Enhanced Cognitive Behavioral Therapy (CBT-E)

Do you know someone who suffers from an eating disorder? This condition has increased significantly in recent years. However, there are highly effective therapeutic approaches, such as CBT-E.
Enhanced Cognitive Behavioral Therapy (CBT-E)

Written by Valeria Sabater

Last update: 15 November, 2022

We’ll start this article with a question: what do you think is the psychological disorder that causes the most deaths per year? The first answers that come to your mind might be depression or schizophrenia. However, statistical data claims that eating disorders (ED) are the mental conditions with the highest mortality rate.

Obviously, this is a serious issue. Even more so, when we consider that, as a result of the pandemic the number of admissions for this problem increased by 20 percent. Furthermore, many of the cases that were already diagnosed greatly intensified. As if that isn’t enough, figures are increasingly rising among preadolescents. In fact, according to the WHO, it’s one of the worst-served areas in mental health. Therefore, we’re facing a real health emergency and undoubtedly require more means and professionals to deal with this reality.

There are some highly effective strategies and means to care for those dealing with anorexia nervosa, bulimia, binge eating disorder, etc. One such therapy is enhanced cognitive behavioral therapy (CBT-E). It’s considered to be one of the most effective approaches for treating eating disorders.

Our society instils the kinds of ideas in young people that suggest their bodies are wrong. Thus, they reject their own images. This leads them toward self-injurious behaviors and poor relationships with food.

Woman in need of enhanced cognitive behavioral therapy
We’re beginning to see eating disorders in children between eight and nine years old

The goal of enhanced cognitive behavioral therapy

Children don’t come into the world hating their bodies. There’s a whole social architecture that orchestrates the progressive rejection of their images. Indeed, in today’s society, which differentiates between ‘normative’ and ‘non-normative bodies’, it’s really easy for them to fall into this trap. Because society claims that thinness is beautiful. It tells us that if we weighed a little less we’d be happier, more successful, and have thousands more ‘likes’ on social media.

This pernicious narrative installed in social media, cinema, and advertising makes our young people undermine their self-esteem. In their attempts to achieve ideal bodies, they discard their real ones and commence on journeys of harmful behaviors. These can range from measuring every calorie they eat to consuming laxatives, inducing vomiting, engaging in self-harm and binge eating, as well as developing highly perfectionistic personalities. In fact, the level of self-destruction is immense.

Enhanced cognitive behavioral therapy CBT-E is an individualized treatment for people with eating disorders (EDs). CBT-E is, right now, the most effective and best-structured resource to care for any sufferer of an eating disorder. In support of this statement, a study conducted by several universities indicated that better results are obtained with CBT-E than with the more classic cognitive-behavioral therapy.

History and proposed goals

Enhanced cognitive behavioral therapy (CBT-E) is a transdiagnostic psychological treatment. This means it works for all types of eating behavior disorders. In 2008, Dr. Christopher Fairburn published a complete guide to the practice of CBT-E.

Initially, a strategy was developed solely for adults who were hospitalized. Due to the fact that the results were highly positive, a further step was taken. A guide was developed for outpatients (not hospitalized) and for the child and adolescent population.

The goal of this treatment is to address the core symptoms of the eating disorder. For instance, distorted thoughts about body schema, weight, or perfectionism. Gradually, the sufferer is guided toward healthier behaviors

Enhanced cognitive behavioral therapy isn’t a ‘one size fits all’ treatment. In fact, the therapist designs a unique approach for each individual, based on their eating problem, and any other psychological problems that may be evident.

How does the treatment work?

Treatment is highly individualized. In all cases, it begins with an interview and initial evaluation to identify the patient’s overall clinical picture. Then, the therapy begins. As a rule, it consists of twenty 50-minute treatment sessions over 20 weeks.

In the case of an individual with a more extreme situation, like an extremely low body weight, the treatment will be longer. It could reach 40 weeks.

One interesting fact is that this therapy isn’t imposed on the patient. As a matter of fact, one of its purposes is to get them to decide for themselves to follow the treatment, not only to regain weight but also to gain control of their lives.

The goal of treatment is recovery. It addresses all aspects that reinforce and shape the eating disorder. In other words, it seeks to ensure that the individual recovers a normal body mass index (BMI). Furthermore, that their emotions, thoughts, and behaviors are healthier.

Goal-focused talk therapy

The goal of the professional in this type of therapy is to make the patient understand how their thoughts are conditioning the way they feel and, therefore, their behavior. The sufferer must realize how their mental focus is reinforcing their totally distorted ideas, beliefs, and schemas. Moreover, it’s driving them toward disordered and harmful behaviors.

The psychotherapeutic relationship is based on conversation and focused on progressive achievements. Therefore, the psychologist establishes what goals their patient must achieve each week.

The patient suffering from bulimia, anorexia, or binge eating disorder must keep a diary. In it, they record their eating, their thoughts, and the emotions they experience between sessions.

A model based on four stages

There are goals to be achieved at each of the four stages of enhanced cognitive-behavioral therapy. The first two focus on the present moment and the last two on the future.

In the first two stages, the work focuses intensely on the processes that are reinforcing the eating disorder. The goal is to improve the patient’s day-to-day thoughts and moods. In steps three and four, the therapeutic strategy focuses on the future and on maintaining a healthy lifestyle. Above all, it centers on how to deal with any setbacks that may appear. In fact, avoiding relapses is a central purpose of this therapy.

girl on enhanced cognitive behavioral therapy
The objective of CBT-E is that the patients themselves decide to regain weight instead of having this decision imposed on them.

Conclusion

Enhanced cognitive behavioral therapy is the first-line treatment for eating disorders. As we’ve already mentioned, the success rates are high. That said, there are always some cases that are more resistant. In these situations, treatment programs in specialized residences are almost always chosen.

The fact remains that there’s a real need to provide more means and resources so that these treatments can reach those who need them. We also shouldn’t overlook the importance of educating our young people about self-esteem. They need to accept their own bodies. They must also develop critical thinking. The kind that refuses to be carried away by the cruel and misleading idea of beauty that society sells to them.

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  • 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.
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