Return to "Enhanced" cognitive behaviour therapy (CBT-E)

What is CBT-E?

What is CBT-E?

CBT-E is the abbreviation for “enhanced cognitive therapy”, and it refers to a “transdiagnostic” personalised psychological treatment for eating disorders. It was developed as an outpatient treatment for adults but is an intensive version for day patient and inpatient settings (Dalle Grave, 2012), and a version for younger people. A detailed treatment guide is available (Fairburn, 2008).

With people who are not significantly underweight, CBT-E generally involves an initial assessment appointment followed by twenty 50-minute treatment sessions over 20 weeks. With people who are underweight treatment needs to be longer, often involving about 40 sessions over 40 weeks.

CBT-E is a highly individualised treatment. It is designed to fit the person's difficulties like a glove and be modified in light of his or her progress.

CBT-E has four stages (see CBT-E map). In Stage One, the focus is on gaining a mutual understanding of the person's eating problem and helping him or her modify and stabilise their pattern of eating. There is also emphasis on personalised education and the addressing of concerns about weight. It is best if these initial sessions are twice-weekly.

In the brief second stage progress is systematically reviewed and plans are made for the main body of treatment, Stage Three.

Stage Three consists of a run of weekly sessions focused on the processes that are maintaining the person's eating problem. Usually this involves addressing concerns about shape and eating; enhancing the ability to deal with day-to-day events and moods; and the addressing of extreme dietary restraint.

Towards the end of Stage Three and in Stage Four the emphasis shifts onto the future. There is a focus on dealing with setbacks and maintaining the changes that have been obtained.

Generally a review session is held some months after treatment has ended. It provides an opportunity for a review of progress and the addressing of any problems that remain or have emerged.

Further Reading

Dalle Grave R. Intensive Cognitive Behaviour Therapy for Eating Disorders. Haupauge, NY, Nova, 2012.

Dalle Grave R.  Multistep Cognitive Behavioural Therapy for Eating Disorders. Jason Aronson, Maryland, 2013.

Fairburn, C. G. Cognitive Behavior Therapy and Eating Disorders. New York: Guilford Press, 2008.

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.