What is enhanced cognitive-behavioral therapy?

Enhanced cognitive-behavioral therapy (CBT-E) is a time-limited,  individualized therapy that is designed to target the mechanisms that maintain eating disorders across individuals of all ages. CBT-E is a transdiagnostic treatment, meaning that it is suitable for treating a variety of eating disorder symptoms associated with binge eating disorder (BED), anorexia nervosa (AN), bulimia nervosa (BN), and other specified feeding and eating disorders (OSFED). CBT-E is delivered through ~20 sessions over the course of 20 weeks, and can be modified to a 40 session schedule for individuals who are underweight and/or struggle with comorbid perfectionism. 

The goal of CBT-E is to assist individuals with  eating disorders in developing awareness as to how their eating disorder functions, how it is maintained, and how to disrupt the reinforcement cycle that sustains symptoms. As such, CBT-E focuses on identifying and breaking down an individual's dysfunctional self-evaluative system that attributes self-worth almost entirely to weight and shape. Treatment is highly collaborative and regularly consists of psychoeducation, self-monitoring records, homework, implementation of techniques, cognitive restructuring, and problem-solving skills.

Individuals who benefit from CBT-E treatment may present with the following:

• Judging self-worth based on body shape

• Preoccupation with thoughts about shape/weight and food/eating

• Body weight and shape checking

• Body avoidance

• Labeling mood states in relation to food intake (e.g. “feeling fat)

• Rigid rules and checking around eating

• Shame and guilt related to shape/weight and food/eating