Enhanced Cognitive Behaviour Therapy

Resources and Handouts

Therapist self-rated cbt-e components checklist (cbt-e cc).

  • CBT-E CC for adults
  • CBT-E CC for adolescents

Bailey-Straebler S, Cooper Z, Dalle Grave R, Calugi S, Murphy R. Development of the CBT-E Components Checklist: A tool for measuring therapist self-rated adherence to CBT-E. IJEDO. 2022;4. doi: https://www.doi.org/10.32044/ijedo.2022.02. Download PDF

Handouts from Cognitive Behavior Therapy and Eating Disorders

From C. G. Fairburn,  Cognitive behavior therapy and eating disorders , Guilford Press, New York, 2008.

  • F2.3 – CBT-E formulation of bulimia nervosa
  • F2.4 – CBT-E formulation of “restricting” anorexia nervosa
  • F2.5 – Transdiagnostic CBT-E formulation
  • T4.2 – Points to make when describing CBT-E
  • T5.1 – Topics to cover when assessing the eating problem
  • F5.2 – CBT-E formulation of eating disorder NOS in the patient’s own words
  • T5.2 – Instructions for self-monitoring
  • F5.3 – Blank monitoring record
  • Example monitoring record
  • T6.1 – Topics to cover when educating patients about eating disorders
  • T6.2 – Patient handout on regular eating
  • F8.3 – Over-evaluation of control over shape and weight – an extended formulation
  • F8.5 – Feelings of fatness
  • F9.3 – Over-evaluation of control over eating – an extended formulation
  • F10.2 – Binge analysis
  • F11.2 – CBT-E formulation of binge eating / purging anorexia nervosa
  • T11.2 – Patient handout on the effects of being underweight
  • T12.1 – Short-term maintenance plan
  • T12.2 – Long-term maintenance plan
  • F13.1 – Transdiagnostic CBT-E formulation with clinical perfectionism added
  • F13.2 – Over-evaluation of achieving and achievement – an extended formulation
  • F13.3 – CBT-E formulation of bulimia nervosa with core low self-esteem added

Handouts from Cognitive Behavior Therapy for Adolescents with Eating Disorders

From Dalle Grave R, Calugi S. Cognitive behavior therapy for adolescents with eating disorders . New York: Guilford Press; 2020.

  • F2.1 – CBT-E map for adolescents with eating disorders
  • F2.2 – The four levels of care of multistep CBT-E for adolescents with eating disorders
  • T3.1 – Topics to be addressed when assessing the nature and severity of the eating disorder
  • T3.2 – Main points made when describing CBT-E to the young underweight patients
  • T4.1 – Step One procedures and when they are implemented
  • F5.3 – Formulation of an underweight adolescent patient with eating disorder highlighting how the effects of significantly low weight maintain the eating problem
  • F5.5 – Blank monitoring record
  • T5.1 – Instructions for self-monitoring
  • T5.2 – Main topics to cover when educating adolescent patients about eating disorders
  • F7.1 – Weight graph for underweight adolescent patient with eating disorder
  • T8.1 – Patient handout on regular eating
  • T9.4 – Main topics to cover when educating patients about purging
  • T9.6 – Main topics to cover when educating patients about excessive exercising
  • T10.1 – Review of how treatment is going after step one
  • T10.2 – Obstacles to change and strategies used to address them
  • F12.2 – A personalized extended formulation of an underweight adolescent patient with an eating disorder
  • F12.3 – Two-prong strategy to address the overvaluation of shape, weight and their control
  • F13.3 – An extended formulation of an adolescent patient with overvaluation of control over eating
  • T16.1 – Short-term maintenance plan template
  • T16.2 Long-term maintenance plan template
  • F17.1. Formulation of an underweight adolescent eating disorder and clinical perfectionism
  • F17.5 – The transdiagnostic formulation with the inclusion of core low self-esteem
  • T17.1 – Interpersonal history table
  • F17.7 – The transdiagnostic formulation with the inclusion of marked interpersonal difficulties
  • F17.9 – Formulation of a not-underweight adolescent patient with an eating disorder and mood intolerance
  • T18.2 – An example of how intensive outpatient CBT-E for adolescents is organized
  • My Monitoring Record
  • My Monitoring Record For Shape Checking
  • MY Weight Chart
  • Dietary Rules Inventory
  • MY MONITORING RECORD
  • MY MONITORING RECORD FOR SHAPE CHECHING
  • EPCL SUMMARY SHEET
  • DIETARY RULES INVENTORY

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Cognitive Behavioral Therapy (CBT) for Eating Disorders

Why CBT Is Often the Preferred Option for Treating Eating Disorders

cbt homework for eating disorders

Rachel Goldman, PhD FTOS, is a licensed psychologist, clinical assistant professor, speaker, wellness expert specializing in eating behaviors, stress management, and health behavior change.

cbt homework for eating disorders

  • Eating Disorders

How Effective Is CBT for Eating Disorders?

  • When CBT Doesn't Work

Cognitive-behavioral therapy (CBT) is the leading evidence-based treatment for eating disorders. CBT is a psychotherapeutic approach that involves a variety of techniques. These approaches help an individual to understand the interaction between their thoughts, feelings, and behaviors. It also helps them to develop strategies to change unhelpful thoughts and behaviors to improve mood and functioning.

At a Glance

Cognitive behavioral therapy is a first-line treatment of eating disorders. CBT focuses on helping people identify and change the thought patterns that play a role in the onset and maintenance of their condition. It also addresses areas including coping skills, low self-esteem, interpersonal problems, and perfectionism that also make eating disorder recovery more complex.

CBT can be an effective treatment for adults with bulimia, binge eating disorder, and other specified eating disorder (OSFED). However, it is essential to note that eating disorders are complex, and each person's needs are different. Other treatments, including hospitalization and residential treatment, may also be necessary.

History of CBT for Eating Disorders

CBT was developed in the late 1950s and 1960s by psychiatrist Aaron Beck, who emphasized the role of thoughts in influencing feelings and behaviors. CBT was initially developed to treat depression, although today it is an evidence-based treatment for many mental health conditions and symptoms, including disordered eating.

Cognitive behavioral therapy itself is not a single distinct therapeutic technique, and there are many different forms of CBT that share a common theory about the factors maintaining psychological distress. Acceptance and Commitment Therapy (ACT) and Dialectical Behavior Therapy (DBT) are examples of specific CBT treatments.

CBT is typically time-limited and goal-oriented. It also involves homework outside of sessions. CBT emphasizes collaboration between therapist and client and active participation by the client. CBT is very effective for many mental health concerns, including depression, generalized anxiety disorder , phobias, and OCD .

CBT for Eating Disorders

Cognitive behavioral therapy for eating disorders was developed in the late 1970s by G. Terence Wilson, Christopher Fairburn, and Stuart Agras. These researchers identified dietary restriction and shape and weight concerns as central to the maintenance of bulimia nervosa , developed a 20-session treatment protocol, and began conducting clinical trials. In the 1990s, CBT was applied to binge eating disorder as well.

Enhanced CBT (CBT-E)

In 2008, Fairburn published an updated treatment manual for Enhanced Cognitive Behavioral Therapy (CBT-E) designed to treat all eating disorders. CBT-E comprises two formats:

  • A focused treatment similar to the original manual
  • A broad treatment with extra modules on mood intolerance, perfectionism , low self-esteem , and interpersonal difficulties that contribute to the maintenance of eating disorders

Other CBT Settings and Formats

CBT has been successfully applied in self-help and guided self-help formats for the treatment of bulimia nervosa and binge eating disorder. It can also be provided in group formats and higher levels of care, such as residential or inpatient settings .

More recent adaptations include the use of technology to widen the range of people who have access to effective treatments such as CBT.

Research has begun on the delivery of CBT treatment by different technologies, including email, chat, mobile app, and internet-based self-help. There is also support for a 10-session CBT for non-underweight eating disorder patients. This approach is brief and effective and allows more patients to get the help that they need.

Cognitive Model of Eating Disorders

The cognitive model of eating disorders posits that the core maintaining problem in all eating disorders is overconcern with shape and weight. The specific way this overconcern manifests can vary. It can drive any of the following:

  • Binge eating
  • Compensatory behaviors such as self-induced vomiting, laxatives, and excessive exercise
  • Strict dieting

Further, these components can interact to create the symptoms of an eating disorder. Strict dieting—including skipping meals, eating small amounts of food, and avoiding forbidden foods—can lead to low weight and/or binge eating. Low weight can lead to malnutrition and also can lead to binge eating.

Bingeing can lead to intense guilt and shame and a renewed attempt to diet. It can also lead to efforts to undo the purging through compensatory behaviors. Patients typically get caught in a cycle.

Components of CBT for Eating Disorders

CBT is a structured treatment. In its most common form, it consists of 20 sessions. Goals are set. Sessions are spent weighing the patient, reviewing homework, reviewing the case formulation, teaching skills, and problem-solving.

