Intensive Cognitive Behavioural Therapy for Eating Disorders

Riccardo Dalle Grave
European Psychiatric Review, 2011;4(1):59-64
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Abstract

Cognitive behavioural therapy (CBT) is the most effective treatment for adults with bulimia nervosa (BN), but it is not effective enough; at best, only half of patients make a full remission and it has not been designed for treating patients with anorexia nervosa (AN) and eating disorder not otherwise specified (EDNOS). To address some of these limitations, an enhanced form of CBT for BN, named CBT-E, has been developed. CBT-E adopts modern procedures to address eating disorder psychopathology, and it is suitable for treating all forms of clinical eating disorders. The treatment was originally designed for adults in standard outpatient settings, but was then adapted for intense levels of care (e.g. intensive outpatient, day-hospital, and inpatient). In this article intensive CBT-E for treating eating disorders will be described. A brief summary of the data supporting this novel form of treatment will also be provided.
Keywords
Cognitive behavioural therapy (CBT), eating disorder, anorexia nervosa (AN), bulimia nervosa (BN), eating disorder not otherwise specified (EDNOS), inpatient treatment
Disclosure The author has no conflicts of interest to declare.
Received: December 19, 2010 Accepted March 03, 2011
Correspondence: Riccardo Dalle Grave, Department of Eating and Weight Disorder, Villa Garda Hospital, Via Montebaldo, 89, I-37016 Garda (VR), Italy. E: rdalleg@tin.it

Eating disorders are common health problems afflicting predominantly adolescent and young women.1 They are often associated with severe morbidity2 and carry increased risk of death.3 Although some progress has been achieved in their treatment, several problems still need to be resolved. Cognitive behavioural therapy (CBT) is the most effective evidence-based treatment available for the management of adults with bulimia nervosa (BN),4 but its effectiveness needs to be improved since only a third to a half of patients make a complete and lasting recovery.5 The effectiveness of CBT in adolescents and in the ‘real world’ also needs to be evaluated. In anorexia nervosa (AN) there is a lack of evidence-based treatments for adults, and in eating disorder not otherwise specified (EDNOS) – the most common eating disorders treated in clinical settings6,7 – there is almost no research on the treatment. The only study evaluating the long-term effectiveness of CBT for AN, and sub-threshold AN, showed a 33% remission at three years after the end of the treatment.8 Finally, in all eating disorder categories it is necessary to evaluate the effectiveness of more intensive levels of care (e.g. day-hospital or inpatient treatment).

To address some of these problems, an enhanced form of CBT (CBT-E) has been developed.9 The treatment, based on the transdiagnostic cognitive behavioural theory of eating disorders,10 is derived from CBT for BN. It is described as ‘enhanced’ because it has been designed to be more potent, and transdiagnostic, in its scope.11 CBT-E, originally designed for adults with eating disorders in conventional outpatient settings, has proved to be as effective for patients with not-underweight EDNOS as for patients with BN, with two-thirds of those who completed treatment having a good outcome.12 Successively, it was adapted for adolescents13 and intense levels of care (e.g. intensive outpatient, day-hospital, and inpatient),14,15 to treat patients with poor response to standard outpatient-based treatment and with features that prevent outpatient treatment from being appropriate.

In this article the transdiagnostic cognitive behavioural theory of eating disorders and an overview of CBT-E and its principal procedures will be provided. This is followed by a description of intensive CBT-E and its implementation with severe eating disorder patients, together with preliminary data on its effectiveness.

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