CBT-E Explained: How Enhanced Cognitive Behavioral Therapy Treats Eating Disorders

What Is CBT-E? A Guide to Enhanced Cognitive Behavioral Therapy

Enhanced Cognitive Behavioral Therapy-E (CBT-E) is a transdiagnostic treatment created to improve outcomes for those suffering from eating disorders; it is based on the transdiagnostic theory of eating disorders by Christopher Fairburn, Zafra Cooper, and Roz Shafran (2003). This leading evidence-based treatment for eating disorders has seen remarkable success, with two-thirds of patients showing significant, long-term improvements (Byrne et al., 2011; Fairburn, 2008; https://www.cbte.co/what-is-cbte/current-status-cbte/).

CBT-E is a type of Cognitive Behavioral Therapy that centers on recognizing, disrupting, and altering the maintaining factors of eating disorders. It is a brief and structured treatment that incorporates cognitive and behavioral techniques and strategies. Additionally, CBT-E stresses the importance of a productive, collaborative relationship between patient and therapist. Like most evidence-based CBT therapies, it employs self-monitoring records, psychoeducation, implementation of techniques, cognitive restructuring, and problem-solving skills. CBT-E primarily focuses on understanding the maintaining factors of the eating disorder. Using the information gathered from the monitoring records and in sessions the patient and therapist work collaboratively to craft a formulation of patient’s disorder, which serves as a road map for therapy. Formulations are often changed over the course of treatment to accommodate the shifting presentation of the patient and the symptoms they’re experiencing.

CBT-E consists of an initial assessment session, followed by about 20 weeks of individual therapy sessions. In certain cases, the forty-session version may be needed (e.g. underweight or diagnosed with anorexia nervosa), but this is only applicable to less than twenty percent of adult outpatients (Fairburn, 2008). Please note the ranges provided are for ideal circumstances and the length of treatment differs based on the patient’s situation, diagnosis and specific needs.

How Can CBT-E Help with Eating Disorders?

CBT-E is a suitable option for those suffering from any type of eating disorder, including binge eating disorder, anorexia nervosa, and bulimia nervosa. Patients who are underweight or have been diagnosed with anorexia nervosa likely require the longer, more intensive version of CBT-E. With this form of CBT, those suffering from eating disorders can gain insight into how their disorder functions, how it is sustained, and how to interrupt the cycle of reinforcement that maintains it (Fairburn, 2008). Additionally, patients gain education about their eating disorder and their health, helping to combat the false beliefs, problematic behaviors and damaging patterns that exacerbate their eating disorder (Fairburn, 2008; Fairburn, 2013). The ultimate goal of treatment is to develop the tools and skills to manage your eating disorder long-term and live a balanced and healthful life.