Enhanced Cognitive Behavioral Therapy for Eating Disorders

Enhance CBT or “CBT-E” is a highly efficient, focused, behavioral therapy that has been researched extensively and is considered the first line treatment for most forms of disordered eating.  CBT-E targets the factors that keep people locked in disordered eating patterns. 

For Bulimia and Binge Eating Disorder, CBT-E treatment consists of 20 treatment sessions over 20 weeks. For Anorexia, CBT-E is generally 40-sessions over 40 weeks.

Columbus Park’s Gold Standard Treatment for Eating Disorders

CBT-E is considered the gold standard outpatient treatment for eating disorders including Anorexia, Bulimia and Binge Eating Disorder.  Even though these conditions present with different problematic behaviors, they share many of the same foundational features at their core. For example, people with AN, BN, and BED often experience extreme concern with weight and shape and/or difficulty coping with negative emotions.  CBT-E helps participants establish regular, balanced eating patterns, stabilize body weight, improve body esteem, and build adaptive skills for coping.

  • The first stage, is focused on helping the client establish a regular and consistent pattern of eating. We focus in on monitoring intake to increase awareness of one’s eating patterns, planning ahead and timing meals thoughtfully to support normalized nutrition throughout the day. In Stage One of CBT-E the client begins to understand the factors that keep him/her/them locked into an eating struggle. We call these factors “maintaining mechanisms.” These maintaining mechanisms include chronic or yo-yo dieting, rigid food-related rules, weight preoccupation, and negative mood states that impact one’s eating.

    Typically in Stage One, we begin to see a pattern of regular eating emerge as we refine our understanding of the factors fueling the problem and learn and practice a host of strategies designed to support the normalization of eating. These first 8-10 session are critically important. We want to see a strong start with a great deal of movement towards regular eating

  • During Stage Two of CBT-E we review progress to date, identify obstacles and map out a plan for Stage 3. This is a relatively short stage, typically 2 sessions over 2 weeks. In this phase of treatment we want to articulate clearly exactly what is fueling theremaining disordered behaviors or thoughts and then outline how we’ll address these triggers in the next phase of treatment.

  • Stage Three of CBT-E targets and defuses the maintaining factors. This stage is typically about 6 sessions over 6 weeks. Here is where we will explore things like over-concern with weight and shape, persistent restrictive or rigid eating styles, and event or mood-related eating behavior. These factors are challenged systematically. In some cases, extreme perfectionism, low self-esteem and/or interpersonal difficulties may be areas that also need further exploration and treatment.

  • Stage Four is about ending well; this stage is generally 4 sessions spread out over 8 weeks. In ending well, we shift to a focus to the future and how to reduce one’s vulnerability to relapse. At this point, the client knows him/her/themself well and can recognize the triggers to ED behaviors. The therapist, of course, is available down the road if for any reason there’s a need to revisit. That said, after a complete CBT-E treatment, one should have all the tools needed to maintain a strong recovery for the long term.

  • All of Columbus Park services are offered virtually. We see that virtual delivery of CBT-E improves attendance and compliance particularly with the more intensive first stage of the treatment.

Frequently Asked Questions About Enhanced Cognitive Behavioral Therapy (CBT-E)

  • The standard CBT-E structure for bulimia and binge eating disorder is 20-sessions over 20-weeks. For anorexia, the treatment duration typically is a bit longer – more like 40 weeks. For all conditions, the treatment sessions are more frequent at the start (2x per week for the first 4-6 weeks) and then gradually spread out over time. Sessions are typically 45 minutes duration.

  • According to extensive research, CBT-E should be the first line treatment for the majority of individuals with Anorexia, Bulimia, Binge Eating Disorder and most other eating difficulties that don’t fall into a diagnostic category. That said, there are some people who will benefit more from second line treatments like Dialectical Behavior Therapy (DBT-ED) or Specialist Supported Clinical Management (SSCM). Of course, in some cases of severe illness, outpatient treatment like CBT-E or even the second line therapies mentioned will not be appropriate as a more intensive setting is needed. If you would like to learn more, please schedule a complimentary call with us so we can establish if CBT-E might be right for you.

  • CBT-E sessions are highly structured with a clear agenda for each meeting. This organization keeps everyone on track. Changing eating behavior takes full attention; we can’t afford to stray off topic. Early on in the treatment, we work on establishing a regular pattern of eating, focusing in on consistency, balance and flexibility. With the support of the therapist, clients build awareness of triggers to disordered eating and start to integrate strategies to effectively manage these triggers. In CBT-E, clients are actively building self-awareness and planning ahead to ensure success. As CBT-E moves along (much of the change actually happens in the first 8 weeks), targets expand to address body image concerns, mood and event-related eating behaviors and common problematic thinking patterns and behaviors like body checking (for ex, reliance on the scale) and body avoidance (for ex, hiding your body).

  • Yes. The goal of CBT-E is complete cessation of disordered eating behaviors by treatment end. We expect participants to be eating regularly, maintaining a healthy weight, and moving on to engage in their lives without the burden of ED thoughts and behaviors. Towards the end of CBT-E, clients learn relapse prevention techniques so they can fully graduate from treatment and trust their ability to sustain recovery.

  • When people think of treatment for eating disorders, they often assume that the work is about uncovering deep emotional wounds and struggles that are driving disordered eating behavior. Surprisingly for many, this is not at all the path to recovery. The key to effective treatment is to identify and change the disordered behaviors first; then like clockwork, critical shifts in emotions and thoughts (including preoccupation with food and weight) follow. At Columbus Park, treatment is about maintaining laser focus on the eating disorder behaviors and using time-efficient treatments to achieve swift change and full recovery.

    Addressing issues that are beyond the eating disorder (for ex, trauma, interpersonal difficulties) or co-occurring with the eating disorder (for ex, anxiety, OCD) can happen in full force once the eating disorder is stabilized.

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