CBT for ARFID

Domain II · Behavioural & cognitive · Jennifer J. Thomas, Kamryn T. Eddy · 2019 · Massachusetts General Hospital

What it is

CBT-AR (cognitive-behavioral therapy for avoidant/restrictive food intake disorder) is a flexible, modular outpatient CBT for ARFID in patients aged about 10 and older. It runs about 20–30 sessions over four stages and comes in a family-supported format and an individual format.

Format

• Formats
• Individual CBT-AR: older adolescents (16+) and adults who are not underweight.

Who practises it, and how they are trained or regulated

• A training-course listing for health educators mentions "three stages". Every Thomas/Eddy source, including the manual's table of contents, describes four. Four is followed here.
• Version followed: CBT-AR as published by Jennifer J. Thomas and Kamryn T. Eddy (Massachusetts General Hospital), Thomas & Eddy (2019) Cambridge manual, reconstructed from the authors' CBT-AR Patient and Family Workbook (version dated 12.4.18), MGH training slides (Eddy 2021; Thomas, IAEDP 2021) and the MGH Academy course outline. The manual itself is not drawn on. The full texts of the open trials (Thomas et al.,…

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

• pressure or bribing, or giving up and serving only safe foods.
• weights that can't be verified; coordinate with the physician.
• discounting progress because the patient still dislikes some foods.
• a formulation that stays generic. Revise it as new information emerges.
• too-large first steps. Choose changes the patient rates as mildly uncomfortable.

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.