Cognitive behavioral therapy for eating disorders typically includes the following components:

  • Challenge of dietary rules . This involves identifying rules and challenging them behaviorally (such as eating after 8 p.m. or eating a sandwich for lunch).
  • Completion of food records immediately after eating and noting thoughts and feelings as well as behaviors.
  • Development of continuum thinking to replace all-or-nothing thinking .
  • Development of strategies to prevent binges and compensatory behaviors , such as the use of delays and alternatives and problem-solving strategies.
  • Exposure to fear foods . After regular eating is well-established and compensatory behaviors are under control, patients gradually reintroduce the foods they fear.
  • Meal planning . The patient should plan meals ahead of time and always know "what and when" their next meal will be.
  • Psychoeducation to understand what maintains the eating disorder and the psychological and medical consequences.
  • Regular weighing (usually once per week) in order to track progress and run experiments.
  • Relapse prevention to identify both strategies that have been helpful and how to deal with potential future stumbling blocks. Because the treatment is time-limited, the goal is for the patient to become their own therapist.
  • The use of behavioral experiments . For example, if a client believes eating a cupcake will cause a five-pound weight gain, he or she would be encouraged to consume a cupcake and see if it does. These behavioral experiments are generally much more effective than cognitive restructuring alone.

Other Key Components

Other components commonly included:

  • Cessation of body checking
  • Challenge of the eating disorder mindset
  • Development of new sources of self-esteem
  • Enhancement of interpersonal skills
  • Reduction of body avoidance

Cognitive behavioral therapy is widely considered to be the most effective therapy for the treatment of bulimia nervosa and should, therefore, usually be the initial treatment offered at the outpatient level.

Research suggets CBT is effective for bulimia nervosa and binge-eating disorders, although there is less evidence of its efficacy for treating anorexia nervosa.

One study compared five months of CBT (20 sessions) for women with bulimia nervosa with 2 years of weekly psychoanalytic psychotherapy. Seventy patients were randomly assigned to one of these two groups.

After 5 months of therapy (the end of the CBT treatment), 42% of patients in the CBT group and 6% of the patients in the psychoanalytic therapy group had stopped binge-eating and purging. At the end of 2 years (completion of the psychoanalytic therapy), 44% of the CBT group and 15% of the psychoanalytic group were symptom-free.

Another study compared CBT-E with interpersonal therapy (IPT), an alternative leading treatment for adults with an eating disorder. In the study, 130 adult patients with an eating disorder were randomly assigned to receive either CBT-E or IPT. Both treatments involved 20 sessions over 20 weeks, followed by a 60-week follow-up period.

At post-treatment, 66% of the CBT-E participants met criteria for remission, compared with only 33% of the IPT participants. Over the follow-up period, the CBT-E remission rate remained higher (69% versus 49%).

A 2018 systematic review concluded that CBT-E was an effective treatment for adults with bulimia nervosa, BED, and OSFED. It also noted that CBT-E for bulimia nervosa is highly cost-effective compared with psychoanalytic psychotherapy.

Good Candidates for CBT

Adults with bulimia nervosa , binge eating disorder , and other specified eating disorder (OSFED) are potentially good candidates for CBT. Older adolescents with bulimia and binge eating disorder may also benefit from CBT.

Patient Responsiveness to Treatment

Therapists conducting CBT aim to introduce behavioral change as early as possible. Research has shown that patients who are able to make early behavioral changes such as establishing more regular eating and reducing the frequency of purging behavior are more likely to be successfully treated at the end of treatment.

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When CBT Doesn't Work

CBT is often recommended as a first-line treatment. If a trial of CBT is not successful, individuals can be referred for DBT (a specific type of CBT with greater intensity) or to a higher level of care such as partial hospitalization or residential treatment program.

If you or a loved one are coping with an eating disorder, contact the  National Eating Disorders Association (NEDA) Helpline  for support at 1-800-931-2237.

For more mental health resources, see our  National Helpline Database .

Agras WS, Fitzsimmons-craft EE, Wilfley DE. Evolution of cognitive-behavioral therapy for eating disorders . Behav Res Ther . 2017;88:26-36. doi:10.1016/j.brat.2016.09.004

Kaidesoja M, Cooper Z, Fordham B. Cognitive behavioral therapy for eating disorders: A map of the systematic review evidence base .  Int J Eat Disord . 2023;56(2):295-313. doi:10.1002/eat.23831

Murphy R, Straebler S, Cooper Z, Fairburn CG. Cognitive behavioral therapy for eating disorders . Psychiatr Clin North Am . 2010;33(3):611-27. doi:10.1016/j.psc.2010.04.004

Waller G, Turner H, Tatham M, Mountford VA, Wade TD. Brief Cognitive Behavioral Therapy for Non-Underweight Patients: CBT-T for Eating Disorders . London: Routledge; 2019.

De jong M, Schoorl M, Hoek HW. Enhanced cognitive behavioural therapy for patients with eating disorders: a systematic review . Curr Opin Psychiatry . 2018;31(6):436-444. doi:10.1097/YCO.0000000000000452

Fairburn CG, Bailey-straebler S, Basden S, et al. A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders . Behav Res Ther . 2015;70:64-71. doi:10.1016/j.brat.2015.04.010

Poulsen S, Lunn S, Daniel SI, et al. A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa . Am J Psychiatry . 2014;171(1):109-16. doi:10.1176/appi.ajp.2013.12121511

Agras WS. Cognitive behavior therapy for the eating disorders .  Psychiatr Clin North Am . 2019;42(2):169-179. doi:10.1016/j.psc.2019.01.001

Waller G, Tatham M, Turner H, et al. A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: Outcomes from a case series of nonunderweight adult patients . Int J Eat Disord . 2018;51(3):262-269. doi:10.1002/eat.22837

Waller, Glenn, Helen Cordery, Emma Corstorphine, Hendrik Hinrichsen, Rachel Lawson, Victoria Mountford, and Katie Russell. 2013. Cognitive Behavioral Therapy for Eating Disorders . Cambridge: Cambridge University Press.

By Lauren Muhlheim, PsyD, CEDS  Lauren Muhlheim, PsyD, is a certified eating disorders expert and clinical psychologist who provides cognitive behavioral psychotherapy. 

CBT-E resources

Handouts from cognitive behavior therapy and eating disorders.

F2.3 - CBT-E formulation of bulimia nervosa

F2.4 - CBT-E formulation of “restricting” anorexia nervosa

F2.5 - Transdiagnostic CBT-E formulation

T4.2 - Points to make when describing CBT-E

T5.1 - Topics to cover when assessing the eating problem

F5.2 - CBT-E formulation of eating disorder NOS in the patient's own words

T5.2 - Instructions for self-monitoring

F5.3 - Blank monitoring record

T6.1 - Topics to cover when educating patients about eating disorders

T6.2 - Patient handout on regular eating

F8.3 - Over-evaluation of control over shape and weight – an extended formulation

F8.5 - Feelings of fatness

F9.3 - Over-evaluation of control over eating – an extended formulation

F10.2 - Binge analysis

F11.2 - CBT-E formulation of binge eating / purging anorexia nervosa

T11.2 - Patient handout on the effects of being underweight

T12.1 - Short-term maintenance plan

T12.2 - Long-term maintenance plan

F13.1 - Transdiagnostic CBT-E formulation with clinical perfectionism added

F13.2 - Over-evaluation of achieving and achievement – an extended formulation

F13.3 - CBT-E formulation of bulimia nervosa with core low self-esteem added

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Overcoming Your Eating Disorder: Guided Self-Help Workbook: A cognitive-behavioral therapy approach for bulimia nervosa and binge-eating disorder

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CBT for Eating Disorders: Developing a Healthy Relationship with Food

Understanding eating disorders.

Eating disorders are complex mental health conditions that can have a profound impact on individuals’ lives. It is crucial to gain a comprehensive understanding of these disorders and their consequences in order to provide effective treatment and support.

An Overview of Eating Disorders

Eating disorders encompass a range of conditions that are characterized by abnormal eating behaviors and distorted attitudes towards food, weight, and body image. The most common types of eating disorders include  anorexia nervosa ,  bulimia nervosa , and  binge eating disorder .

Anorexia nervosa  is characterized by severe restriction of food intake, resulting in significant weight loss and a distorted perception of one’s body shape and size. Individuals with anorexia may exhibit obsessive thoughts about food, intense fear of gaining weight, and a relentless pursuit of thinness.

Bulimia nervosa  involves recurring episodes of binge eating, followed by compensatory behaviors such as self-induced vomiting, excessive exercise, or the misuse of laxatives or diuretics. People with bulimia often experience a sense of loss of control during binge episodes and may have a preoccupation with body shape and weight.

Binge eating disorder  is characterized by recurrent episodes of uncontrollable overeating, often accompanied by feelings of guilt, shame, and distress. Unlike bulimia, individuals with binge eating disorder do not engage in compensatory behaviors, which can lead to significant weight gain and associated health problems.

The Impact of Eating Disorders

Eating disorders can have severe physical, emotional, and social consequences. The physical effects of these disorders can vary depending on the specific condition, but may include malnutrition, electrolyte imbalances, cardiovascular complications, gastrointestinal problems, and hormonal disruptions.

Emotionally, individuals with eating disorders often experience feelings of shame, guilt, and low self-esteem. They may also struggle with anxiety, depression, and obsessive-compulsive tendencies. The constant preoccupation with food, weight, and body image can significantly impact their daily functioning and overall quality of life.

