CBT-E

ENHANCED COGNITIVE BEHAVIORAL THER APY (CBT-E) 
FOR EATING DISORDERS

CBT-E is an evidence-based treatment for eating disorders (EDs) including Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. Research shows that CBT-E is highly effective. Two-thirds of those who complete treatment achieve full or partial remission. The approach involves a a number of techniques. At the Center for the Obsessive Mind, we employ elements of this approach in online treatment for eating disorders.

HOW IT WORKS

EDUCATION

To start, CBT-E educates those who suffer with EDs about how the disorder started and is maintained. When people feel badly about their weight and shape and decide to restrict their intake, this restraint often leads to weight loss. Given the social bias toward thinness, when one loses weight after restricting, this behavior is reinforced. On top of this, the weight loss will reinforce the focus on weight and shape that leads to more restraint. This cycle can also lead to a very low body weight.

What’s more, attempts to restrict often lead people to eat past fullness. This is, in part, due to biological changes that occur in the face of extreme hunger. People also tend to engage in all or none thinking after they break food rules. For example, someone might think they’re either “being good” or “being bad” when they eat certain things. This mindset often leads to bingeing because if they eat a “bad” food, then they believe they’re being bad. As a result, their logic follows that they might as well take advantage of this “opportunity” to eat foods that are often off limits. The pleasure in eating certain foods reinforces the bingeing.

Purging may follow these binges. When people purge or engage in compensatory behaviors, these actions are reinforced as they reduce discomfort. So what starts as an attempt to restrict can have a number of unfavorable outcomes that reinforce the problematic behaviors.

ADDITIONAL THERAPEUTIC APPROACHES

Given the issues with restriction, the first step in CBT-E is to support regular eating. In CBT-E, people also monitor their eating so that they can see patterns and change them. This logging also helps individuals to see bingeing, purging or restricting as moments to learn from rather than as failures.

The therapy is also focused on a number of other concepts. Treatment examines how much attention people give to their weight and shape and encourages people to redistribute this attention to serve their values and goals. As part of CBT-E, individuals learn how their view may be skewed. For example, people with EDs tend to compare themselves to people that they think are more attractive than them. Understanding these automatic biases can help people to take their thoughts less seriously and to act in support of their health.