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The transdiagnostic view on the eating disorders and their treatment

CREDO has had a longstanding interest in transdiagnostic treatment. Over 10 years ago we put forward a transdiagnostic view on the processes that maintain eating disorder psychopathology (Fairburn, Cooper and Shafran, 2003). We argued that the main maintaining processes are likely to be largely the same across the eating disorders and that therefore if they can be disrupted in one eating disorder it should be possible to disrupt them in the other eating disorders. Hence we reconceptualised the existing evidence-based form of CBT for bulimia nervosa as a treatment for the eating disorder features seen in bulimia nervosa rather than a treatment for bulimia nervosa per se, and we adapted it to make it suitable for all forms of eating disorder. The result was the development of a new transdiagnostic cognitive behavioural treatment, so-called  ''enhanced CBT'' (CBT-E). This treatment, and the theory upon which it is based, has been the primary focus of CREDO's research on eating disorders over the past 15 years.

The transdiagnostic treatments for eating disorders (CBT-E)

Enhanced CBT (CBT-E) is a treatment of eating disorder psychopathology, irrespective of the eating disorder diagnosis.  We have conducted two randomised controlled evaluations of CBT-E in patients who were not markedly underweight (body mass index over 17.5).  The first involved a two-site comparison (Oxfordshire and Leicestershire) of its “focused” and “broad” versions with a waiting list control condition (Fairburn et al, 2009).  The second was a direct comparison of CBT-E with interpersonal psychotherapy (IPT) (Fairburn et al, 2015).  In both studies it was found that two-thirds of those who started treatment made a full response to 20 sessions of focused CBT-E, whatever their eating disorder diagnosis, and this was well maintained over the following year.  This was despite an average duration of eating disorder of about nine years. 

We have investigated the use of CBT-E to treat more underweight patients (i.e., those with anorexia nervosa).  The response rate appears to be somewhat lower and fewer patients are able to complete treatment (Fairburn et al, 2013).

We have also been collaborating with Dr Ricardo Dalle Grave and colleagues in Verona on the use of CBT-E with younger patients and in day patient and inpatient settings.

Other studies of CBT-E have taken place in UK, Australia, Denmark, Italy and the USA.

The main focus of our current work is on the development of an online version of CBT-E (termed “CBTe”).  This will be directly accessed via search engines and be capable of being used without the involvement of a clinician or therapist.  Click here for further information on CBTe.

Further Reading about CBT-E

Fairburn, C. G., Cooper, Z., & Shafran, R. Cognitive behaviour therapy for eating disorders: A "transdiagnostic" theory and treatment. Behaviour Research and Therapy, 2003, 41, 509-528.

Fairburn CG, Cooper Z, Doll HA, O’Connor ME, Bohn K, Hawker DM, Wales JA, Palmer RL. Transdiagnostic cognitive behavioral therapy for patients with eating disorders: A two-site trial with 60-week follow-up.  American Journal of Psychiatry 2009; 166: 311-319. 

Fairburn CG, Cooper Z, Doll HA, O'Connor ME, Palmer RL, Dalle Grave R.  Enhanced cognitive behaviour therapy for adults with anorexia nervosa: A UK-Italy study.  Behaviour Research and Therapy 2013; 51: 2-8. 

Fairburn CG, Wilson GT. The dissemination and implementation of psychological treatments: Problems and solutions. International Journal of Eating Disorders 2013, 46: 516-521.

Fairburn CG, Bailey-Straebler S, Basden S, Doll HA , Jones, R, Murphy R, O'Connor ME, Cooper Z. A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders.  Behaviour Research and Therapy, 2015; 70: 64-71.