Socially, eating disorders can lead to isolation and strained relationships, as individuals may withdraw from social activities that involve food or feel misunderstood by others. The secrecy and shame associated with these disorders can make it challenging for individuals to seek help and support.

Understanding the complexities of eating disorders is essential to recognize the need for appropriate interventions and treatment approaches.  Cognitive Behavioral Therapy (CBT)  is one such approach that has shown promise in the treatment of eating disorders. In the following sections, we will explore the principles and techniques of CBT as applied to eating disorders. For further information, you can visit our article on  CBT for eating disorders .

Introduction to Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is an evidence-based psychological treatment that has shown effectiveness in various mental health conditions, including  eating disorders . This section provides an introduction to CBT, outlining what it is and the principles underlying its approach.

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy, commonly referred to as CBT, is a form of therapy that focuses on the connection between thoughts, emotions, and behaviors. It is grounded in the understanding that our thoughts and beliefs influence our feelings and actions. By identifying and challenging negative or distorted thoughts, individuals can develop healthier cognitive patterns and subsequently improve their emotional well-being and behavior.

CBT is a goal-oriented and time-limited therapy that typically involves a structured and collaborative approach between the therapist and client. It is designed to be practical and focused on the present moment, with an emphasis on identifying and changing maladaptive patterns of thinking and behavior.

The Principles of CBT

CBT is guided by several fundamental principles that underpin its therapeutic approach:

  • Cognitive Restructuring:  CBT recognizes that our thoughts and interpretations of events significantly impact our emotions and behavior. By identifying and challenging negative or irrational thoughts, individuals can replace them with more accurate and adaptive thinking patterns.
  • Behavioral Activation:  CBT emphasizes the importance of engaging in positive and healthy behaviors to improve mood and overall well-being. By actively participating in activities that bring joy and fulfillment, individuals can counteract negative emotions and break the cycle of avoidance or withdrawal.
  • Skills Building:  CBT equips individuals with practical skills and strategies to cope with challenging situations and manage distressing emotions. These skills may include relaxation techniques, problem-solving skills, and assertiveness training, among others.
  • Collaborative Therapeutic Relationship:  CBT is a collaborative process between the therapist and client, where they work together to identify and address specific goals. The therapist provides guidance and support while empowering the client to take an active role in their treatment.
  • Homework Assignments:  CBT often involves homework assignments to reinforce and practice the skills learned during therapy sessions. These assignments encourage individuals to apply new coping strategies and insights in their everyday lives, promoting long-lasting change.

By applying these principles, CBT aims to help individuals with eating disorders challenge distorted thoughts related to body image, weight, and food, as well as modify maladaptive behaviors associated with eating and exercise. In the next section, we will explore how CBT is specifically applied to eating disorders and the goals it aims to achieve.

CBT for Eating Disorders

Cognitive Behavioral Therapy (CBT) has proven to be an effective approach in the treatment of eating disorders. By addressing the underlying thoughts, beliefs, and behaviors associated with these disorders, CBT aims to bring about positive changes in individuals struggling with their relationship with food and body image .

How CBT is Applied to Eating Disorders

CBT for eating disorders involves a structured and collaborative approach between the therapist and the individual seeking treatment. The therapist helps the individual identify and challenge distorted thoughts and beliefs related to food, weight, and body image. By recognizing and modifying these maladaptive thoughts, individuals can develop healthier attitudes and behaviors towards eating.

The therapy process typically begins with an assessment phase, where the therapist works closely with the individual to understand the nature and severity of their eating disorder. This assessment may include discussions about eating habits, body image concerns, and emotional triggers.

Once the assessment is complete, the therapist and individual collaboratively establish specific treatment goals. These goals can include reducing the frequency of disordered eating behaviors, improving body image, and developing healthier coping strategies. The therapist then guides the individual through a series of therapeutic techniques designed to address their specific needs.

The Goals of CBT in Treating Eating Disorders

The primary goals of CBT in treating eating disorders are to help individuals gain control over their eating behaviors, challenge and modify negative thoughts and beliefs, and develop healthier coping skills. By addressing the underlying psychological factors contributing to the disorder, CBT aims to promote long-term recovery and prevent relapse.

Some specific goals of CBT for eating disorders include:

  • Normalization of eating patterns : CBT helps individuals establish regular and balanced eating habits by addressing restrictive or binge-purge behaviors. This involves identifying triggers and developing strategies to manage them effectively.
  • Cognitive restructuring : The therapist works with the individual to challenge and modify distorted thoughts and beliefs related to body image, weight, and food. By replacing negative thoughts with more realistic and positive ones, individuals can develop a healthier self-perception.
  • Developing healthy coping skills : CBT teaches individuals alternative ways to manage emotions and stress, reducing their reliance on disordered eating behaviors. Techniques such as relaxation exercises, problem-solving strategies, and assertiveness training can be incorporated to develop effective coping skills.
  • Identifying and addressing underlying issues : CBT aims to uncover and address any underlying psychological, emotional, or interpersonal issues that contribute to the development and maintenance of the eating disorder. By exploring these factors, individuals can gain insight into their triggers and develop strategies to manage them more effectively.

CBT for eating disorders can be a transformative approach for individuals seeking recovery. By empowering individuals to challenge their disordered thoughts and develop healthier coping skills, CBT offers a fresh start towards a healthier relationship with food and body image.

Techniques Used in CBT for Eating Disorders

Cognitive Behavioral Therapy (CBT) is a highly effective approach in the treatment of eating disorders. This therapeutic approach employs various techniques to help individuals address the underlying thoughts, emotions, and behaviors associated with their disordered eating patterns. The following techniques are commonly used in CBT for eating disorders:

Psychoeducation and Awareness

Psychoeducation plays a crucial role in CBT for eating disorders. Therapists provide individuals with the necessary information about their specific eating disorder, its causes, and the impact it has on their physical and mental health. By increasing awareness, individuals gain a better understanding of their condition, which can help motivate them to make positive changes.

Through psychoeducation, individuals also learn about healthy eating habits, nutritional needs, and the negative consequences of disordered eating behaviors. This knowledge empowers individuals to make informed decisions and take control of their recovery process.

Cognitive Restructuring

Cognitive restructuring is a core component of CBT for eating disorders. This technique focuses on identifying and challenging negative thought patterns and beliefs that contribute to disordered eating behaviors. Therapists work with individuals to examine their distorted thoughts related to body image, self-worth, weight, and food.

By challenging these negative thoughts and replacing them with more realistic and positive ones, individuals can develop healthier attitudes towards their bodies and eating habits. Cognitive restructuring helps individuals break free from the cycle of negative self-perception and promotes a more balanced and compassionate view of themselves.

Behavioral Experiments and Exposure

Behavioral experiments and exposure techniques are utilized in CBT for eating disorders to help individuals confront and overcome their fears related to food, body image, and weight. These techniques involve gradually exposing individuals to situations that trigger anxiety or distress surrounding their eating disorder.

For example, individuals may engage in exposure exercises where they eat fear foods or challenge their rigid food rules. By gradually facing these fears, individuals learn that their anxieties and fears are often exaggerated and that they can tolerate uncomfortable feelings without resorting to disordered eating behaviors.

In addition to exposure exercises, therapists may also use behavioral experiments to test the validity of individuals’ beliefs about themselves, food, or body image. Through these experiments, individuals gain insights into the discrepancies between their expectations and reality, leading to a shift in their thoughts and behaviors.

By incorporating techniques such as psychoeducation and awareness, cognitive restructuring, and behavioral experiments and exposure, CBT provides individuals with the tools and strategies needed to address their disordered eating patterns. These techniques empower individuals to challenge negative thoughts, develop healthy coping skills, and work towards long-term recovery and relapse prevention.

Benefits of CBT for Eating Disorders

Cognitive Behavioral Therapy (CBT) has been widely recognized as an effective treatment approach for individuals with eating disorders. By addressing the underlying thoughts, emotions, and behaviors associated with these disorders, CBT offers several benefits that contribute to the recovery process. Let’s explore some of these benefits in more detail.

Empowering Individuals to Take Control

One of the primary goals of CBT for eating disorders is to empower individuals to take control of their thoughts and behaviors related to food, body image, and weight. Through CBT, individuals learn to challenge and modify distorted beliefs, such as negative self-perceptions and unrealistic standards of beauty. By gaining a better understanding of the underlying factors driving their eating disorders, individuals can develop a sense of agency and actively work towards healthier thought patterns and behaviors.

Developing Healthy Coping Skills

CBT equips individuals with practical skills and strategies to manage difficult emotions and stressful situations. Through techniques such as  cognitive restructuring  and  behavioral experiments , individuals learn to identify and challenge unhelpful thoughts, replace them with more realistic and adaptive ones, and engage in healthier behaviors. These coping skills not only help individuals navigate triggers and challenges related to their eating disorders but also provide them with valuable tools for managing stress and emotions in other areas of life.

