What Is Enhanced Cognitive Behavioural Therapy? A Clinical Psychology and Eating Disorders Podcast.
As this podcast is mainly for psychology students and professionals, we should have all heard about cognitive behavioural therapy, what is it and why it is so effective at treating a wide range of mental health conditions. As well as different forms of cognitive behavioural therapy have been adapted to treat different conditions, like psychosis, and now we’ll going to look at a different form of cognitive behavioural therapy that focuses on treating Eating Disorders. This is going to be a great podcast episode that is absolutely perfect for anyone interested in mental health, clinical psychology and eating disorders.
This podcast episode has been sponsored by Abnormal Psychology: The Causes and Treatments For Depression, Anxiety And More. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it.
Introduction To Enhanced Cognitive Behavioural Therapy
As many of us know, Cognitive Behavioural Therapy (CBT) is a very popular and extremely well-researched psychotherapy that is highly effective at treating a wide range of mental health conditions. For example, depression, OCD, anxiety amongst a bunch of other conditions. As well as CBT focuses on identifying a client’s patterns of thoughts, emotions and/ or the behaviours that negatively impact and influence their lives.
As a result of its effectiveness, CBT has been adapted into different forms to treat different conditions more effectively. Including Enhanced CBT (CBT-E) that is focused on treating eating disorders, and this will the focus of this brilliant podcast episode.
What Is CBT-E?
When it comes to treating eating disorders, like Anorexia (AN), Binge Eating Disorder (BED) and Bulimia Nervosa (BN), CBT-E is considered a first-line and evidence-based treatment for these conditions amongst other eating disorders. And even though, these conditions present us, as current or future, psychologists with very different problematic behaviours, they all share the same foundational features at their very core. Such as people with Anorexia, BED and Bulimia, they all often experience extreme concerns with their weight, body shape and/ or find it difficult to cope with negative emotions.
These factors lead to a client to “overvalue” their body shape and weight and mood intolerance, all of which are common triggers to problematic eating behaviours. Such as binge eating, purging and food restriction.
Therefore, CBT-E is a very structured and manualised treatment like other forms of CBT, that is intended to fit the client “like a glove” by focusing on creating a personalised map or formulation of the client’s eating disorder in order to create a customised plan for addressing the unique patterns and challenges.
Personally, this is why I love formulation so much, because it is so critical and important when it comes to mental health conditions. Since you can have two clients with the exact same eating disorder, but you cannot treat them exactly the same, because each other will have their own backgrounds, histories and social and psychological factors that can be causing the maladaptive coping mechanisms. And that’s why creating a formulation that is personalised to the client is so critical.
However, CBT-E isn’t a first-line approach for adolescents and children with anorexia or bulimia. In these cases, it is very common for treatments for children and teenagers with eating disorders to incorporate caregivers either as a central part of the treatment or very closely integrated. Since Family-based treatment is a far more common recommendation for younger people presenting with disordered eating.
What Are The Four Stages of CBT-E?
In terms of practicalities, there are four stages of CBT-E that are done over the course of 20 to 40 weeks using regular outpatient therapy sessions. Normally not a lot of clients reach the 40 week mark since this is only really for clients who need to restore their weight like clients with anorexia nervosa. As well as CBT-E highlights to clients the importance of “starting well” and building as much momentum at the start of therapy as they can, so sessions are normally twice a week for the first four to eight weeks, then they drop down to once a week for eight weeks and then go every-other-week afterwards.
And I know I was surprised when I learnt that therapy sessions were twice a week at the start so I think others will be too. Yet there are a range of reasons for this, but one of them has to be that eating disorders are extremely deadly conditions as we’ve spoken about before.
Therefore, it is critical to try to build as much momentum in the early parts of the therapy just to try and give the therapy as much chance of working as possible.
Stage One of CBT-E
The entire point of stage one is about understanding and then systematically addressing the factors that keep the client locked into their eating difficulties. To do this the therapy would guide the client in establishing a pattern of consistent as well as regular eating, and the client would learn how to effectively plan ahead, anticipate challenges and maintain a predictable routine of eating every few hours.
Additionally, this first stage involves a lot of building self-awareness, education and problem-solving for the client to help them avoid known triggers. Then the therapist would expect significant change during this brief first stage of the first four to eight weeks.
Stage Two Of CBT-E
Secondly, stage two is only a session or two where the client and therapist reviews progression, collaborate on building a plan for Stage Three and identify any ongoing challenges.
What Is Stage Three of CBT-E?
Now Stage Three occurs during the once-a-week sessions and they focus on factors that could be fuelling the remaining problematic eating behaviours. These are typically concerned with body shape and weight. Also a lot of attention at this stage is focused on forms of over-control of food, like the types of food that a client continues to avoid, the restriction of their overall food intake and more.
Overall, stage three focuses on the mood and event-related triggers of a client’s disordered eating.
What Is Stage Four Of CBT-E?
Finally, the fourth and final stage focus on the therapist and the client looking ahead to the future and life after CBT-E. Therefore, the client learns about consistency, mindfulness and how to engage strategies to reduce the vulnerability of them relapsing in the future.
Barriers To Treatment and Barriers To CBT-E
I always like to offset therapy-based podcast episodes by highlighting the immense problems that some amazing future-clients have when it comes to accessing therapy. I mainly do this because I want to help raise awareness so hopefully these barriers can be ripped down in the future. And yes, sometimes I really am that much of an optimist.
When it comes to CBT-E, there are a number of barriers that prove very problematic for people because CBT-E is very expensive and it isn’t accessible to a lot of people. Especially in countries like the USA where they don’t have free healthcare, as well as from what I’ve read it seems to be difficult to find CBT-E providers that accept commercial insurance or Medicaid.
Additionally, and please note this is NOT an official recommendation from me in any way, shape or form, but I have read a few experts recommend the book Overcoming Binge Eating By Christopher Fairburn by saying that his self-help guide can be used as an effective course for BED and sometimes BN, as well as it could be more effective if there was external support available as a supplement.
But again, I am NOT recommending that book officially.
Thankfully, there are some specialised eating disorder training and research centres that offer CBT-E at a reduced rate or even free of charge in exchange for participation in research studies. That is brilliant in my opinion, but this is a major problem that still needs to be fixed in society.
Clinical Psychology Conclusion
I will never deny that eating disorders are extremely deadly mental health conditions and treating the people with these conditions is beyond critical. I know I occasionally mention that psychotherapy saves lives, but in this case, I truly, truly mean it.
And as current or future psychologists, we need to acknowledge that what we do has amazing power and is a force of good for people and their lives, so just remember that when you’re down or having a rough time.
Because you truly never know what positive impact you’ll have on someone in their darkest hour.
I really hope you enjoyed today’s clinical psychology podcast episode.
If you want to learn more, please check out:
Abnormal Psychology: The Causes and Treatments For Depression, Anxiety And More. Available from all major eBook retailers and you can order the paperback and hardback copies from Amazon, your local bookstore and local library, if you request it.
Have a great day.
Clinical Psychology and Eating Disorder References
Atwood, M.E., Friedman, A. (2019). A systematic review of enhanced cognitive behavioral therapy (CBT-E) for eating disorders. International Journal of Eating Disorders, 53(3), 311-330.
Murphy R, Straebler S, Cooper Z, Fairburn CG. Cognitive behavioral therapy for eating disorders. Psychiatr Clin North Am. 2010 Sep;33(3):611-27. doi: 10.1016/j.psc.2010.04.004. PMID: 20599136; PMCID: PMC2928448.
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