; Ending Well. Appendices include a note for therapists, a note for relatives and friends, and one for readers who are also overweight. It suits anyone with a…
• Variants: a 16-week weekly version (50-minute sessions; weeks 1 to 4 introduction, 5 to 6 transition, 7 to 14 main body, 15 to 16 final stage) was used in a BED trial "adapted from Fairburn and Mitchell". The INTERBED version runs 20 sessions: initial phase (sessions 1 to 3: motivation,…

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Is there physical contact? Was it explained beforehand, and do you feel free to say no or stop at any point?
• 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?
• 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

• activity happens for its own sake.
• safety behaviours that spoil the test. Working: belief ratings drop.
• reading as avoidance of behavioural change. Working: patient links reading to their own records.
• arguing the patient out of thoughts. Working: the patient generates alternatives without prompting.
• reacting only after binges. Working: the patient problem-solves ahead and event-triggered binges drop.

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.