Long-term Recovery and Relapse Prevention

CBT is known for its effectiveness in promoting long-term recovery and preventing relapse in individuals with eating disorders. By addressing the underlying factors contributing to these disorders, CBT helps individuals develop a strong foundation for sustainable change. Through the acquisition of healthier coping skills, individuals are better equipped to handle potential triggers, setbacks, and high-risk situations. CBT also emphasizes the importance of ongoing self-monitoring and relapse prevention strategies, enabling individuals to maintain their progress even after completing formal therapy.

In summary, CBT offers numerous benefits for individuals with eating disorders. By empowering individuals to take control, developing healthy coping skills, and promoting long-term recovery and relapse prevention, CBT plays a vital role in helping individuals break free from the grip of their eating disorders and achieve a fresh start towards a healthier and more fulfilling life. If you’re interested in learning more about CBT or finding CBT therapists near you, check out our articles on  cognitive behavioral therapy  and  CBT therapists near me .

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Avoidance Hierarchy (Archived)

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Cognitive Behavioral Model Of Anorexia Nervosa (Fairburn, Cooper, Shafran, 2003)

Cognitive Behavioral Model Of Anorexia Nervosa (Fairburn, Cooper, Shafran, 2003)

Cognitive Behavioral Model Of Bulimia Nervosa (Fairburn, Cooper, Shafran, 2003)

Cognitive Behavioral Model Of Bulimia Nervosa (Fairburn, Cooper, Shafran, 2003)

Cognitive Behavioral Model Of Intolerance Of Uncertainty And Generalized Anxiety Disorder Symptoms (Hebert, Dugas, 2019)

Cognitive Behavioral Model Of Intolerance Of Uncertainty And Generalized Anxiety Disorder Symptoms (Hebert, Dugas, 2019)

Cognitive Distortions – Unhelpful Thinking Styles (Common)

Cognitive Distortions – Unhelpful Thinking Styles (Common)

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Demanding Standards – Living Well With Your Personal Rules

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Overcoming Eating Disorders (Second Edition): Therapist Guide

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Overgeneralization

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Starvation Syndrome – The Effects of Semi-Starvation

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Therapy Blueprint (Universal)

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Transdiagnostic Cognitive Behavioral Model Of Eating Disorders (Fairburn, Cooper, Shafran, 2003)

Transdiagnostic Cognitive Behavioral Model Of Eating Disorders (Fairburn, Cooper, Shafran, 2003)

Uncertainty Beliefs – Experiment Record

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Understanding Anorexia

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  • Test (PDF) Download Primary Link Archived Link
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  • Reference Garner et al. (1982). The Eating Attitudes Test: Psychometric features and clinical correlates. Psychological Medicine, 12, 871-878
  • Interview Download Primary Link Archived Link
  • Questionnaire (EDE-Q) Download Primary Link Archived Link
  • Questionnaire for Adolescents (EDE-A) Download Primary Link Archived Link
  • Reference Fairburn, C. G., Cooper, Z., & O’Connor, M. (1993). The eating disorder examination. International Journal of Eating Disorders, 6, 1-8.
  • Scale Download Primary Link Archived Link
  • Reference Tatham, M., Turner, H., Mountford, V. A., Tritt, A., Dyas, R., & Waller, G. (2015). Development, psychometric properties and preliminary clinical validation of a brief, session‐by‐session measure of eating disorder cognitions and behaviors: The ED‐15. International Journal of Eating Disorders, 48(7), 1005-1015.
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  • Cognitive Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR): patient and family workbook | Thomas, J.J, Eddy, K.T | 2019 Download Primary Link Archived Link
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  • Module 4: Self-Monitoring Download Primary Link Archived Link
  • Module 5: Food And Energy Download Primary Link Archived Link
  • Module 6: Eating For Recovery - Part 1 Download Primary Link Archived Link
  • Module 6: Eating For Recovery - Part 2 Download Primary Link Archived Link
  • Module 8: Binge Eating Download Primary Link Archived Link
  • Module 9: Purging Download Primary Link Archived Link
  • Module 10: Driven Exercise Download Primary Link Archived Link
  • Module 11: Body Image 1 - Body Checking Download Primary Link Archived Link
  • Module 12: Body Image 2 - Body Avoidance Download Primary Link Archived Link
  • Module 13: Core Beliefs Download Primary Link
  • Module 14: Maintaining Your Gains And Dealing With Setbacks Download Primary Link Archived Link
  • Appendix: Getting Educated About Eating Disorders Download Primary Link Archived Link

Treatment Guide

  • Eating Disorders: Recognition And Treatment (NICE Guideline) | NICE | 2020 Download Primary Link
  • Maudsley Service Manual For Child And Adolescent Eating Disorders | Eisler, Simic, Blessitt, Dodge | 2016 Download Primary Link Archived Link
  • Eating disorders: recognition and treatment | National Institute for Health and Care Excellence (NICE) | 2020 Download Primary Link Archived Link
  • Group cognitive remediation therapy for adolescents with anorexia nervosa: The flexible thinking group | Maiden, Baker, Espie, Simic, Tchanturia | 2014 Download Primary Link Archived Link
  • Eating disorders from the inside out | Dr Laura Hill | 2012 Download Primary Link
  • Change Process Balance Sheet Download Primary Link Archived Link
  • Tackling Avoided Foods Download Primary Link Archived Link
  • Self-Monitoring Form Download Primary Link Archived Link
  • Blank Monitoring Record | CREDO Download Primary Link Archived Link

Recommended Reading

  • Cooper, Z., Fairburn, C. (2009). Management of bulimia nervosa and other binge-eating problems. Advances in Psychiatric Treatment, 15, 129-136 Download Primary Link
  • Cooper, Z., & Fairburn, C. G. (2011). The evolution of “enhanced” cognitive behavior therapy for eating disorders: Learning from treatment nonresponse. Cognitive and behavioral practice, 18(3), 394-402 Download Primary Link
  • Murphy, R., Straebler, S., Cooper, Z., & Fairburn, C. G. (2010). Cognitive behavioral therapy for eating disorders. Psychiatric Clinics of North America, 33(3), 611-627 Download Primary Link
  • Pallister, E., & Waller, G. (2008). Anxiety in the eating disorders: Understanding the overlap. Clinical psychology review, 28(3), 366-386. Download Archived Link
  • Wade, T. D., Shafran, R., Cooper, Z. (2023). Developing a protocol to address co-occurring mental health conditions in the treatment of eating disorders. International Journal of Eating Disorders Download Primary Link
  • Waller, G. (2016). Recent advances in psychological therapies for eating disorders. F1000Research, 5. Download Primary Link

What Are Eating Disorders?

Signs and symptoms of eating disorders.

Common to many of the eating disorders are a preoccupation with weight and body shape, significant anxiety about gaining weight, and behaviors intended to mitigate the anxiety.

Symptoms of anorexia nervosa may include:

  • restriction of energy intake leading to weight that is less than minimally normal or expected in the context of age, sex, developmental trajectory, and physical health;
  • an intense fear of gaining weight, an intrusive dread of fatness, or persistent behavior that interferes with weight gain;
  • disturbed perception of one’s body weight (e.g., a self-perception of being too fat);
  • self-evaluation is unduly influenced by body weight or shape;
  • a persistent lack of insight regarding the seriousness of low body weight;
  • endocrine disorder resulting in amenorrhea or loss of sexual interest or potency.

Symptoms of bulimia nervosa include:

  • recurrent episodes of binge eating (overeating) where excessively large amounts of food are consumed in a discrete period of time;
  • a feeling of lack of self-control over eating during a binge-eating episode;
  • recurrent behaviors to counteract weight gain such as self-induced vomiting, purging, fasting, use of drugs, diuretics, or excessive exercise;
  • a self-perception of being too fat and an intrusive dread of fatness.

Psychological Models and Theory of Eating Disorders

Fairburn, Cooper, and Shafran (2003) proposed a transdiagnostic cognitive behavioral model of eating disorders that describes the maintenance of both anorexia nervosa and bulimia nervosa. Central to the model is the individual’s judgment of their self-worth in terms of body weight or shape. Disordered eating behaviors are understood as a consequence of these self-beliefs.

Evidence-Based Psychological Approaches for Working with Eating Disorders

Enhanced cognitive behavior therapy for eating disorder (cbt-e).

In 2003, Fairburn et al. argued for value in viewing eating disorders from a transdiagnostic perspective. They say that common mechanisms, such as a restricted assessment of self-worth, underpinned both anorexia and bulimia. CBT-E includes elements that focus on modification of eating habits, weight-control behavior, and concerns about eating, shape, and weight.

Family-Based Treatment (FBT) / Maudsley Family Therapy

FBT is an outpatient, intensive treatment in which the family is used as the primary resource to renourish the affected child or adolescent. It is described as a highly practical approach that attempts to modify problems in family structure that make refeeding more difficult (Lock and le Grange, 2005). Average length of treatment is 9–12 months. A 2013 meta-analysis indicated that individual therapy and FBT were equivalently effective at the end of treatment, but that FBT was superior at 6–12 month follow-up (Couturier, Kimber, & Szatmari, 2013).

