What are CBT-BN, CBT-BED and CBT-E?
Eating problems and disorders are common, so it is helpful to know that among the potentially effective treatments available there is one within the field of Cognitive Behavioural Therapy (CBT). The National Institute for Health and Care Excellence (NICE) recommends these specially adapted forms of CBT for bulimia nervosa, binge eating disorder and mixed states ('eating disorder not otherwise specified' - EDNOS) are first-line for self-help and therapist supported treatments of choice. Approximately only 10-15% of adults experiencing an eating disorder will meet a diagnosis of anorexia nervosa and be significantly underweight. The evidence base for using CBT in treating anorexia nervosa is smaller and NICE guidance suggests a number of treatments are potentially helpful - see the NICE guidelines for more information. The emphasis of this article is on these other more common types of overeating problems.
So what is CBT-E (Enhanced Cognitive Behaviour Therapy or Transdiagnostic CBT for Eating Disorders) and how might it benefit me?
CBT-E is the cutting edge development in CBT treatment especially designed for eating problems and disorders. It differs from standard CBT because it is based on, and is aimed at addressing, a specific theoretical model of the psychological and behavioural mechanisms that underlie and maintain the eating problems. It is a structured, tailored form of one-to-one talking therapy in which you and your therapist work together as a team. It focuses on helping you change your eating behaviours now and in the future (it does refer to the past but does not centre on it). Generally the twenty sessions version of the treatment is recommended for most people (around five months).
What does it involve?
Initially it has predominantly a behavioural emphasis, the first eight sessions being undertaken twice weekly to give you the best opportunity to break into the eating behaviours. This concentrates on establishing a more regular eating pattern, reducing binge eating and loss of control. This can have the additional effect of reducing preoccupation, anxiety and improving mood. Progress is measured throughout treatment and is anticipated after only four weeks.
The stage two review is an opportunity to assess change and collaboratively design stage three, targeting the maintaining processes that have been identified so far. At this point the frequency reduces to weekly.
Section three itself (consisting of eight sessions), addresses concerns about shape and weight, thinking about and developing the life you want to live, rules about food and dealing with event-changes and mood-changes effectively. It may also include more intense work on low self-esteem, clinical perfectionism or interpersonal problems if appropriate.
This is a highly comprehensive treatment but the components are uniquely tailored to your needs. The last few sessions are undertaken on a fortnightly basis addressing how to get back on track when lapses occur and awareness of potential triggers for setbacks in the future. A review session 20 weeks after the end of treatment is an opportunity to discuss how setbacks have been managed and to make recommendations for continued progress.
Why is this adapted form of CBT recommended by NICE and how was it developed?
In the early 1980s a psychiatrist, Professor Christopher Fairburn, started work with a team of psychologists at the Centre for Research on Eating Disorders at Oxford (CREDO) (at the Department of Psychiatry at the University of Oxford). They began researching and developing effective treatments for people experiencing eating problems and disorders.
The team developed specific adaptations of CBT; CBT-BN for bulimia nervosa and CBT-BED for binge eating disorder. In 2004 the NICE guidelines (which review and make recommendations for evidence-based best practice for health professionals) were published and these treatments were specifically recommended for these difficulties and for EDNOS to be treated with the closest fitting approach. Taking 20 years to refine these adaptations of CBT mean they have become leading treatments for these difficulties, and have accumulated one of the largest bodies of research evidence in any psychological field.
Response rates have now further improved. Throughout the 1990s the treatment was adjusted as the research team analysed, experimented with and adapted the treatment components that were leading some patients to achieve a better response outcome than others. Additionally an argument emerged from the research data suggesting that the various types of eating disorders may have more in common than differences.
The 'transdiagnostic' treatment that evolved was CBT-E, an approach comprehensive enough to be applied irrespective of differential diagnosis and appropriate for the mixed patterns of difficulties that people with eating disorders typically experience over time. In 2008 the research group published the transdiagnostic theoretical model of the 'roots' that underlie an eating disorder. The CBT-E treatment is designed to address these roots and the means to measure change in these underlying mechanisms. Research trials suggest that about two thirds of clients undertaking this treatment have an excellent response. CBT-E is one of the treatments available that offers hope to adults experiencing common eating problems and disorders.
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