Resources for Working with Eating Disorders

Psychology Tools resources available for working therapeutically with eating disorders may include:

  • psychological models of eating disorders including anorexia and bulimia
  • information handouts for eating disorders including anorexia and bulimia
  • exercises for eating disorders including anorexia and bulimia
  • CBT worksheets for eating disorders including anorexia and bulimia
  • self-help programs for eating disorders including anorexia and bulimia
  • Couturier, J., Kimber, M., & Szatmari, P. (2013). Efficacy of family‐based treatment for adolescents with eating disorders: A systematic review and meta‐analysis. International Journal of Eating Disorders , 46 (1), 3–11.
  • Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviourtherapy for eating disorders: A ‘transdiagnostic’ theory and treatment. Behaviour Research and Therapy , 41 (5), 509–528.
  • Lock, J., & le Grange, D. (2005). Family‐based treatment of eating disorders. International Journal of Eating Disorders , 37 (S1), S64–S67.
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CBT for eating disorders: What is it and how does it work?

  • March 8, 2023

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Written by Oxford CBT therapist Paul Jenkins .

CBT Eating Disorders

Many people do not seek help for an eating disorder (ED) and, of those who do, some do not receive ‘evidence-based treatments’ – that is, a psychological therapy which has shown to be effective in several research studies.  Issues such as stigma and previous experiences can get in the way of people getting the help they need.

It can sometimes be confusing knowing what the ‘best’ psychological therapy is and, indeed, no therapy has been proven to be 100% effective.  However, knowing what to expect before seeking professional support can certainly help in being prepared and can also get you thinking about what kind of treatment might work.

What follows below is a guideline for the treatment of EDs in adults, with a particular focus on a treatment known as CBT (Cognitive Behaviour Therapy).  This is a type of psychological therapy that focuses on changing thoughts and behaviours and, in its many forms, is used as a treatment for a variety of psychological problems.  There are similar treatments available for young people, although they can vary in their approach due to the different needs of this population.

CBT has been adapted to work with eating disorders.  The term “CBT-ED” is an umbrella term used to refer to all ‘evidence-based’ forms of CBT for EDs.  There are different varieties (a bit like different varieties of apples, for example!), which all have slightly different formats but which share the approach of encouraging behavioural change to address the thoughts and emotions that underpin eating disorders .

CBT-ED has been widely researched and recommended in several national guidelines , including those in the UK. It is effective for all types of eating problems, including anorexia nervosa, binge-eating disorder, and bulimia nervosa. In general, around two-thirds of those who complete treatment will do well.

CBT-ED typically lasts 20 sessions (for those who are not underweight) and up to 40 sessions (for those who are underweight).  There is also a 10-session course of treatment (known as CBT-T).  You can therefore expect treatment to last several months and, if you are underweight, perhaps longer than this.

How Will I Know if I’m Getting CBT-ED?

As CBT-ED is a personalised treatment, it is likely to be delivered slightly differently from therapist to therapist and treatment recommendations within EDs vary (e.g., treatment duration for anorexia nervosa is typically longer due to the need to restore weight).  However, there are several elements of CBT-ED that should, in the vast majority of cases, be delivered uniformly.  Although not an exhaustive list, CBT-ED should include :

– Creation of a personalised treatment plan (usually referred to as a formulation) that shows the key factors maintaining the eating problem.  These might include things like the perceived importance of weight and shape and the presence of low weight (if applicable);

– Regular self-monitoring of dietary intake and associated thoughts and feelings.  Such diaries are usually completed by the patient daily and shared with the therapist;

– Advice to eat regular meals and snacks to avoid feeling hungry, particularly in the early stages of treatment;

– Completion of ‘homework’ (i.e., tasks carried out between sessions to help practice what is learned in sessions);

– Reference to useful self-help materials, such as books or worksheets – particularly those written from a CBT perspective;

– Regular weighing – typically once per week;

– A focus on making early change, typically achieved by changing eating behaviour soon in treatment;

– Discussion of related areas (e.g., low self-esteem), although this is usually postponed until a significant behavioural change has been observed (e.g., reduction in the frequency of binge eating, weight restoration);

– Spacing sessions further apart towards the end of treatment (e.g., fortnightly) and focusing on the maintenance of change and minimising the risk of relapse.

Some Caveats

For those who are overweight, CBT generally advises treating the ‘eating disorder’ before addressing obesity or other weight-related issues.  Although weight loss can be an appropriate goal for some people, this is best left until the eating disorder is addressed, by which point a decision about weight loss can be made.  In any case, body acceptance is an important component of most psychological interventions for disordered eating.

As an ‘individual’ treatment, significant others are not routinely included but there is the facility for this to happen if doing so can help facilitate treatment (and is acceptable to the patient).  This is rarely the case in every session but, rather, a few of these sessions (which take place straight after a one-to-one session) can be conducted throughout treatment.  (Again, there are some notable differences here regarding the treatment of younger patients.)

Finally, some treatments advocate the provision of sessions twice per week in the initial phases.  This is usually used to promote initial behavioural change and will become weekly after a change has been achieved.

Are There any Checklists I can Use to See if I’m Getting CBT?

An Australian team led by Tracey Wade designed a 15-item checklist to help patients identify evidence-based treatment for EDs.  Although some items are unique to the Australian context, they included questions such as whether the therapist is registered with a professional body, whether the therapist receives regular supervision specific to EDs, whether treatment focuses on early (behavioural) change, how many sessions are planned, and how / whether other healthcare professionals (e.g., GPs, dietitians) are involved.

There is also a guide describing the core features of CBT-E, a particular form of CBT-ED, available here .  This has some similarities with Wade and colleagues’ checklist, such as a focus on early change, but also notes some important features of CBT-E, such as the use of ‘self-monitoring’, ‘open’ weighing, and regular eating.

Are there Any Therapist Registers?

There are several professional bodies in the UK with which therapists might be registered.  These include the British Association for Behavioural and Cognitive Psychotherapies (BABCP) and the British Association for Counselling and Psychotherapy (BACP).  Registration and/or accreditation with a professional body does not guarantee experience with EDs but does mean that registrants will be asked to demonstrate that they meet certain standards of proficiency, training, and experience and to adhere to a code of ethics and conduct.

Supervision is a common practice of psychological therapists whereby they discuss elements of their work (including detail of what is covered in sessions) with another practitioner.  This is typically ‘confidential’ (in the sense that patients’ full names are rarely used) and usually with a therapist with similar experience and training.  However, supervision is important for the appropriate delivery of CBT and helps protect patients from harm.  In EDs, therefore, it is typically an expectation that therapists will have ED-specific supervision to support them in their work.

What Should I Do if I Am (or Someone I Know is) Thinking of Starting Therapy for an Eating Disorder?

If you’re thinking about starting psychological treatment for an eating disorder, it might be worth considering some of the elements mentioned above and discussing these at your assessment. Most therapists will be open to discussing these. As mentioned above, CBT-ED can (and, perhaps, should) be delivered in different ways but it is important that you are satisfied with the responses your therapist gives.

Starting treatment is a difficult step and treatment itself can involve many challenges. Knowing what to expect will help you get the help you need to recover.

If you would like an idea of your present needs try our online self assessment quiz here .

All clinicians at Oxford CBT practice  Cognitive Behavioural Therapy , or are Psychologists, providing evidence-based interventions and support for a range of issues for both young people and adults. If you would like to book an appointment you can do so on our  online booking portal . If you have a question please get in touch via our  online contact form  or call us on 01865 920077.

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Eating Disorders

Eating disorders are serious behavioral health conditions that often have devastating physical health consequences. Individuals who severely restrict their caloric intake, or engage in compensatory behaviors like self-induced vomiting often experience increased mortality due to extreme stress caused to the various organs of the body.

How CBT Can Help

CBT therapists educate clients about their diagnosis and about CBT, help them set goals, and teach essential thinking and behavioral skills. CBT techniques for eating disorders focus on the thoughts and beliefs that lead to the disordered eating, as well as emphasize behavior changes that promote healthy eating and reduce compensatory behaviors. CBT therapists identify thoughts and beliefs that contribute to over-valuation of body shape and weight, and work with clients to evaluate and change their negative self-image. 

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Cognitive behavioral therapy (CBT) for eating disorders

cbt homework for eating disorders

What is cognitive behavioral therapy?

Cognitive behavioral therapy (CBT) is a type of psychological treatment that involves talking about a recurring problem with a trained mental health therapist. Sometimes called “talk therapy,” this method is often used to address the challenges behind complications like depression, drug and alcohol use, anxiety disorders, and eating disorders .

The goal of CBT is to help patients recognize both their challenging behaviors and the unhelpful thought patterns they stem from. Once a pattern is recognized, the therapist will work with the patient to help instill different problem-solving skills, allowing the patient to manage, and eventually, overcome these patterns of disordered eating.

The overall idea underpinning cognitive behavioral therapy is that these difficult behaviors and thought patterns are learned, and , with help and persistence, can be unlearned and replaced with healthier strategies for dealing with life’s stressors.

How to treat eating disorders with cognitive behavioral therapy

According to the American Psychiatric Association, eating disorders of all types affect nearly 5% of the population. (1)

Cognitive behavioral therapy has long been used as a way to help people struggling with eating disorders, and some studies support the idea that the method can be very effective.

How are eating disorders treated with cognitive behavioral therapy?

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes four broad types of eating disorders: anorexia nervosa (AN); bulimia nervosa (BN); other specified feeding or eating disorder (OSFED); and binge eating disorder (BED). While they may manifest differently, they all have a core issue in common: the over-importance placed on shape, size, and weight and disordered patterns of eating.

When used to treat eating disorders, cognitive behavioral therapy focuses on dismantling this central belief and the processes used by patients to maintain their condition. 

This is often done by having the patient complete certain tasks at home, including: (2)

  • “Challenging” their eating patterns
  • Keeping a food log and/or daily journal
  • Exposing themselves to feared foods, such as those high in carbs or fat
  • Meal planning
  • Weekly weighing

Other methods are used to replace unhelpful thought patterns—such as the “all or nothing” mindset behind many eating disorder cases—with more nuanced or long-term perspectives. Patients practice with games, puzzles, and other exercises to help instill these new views. (3)

Patients are also given a psychoeducation to help understand the causes of their condition. This allows them to better recognize signs of their unhelpful thought patterns and gives them a better chance to prevent relapse through intervention.

What to expect in cognitive behavioral therapy?

Cognitive behavioral therapy is a structured form of psychotherapy, typically involving a number of sessions over a number of weeks. The sessions can be one-on-one or take place in a group setting. Specific goals are also set at the start and worked toward through a series of in-office evaluations and at-home “homework” assignments.

During the initial meetings, therapists talk to patients about their specific concerns, as well as their mental and physical health history. It may take several sessions for a therapist to get a handle on all the specifics of the case.

As time goes on, the sessions will focus more on four major goals: (2)

  • Identifying unhelpful thought and behavioral patterns.,
  • Uncovering the thoughts, emotions, and beliefs behind those patterns.,
  • Recognizing any negative or inaccurate emotions, thoughts or beliefs behind those patterns
  • Reshaping those unhelpful thoughts

A number of methods are used in unearthing and changing these cognitive patterns. One example is “homework assignments.” Patients are asked to try certain things at home, as tools to reinforce realizations, break unhelpful patterns, or instill new problem-solving strategies.

At the end of the session (typically 20-40 weeks but can be longer), patients are once again evaluated by their therapist, and a future course of action is decided, based upon their progress.

Types of cognitive behavioral therapy

Much like “eating disorder,” cognitive behavioral therapy is an umbrella term. 

There are many different variations on CBT. While all are centered around the idea that learned behaviors and thought patterns can be changed for the better, they use slightly different approaches to achieve that goal.

One popular method is called acceptance and commitment therapy (ACT). Like its name may suggest, this form of CBT involves a patient learning to accept their thoughts for what they are, rather than feeling guilty for them. Paired with other mindfulness-based teachings, ACT also stresses the need to commit to a problem head-on, rather than running away from or avoiding it.

Cognitive remediation therapy (CRT) is another commonly employed form of CBT. It’s a group of exercises that help patients reinforce new thinking patterns and problem-solving skills, using games, puzzles, and other brain-building routines. CRT also gets patients to recognize the importance of the process, rather than the content of their thoughts. (4)

Many therapists have also started using a version of CBT called enhanced cognitive behavioral therapy (CBT-E). This method has been adapted to address the similar underlying issues at play in most eating disorders. CBT-E also focuses more on addressing outside obstacles that could prevent a patient from getting better. (2)

Many of these methods are more effective in tandem, and it’s not unusual for therapists to use several different CBT approaches with the same patient.

Evaluating cognitive behavioral therapy as an eating disorder treatment

Approximately one-third (33.8%) of patients with anorexia nervosa, 43.2% with bulimia nervosa, and 43.6% with binge eating disorder sought treatment at some time in their life, according to a poll by the National Comorbidity Survey Replication. (5)

But how effective is CBT in particular?

What are the benefits of CBT?

Originally developed to help treat depression, cognitive behavioral therapy has been used for eating disorders since the 1970s, with many found benefits.

First, the method is structured, giving patients a clear idea of what they can expect, from the amount of time they must dedicate to treatment to overall goals. This format also makes CBT easily adaptable, and it can be administered in group settings, one-on-one, or even as a self-help guide.

The sessions can span around 20 weeks—a much shorter timeframe than many other therapeutic methods. Interpersonal psychotherapy , for example, can take as long as 13 to 17 months to achieve the same results as CBT. (2) But treatment can also continue for a much longer time period, as eating disorders are complex conditions that often go unrecognized for years. In many cases, eating disorders may take years to treat, and recover from. 

Cognitive behavioral therapy aims to redirect the type of thinking that allows unhelpful behavior to continue. In particular, the methods ACT and CRT employ have been found to enhance something known as cognitive flexibility—an underlying issue in many eating disorders. (6)

Adults struggling with bulimia nervosa and not otherwise specified (NOS) eating disorders have responded particularly well to CBT practices. In fact, cognitive behavioral therapy is considered the leading evidence-based treatment for bulimia nervosa by some. (7)

What are the limitations of CBT?

CBT’s structured nature is not for everyone, especially those with more complex or overlapping issues. The homework portion of the therapy is also not a great tool for every individual, as some people may find it burdensome or live in an environment that makes completing the tasks difficult.

Cognitive behavioral therapy also embodies the old adage that says, you can bring a horse to water, but you can’t make them drink. While it’s possible to point out to patients the mechanics behind their emotional reactions and behavioral patterns, change will only happen if and when the patient is ready to embrace it.

This is why traditional “talk” therapy treatment approaches may not work for some people. As its name suggests, CEBT is very cognitive in focus, with emphasis placed on the mind, thinking, and talking. This is sometimes referred to as “top-down” therapy. 

But there are many other types of therapies that focus on the body, the senses and feelings–or “bottom-up” processing–that can be effective when talk therapy “hits a wall.” These include art therapy, dance, movement, or yoga therapy, eye-movement desensitization and reprocessing (EMDR), somatic experiencing therapy. 

Sometimes called alternative therapies, these modalities can help patients explore feelings and memories that may be buried or deeply entrenched beliefs that traditional talk therapy may not be able to access. These body-focused methods can be more effective in treating emotional, physical, and sexual trauma, which can play a significant role in the development of eating disorders. This type of care is sometimes referred to as “trauma-informed” care.

There has also been some dispute over CBT clinical trials. While it is widely regarded as an effective practice, some in the psychiatric community have argued that CBT clinical trials have been small and less diverse than other studies. Results of these studies have also compared CBT treatment against no treatment at all, or forms of “pseudotherapy,” rather than other forms of psychotherapy, others have noted. (8)

Efficacy of cognitive behavioral therapy in healing eating disorders

Yet, cognitive behavioral therapy continues to receive high marks in clinical trials for treating eating disorders.

One 2014 study compared a group of patients undergoing CBT for bulimia nervosa against a group of patients receiving psychoanalytic psychotherapy. (9) At the end of their five-month course of treatment, 42% of patients in the CBT group had stopped binge-and-purging behavior, compared to 6% in the psychoanalytic group. Within two years, 44% of the CBT group were no longer showing signs of BN, compared to 15% in the psychoanalytic group.

Results for CBT-E proved even better in a 2015 study, where it was compared against interpersonal psychotherapy (IPT). (10) Within the CBT-E group, 66% of patients were considered in remission by the end of their 20-week session. Just 33% of the IPT group reached that point at the 20-week benchmark.

And a 2018 review of CBT-E found the method to not only be effective for curbing bulimia nervosa, but also much more cost effective for patients, versus psychoanalytic psychotherapy. (11)

While more research on CBT’s effectiveness in treating eating disorders is needed, especially in adolescents, the data so far is encouraging, especially for those struggling with bulimia nervosa and not otherwise specified (NOS) eating disorders.

Cognitive behavioral therapy at Within Health

At Within Health our clinical care team incorporates CBT into many of our treatment programs, and group therapy sessions. Our team will work with you to get to the core of understanding the connection between your thoughts, emotions, and behaviors, and how they each influence your relationship with food. We will also help you identify better coping skills, particularly for managing any underlying mental health conditions, like depression or anxiety. Our clinicians apply a trauma-informed approach to treating people with eating disorders, as we understand the interconnectedness of trauma in the disordered eating space. We offer clinically-superior compassionate programs built to suit the needs of each individual client. 

‍ All of the programs, and group therapy sessions offered at Within Health happen remotely, as we provide virtual care programs . If you’d like to learn more about how we apply CBT principles in our treatment of people with eating disorders, as well as the benefits of compassionate care, please call our clinical team today.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.

  • American Psychiatric Association. (2021, March). What are Eating Disorders?
  • Psychiatric Clinics of North America. (2010, September). Cognitive Behavioral Therapy for Eating Disorders .
  • Lindvall Dahlgren, C., van Noort, B.M., Lask, B. (2015). The Cognitive Remediation Therapy (CRT) Resource Pack for Children and Adolescents with Feeding and Eating Disorders . Oslo University Hospital.
  • Shanghai Arch Psychiatry. (2017, December). The Application of Cognitive Remediation Therapy in The Treatment of Mental Disorders .
  • National Institute of Mental Health. Eating Disorders .
  • Plos One. (2012, January). Poor Cognitive Flexibility in Eating Disorders: Examining the Evidence using the Wisconsin Card Sorting Task .
  • Behavior Research and Therapy. (2017, January). Evolution of cognitive-behavioral therapy for eating disorders .
  • The BMJ . (2002, February). All you need is cognitive behaviour therapy?
  • The American Journal of Psychiatry. (2014, January). A Randomized Controlled Trial of Psychoanalytic Psychotherapy or Cognitive-Behavioral Therapy for Bulimia Nervosa .
  • Behaviour Research and Therapy. (2015, July). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders .
  • Current Opinion in Psychiatry. (2018, November). Enhanced cognitive behavioural therapy for patients with eating disorders a systematic review .

Further reading

cbt homework for eating disorders

Interpersonal psychotherapy for eating disorders

cbt homework for eating disorders

Emotion-focused therapy for eating disorders

cbt homework for eating disorders

Experiential therapy for eating disorders

cbt homework for eating disorders

Using radically open dialectical behavior therapy to treat eating disorders

Exposure therapy for eating disorders, group therapy for eating disorders.

cbt homework for eating disorders

Self-help and eating disorder treatment

cbt homework for eating disorders

Psychoanalysis

cbt homework for eating disorders

Medical nutrition therapy for eating disorder recovery

cbt homework for eating disorders

Group therapy for eating disorder treatment

cbt homework for eating disorders

Family-based therapy for treating eating disorders

cbt homework for eating disorders

Exposure therapy for eating disorder treatment

cbt homework for eating disorders

Dialectical behavior therapy (DBT) for eating disorders

cbt homework for eating disorders

Cognitive emotional behavioral therapy

cbt homework for eating disorders

Art therapy for eating disorders treatment

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Cognitive Behavioral Therapy (CBT) for Eating Disorders

Cognitive Behavioral Therapy (CBT) is used by psychologists worldwide for many disorders. Similarly, CBT is the leading treatment option for eating disorders such as binge eating , anorexia nervosa, bulimia nervosa, and avoidant restrictive food intake disorder (ARFID). Cognitive behavioral therapy can be used in both outpatient and inpatient settings. The following section will explore what CBT is and the ways CBT helps aid individuals affected by these eating disorders.

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy is a form of psychotherapy in which patients meet with their therapist to talk about their issues. Their therapists help guide them in becoming more aware of their negative thought processes and help them develop healthy coping mechanisms to better combat their negative thoughts and tackle their issues in a more coherent and effective way. It is the most preferred type of psychotherapy and can be used to treat a wide range of issues with fewer sessions. 

It emphasizes an active partnership between the patient and the therapist, often involving homework outside of the sessions. In some cases, CBT is paired with medications to better support the treatment process. Due to CBT’s exploratory nature into the patient’s emotional well being, it can be uncomfortable at times . It forces the individual to face themselves and their problems head on, and for most people that thought can be extremely intimidating and painful. However with an open mindset, it is proven to be very effective and long lasting.

How does CBT Help Combat Eating Disorders?

Because cognitive behavioral therapy involves the patient working with a therapist to develop techniques to combat negative and distorted thoughts about oneselves or situations, it has been found to be highly effective when treating eating disorders. Eating disorders such as binge eating, anorexia, bulimia, and ARFID often have the people affected by them to become highly critical of their behaviors and body image . 

Treatment involving CBT for eating disorders typically involves a whole team of professionals:

  • Nutritionist
  • Psychiatrist
  • Healthcare physician

Depending on the stage the individual is at on their journey to recovery, all or only some of the aforementioned are necessary. Similarly, outpatient versus inpatient care is determined by the individual’s stage of recovery. The aim of CBT with eating disorders is to normalize healthy eating behaviors and how the patient responds to food. 

Cognitive Behavioral Therapy for Binge Eating

Binge eating is characterized by an individual who experiences recurrent episodes of eating large amounts of food to the point of discomfort. They often feel out of control during the episodes followed by feelings of shame and guilt. Usually, they do not engage in purging or rigorous workouts to compensate for their episodes. The following section will outline the steps taken to combat binge eating through the use of cognitive behavioral therapy:

  • Patients will meet with their therapist to begin addressing their negative behaviors and thoughts associated with binge eating disorder. 
  • Therapists will educate their patients on the benefits of balanced eating and nutrition.
  • Healthy coping strategies will be developed to combat negative emotions that trigger binge eating episodes.
  • Implementation of the healthy coping strategies will allow the patient to improve their self esteem and combat the disorder.

Get Binge Eating Disorder Treatment

Cognitive Behavioral Therapy for Anorexia

Anorexia is characterized by a severely restrictive diet and/or avoidance of food. People suffering from this disorder will go to extreme measures to control their weight. Excessive exercising, controlling their caloric intake, and misusing laxatives, diuretics, and diet aids are some examples of the measures they use. CBT has proven to be effective however, the best results are achieved through in-patient care. Anorexia has the highest mortality rate making it dangerous and a difficult eating disorder to overcome. 

Enhanced Cognitive Behavioral Therapy (CBT-E)

Patients suffering with anorexia nervosa go through enhanced CBT on their journey to recovery. The primary reason for this is CBT-E is the ideal form of treatment for people who are at a minimal body weight range or higher. The process can take up to  20 sessions over 20 weeks; if the individual is severely underweight sessions can last 40 plus weeks. The following will outline the steps taken between the patient and therapist throughout the CBT-E process:

  • Step 1 – Educate the patient on anorexia, and focus on stabilizing eating patterns, and understanding/combating negative emotions surrounding the disorder. 
  • Step 2: Progress check and goals are set. A continuation of healthy coping mechanisms are practiced. 
  • Step 3: Weekly sessions are focused on behaviors and symptoms. Homework is focused on improving daily function and moods. 
  • Step 4: Relapse prevention is focused on through managing setbacks and focusing on the future of the patient’s recovery.

Get Anorexia Nervosa Treatment

Cognitive Behavioral Therapy for Bulimia

Bulimia is characterized by the individuals’ obsessive need to control their weight through extreme dietary measures following a binge eating episode to make up for their sense of loss of control. Although purging bulimia is more prevalent among people suffering, there are two types – purging and nonpurging. The misuse of diuretics and laxatives are also common. While bulimia and anorexia can have similar criteria for diagnosis, the main difference is that food restriction practices with people suffering from bulimia are interrupted by an episode of binge eating. Evidence shows, CBT is the number one combative practice for adults with bulimia. The following section will outline the process patients will undergo:

  • Engage in 20 sessions in which they will identify their negative thoughts and feelings toward their eating habits with their therapist.
  • Become educated on the disorder and healthy practices for eating as well as retraining their thoughts.
  • Engage in outside homework focused on improving their self esteem and their relationship with food.

Get Bulimia Nervosa Treatment

Cognitive Behavioral Therapy for ARFID

Avoidant restrictive food intake disorder is characterized by the avoidance of food due to the individuals eating or feeding disturbance based on sensory characteristics of food and/or the lack of interest in eating. Most people with ARFID started out as a typical picky eater in early childhood. This disorder can lead to malnutrition and low energy levels. 

While ARFID is a fairly new recognized eating disorder, cognitive behavioral therapy for ARFID (CBT-AR) has shown to be highly effective for ages 10 and up. The following section will outline the steps taken to help individuals suffering with ARFID:

  • Consists of 20 to 30 sessions between the therapist and patient.
  • Therapists will incorporate parent/family involvement for younger patients.
  • Step 1: Education on ARFID and zoning in on the patients avoidant patterns paired with psychotherapy. 
  • Step 2: Goals are set through exploratory collaboration between the therapist and patient on how to overcome barriers for treatment.
  • Step 3: Patient actively works through their food aversions and fears. Exposure of food and volume increase is encouraged.
  • Step 4: Prevention plan for relapse is discussed by encouraging patients to use the tools obtained through treatment to ensure their long term success after treatment is complete.

Each session is structured with clear goals in mind and continued practice through outside homework helps patients stay on track. Patients’ nutritional deficiencies should decline, and they should be able to eat several foods from each food group by the end of treatment. 

Get ARFID Treatment

Get Cognitive Behavioral Therapy for Eating Disorders

If you or a loved one suffer from an eating disorder, it may seem like a hopeless journey full of pain and disappointments. But there is hope! Find a mental health professional that treats eating disorders .

https://www.verywellmind.com/cognitive-behavioral-therapy-for-eating-disorders-4151114

https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bed

https://www.waldeneatingdisorders.com/blog/cognitive-behavioral-therapy-binge-eating-disorder-8-key-treatment-benchmarks/

https://www.mayoclinic.org/diseases-conditions/anorexia-nervosa/symptoms-causes/syc-20353591

https://www.verywellmind.com/yes-eating-disorders-can-be-deadly-1138269

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928448/

​​ https://www.nationaleatingdisorders.org/learn/by-eating-disorder/arfid

https://columbuspark.com/2021/02/02/arfid-treatment-cognitive-behavioral-therapy-for-arfid-cbt-ar/

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Author: Anthony Bart

Anthony Bart is a huge mental health advocate. He has primarily positioned his marketing expertise to work with mental health professionals so that they can help as many patients as possible. He is currently the owner of BartX, TherapistX, and TherapyByPro.

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  • Eating Disorders

CBT-E for Adolescents with Eating Disorders

Cbt-e is an alternative to fbt for adolescents with eating disorders..

Posted January 31, 2020 | Reviewed by Chloe Williams

  • What Are Eating Disorders?
  • Find a therapist to heal from an eating disorder

Eating disorders have a profound impact on the physical health and psychological and interpersonal development of adolescents. Early intervention and effective treatment are essential in order to avoid long-lasting psychological and medical complications including, in some cases, an early death.

A specific form of family therapy , termed family-based treatment (FBT), is the leading evidence-based treatment for adolescents with anorexia nervosa. There is also some more limited support for its use with young people with bulimia nervosa and its variants. However, FBT is not embraced by all families and patients because it requires parents to participate at sessions and that parents control the eating of their child. It’s also is labor-intensive, and fewer than half of patients exhibit a full recovery. These considerations indicate that alternative approaches are needed.

CBT-E (Enhanced Cognitive Behavior Therapy)

CBT-E was developed to address the psychopathology of eating disorders in adults, rather than a specific eating disorder diagnosis. It is a treatment for all forms of eating disorders including anorexia nervosa, bulimia nervosa, binge-eating disorder, and other similar states​.

When working with people who are not significantly underweight, CBT-E generally involves an initial assessment appointment followed by 20 individual treatment sessions over 20 weeks, lasting 50-minutes each.

With people who are underweight, treatment needs to be longer, often involving around 40 sessions over 40 weeks. In this version of CBT-E, weight regain is integrated with addressing eating disorder psychopathology. Before embarking on weight regain, patients and therapists spend the first weeks of this treatment carefully considering the reasons for and against this change. The goal in CBT-E is for patients themselves to decide to regain weight rather than having this decision imposed upon them. During the final step of weight regain, the patients are helped to successfully maintain their weight.

CBT-E can be delivered in two forms: (1) a “focused” form, which exclusively addresses the specific psychopathology of eating disorders, or (2) a “broad” form, which features specific modules to address one or more of the adjunctive mechanisms maintaining the eating disorder (i.e., clinical perfectionism , core low self-esteem , interpersonal difficulties, and mood intolerance).

CBT-E has been evaluated in numerous controlled and cohort clinical trials and is now recommended for all clinical forms of adult eating disorders.

CBT-E adapted for adolescents

CBT-E has been adapted for adolescents taking into account two distinctive characteristics, namely physical health and parental involvement. Indeed, some medical complications associated with eating disorders are particularly severe in this age range, therefore periodical medical assessments and a lower threshold for hospital admission are integral parts of CBT-E for adolescents. In addition, parental involvement in the treatment is required in the great majority of cases.

CBT-E has a number of features that make it well suited to adolescent patients with eating disorders. Firstly, it adopts a flexible and individualized approach, which is easily adaptable to the needs of adolescents’ cognitive development. Indeed, CBT-E isn’t a “one-size-fits-all” treatment. The therapist creates a specific version of CBT-E to match the exact eating problem of the person receiving treatment. Moreover, CBT-E is both comprehensible and easy to receive and promotes the pursuit of control and autonomy as it actively involves the patients in the decision to change. These are issues of major relevance to younger patients, who therefore respond favorably to a collaborative treatment such as CBT-E. Last but not least, CBT-E includes several strategies for actively engaging patients in the treatment, a feature that is vital for the management of adolescents who, by nature, are usually ambivalent about their treatment.

CBT-E for adolescents involves two preparatory/assessment sessions followed by three main steps: Step One – Starting Well and Deciding to Change; Step Two – Addressing the Change; Step Three – Ending Well. Treatment is delivered, as the adult version of CBT-E, by a single therapist in 20 sessions in not underweight patients, but in those patients who are underweight, treatment can be often concluded in 30 sessions, and it can be delivered in the “focused” or in the “broad” form.

Parents are asked to participate alone in an interview lasting approximately 90 minutes during the first week of the treatment. Subsequently, the patient and parents are seen together in sessions four to six (in patients who are not underweight) or sessions eight to ten (in patients who are underweight). Further, 15 to 20 minutes sessions are held immediately after the patient’s individual session. These joint sessions should inform parents about what is happening and the patient’s progress; they should also be used to discuss, with the patient’s prior agreement, how they might help the patient make changes.

How effective is CBT-E for adolescents?

To date, four different cohort studies on patients aged between 11 and 19 years assessed the effectiveness of CBT-E for adolescents. Three of the four studies investigated the effects on patients with anorexia nervosa, and one investigated the effects on non-underweight adolescents with other eating disorders. Findings from these studies showed that most adolescent patients with eating disorders agreed to address the treatment. In patients with anorexia nervosa who complete the treatment (60 to 65 percent) about 60 percent achieved a full response (i.e., normal weight and minimal eating disorder psychopathology), while about 70 percent of non-underweight patients displayed minimal residual eating disorder psychopathology, and half of those with prior episodes of binge-eating or purging reported no longer having them.

cbt homework for eating disorders

The results of these studies led the National Institute for Health and Clinical Excellence (NICE) guidelines to recommend CBT-E for adolescents with eating disorders as an alternative to FBT when FBT is unacceptable, contraindicated, or ineffective.

Conclusions

In conclusion, CBT-E is a promising treatment for adolescents with eating disorders. It has a number of advantages. It is acceptable to young people, and its collaborative nature is well suited to ambivalent young patients who may be particularly concerned about issues of control. The transdiagnostic scope of the treatment is an advantage as it is able to treat the full range of disorders that occur in adolescent patients. It therefore provides a strong alternative to FBT.

Dalle Grave, R. (2019). Cognitive-behavioral therapy in adolescent eating disorders. In J. Hebebrand & B. Herpertz-Dahlmann (Eds.), Eating disorders and obesity in children and adolescents (pp. 111-116). Philadelphia: Elsevier.

Dalle Grave, R., & Calugi, S. (2020). Cognitive behavior therapy for adolescents with eating disorders. New York: Guilford Press.

Dalle Grave, R., Sartirana, M., & Calugi, S. (2019). Enhanced cognitive behavioral therapy for adolescents with anorexia nervosa: Outcomes and predictors of change in a real-world setting. International Journal of Eating Disorders, 0(0). doi:10.1002/eat.23122

Lock, J., & Le Grange, D. (2019). Family-based treatment: Where are we and where should we be going to improve recovery in child and adolescent eating disorders. International Journal of Eating Disorders, 52(4), 481-487. doi:10.1002/eat.22980

National Institute for Health and Care and Clinical Excellence. (2017). Eating disorders: recognition and treatment | Guidance and guidelines | NICE. Retrieved from https://www.nice.org.uk/guidance/ng69

Riccardo Dalle Grave M.D.

Riccardo Dalle Grave, M.D., is head of the Department of Eating and Weight Disorders at the Villa Garda Hospital in Italy. He is the author of Cognitive Behavior Therapy for Adolescents with Eating Disorders.

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Home / Mental Health / What is disordered eating and when does it become an eating disorder?

What is disordered eating and when does it become an eating disorder?

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cbt homework for eating disorders

Disordered eating refers to a wide range of behaviors that involve eating in a way that prevents full participation in life activities or impairs healthy growth and development. At best, disordered eating can lead to physical and psychological symptoms in children and teens. At worst, disordered eating can develop into an eating disorder. Eating disorders refer to a number of related mental illness diagnoses that affect millions of Americans each year. If left untreated they can become life-threatening. Eating disorders have one of the highest rates of death associated with them of any mental health diagnosis. Though the phrase “ disordered eating” can be used to describe a range of problematic eating behaviors, there are specific criteria for eating disorders defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5 TR). These include anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant restrictive food intake disorder (ARFID), and other specified feeding and eating disorders.

Who is most at risk for eating disorders?

“More and more, our data suggests that eating disorders are much more equal opportunity and affect a much broader range of individuals than the stereotypical white, cisgender, wealthy, emaciated adolescent girl,” states Dr. Jocelyn Lebow, Ph.D., L.P., a clinical psychologist at Mayo Clinic in Rochester, Minnesota. Eating disorders affect people of all gender identities, ethnicities, cultures, ages and body sizes.

What causes eating disorders?

A variety of factors increase the risk of eating disorders including family history, trauma, weight-related bullying and many mental health diagnoses such as obsessive-compulsive disorder. People who identify as transgender or nonbinary also are at increased risk. One of the biggest risk factors, Dr. Lebow stresses, is any sort of dieting or food restriction, even when these behaviors begin as a result of good intentions to “get healthier” or even in response to advice from professionals. Certain sports where size or weight plays a role also can put young athletes at risk. Weight bias also increases the risk of eating disorders, which is important, as more than 40% of American adults report having faced some sort of stigma, teasing or unfair treatment related to their weight, according to the American Psychological Association. Additional culprits may include individual biology and personality traits, environmental triggers such as trauma, and societal influence including social media and the too-common unspoken narrative that “thin = good,” which is often referred to as the “thin ideal.”

When does being health-conscious cross over into eating disorder risk?

“In kids, one of the signs that eating behaviors have crossed the line is when we see a large deviation from their growth curve or trend. This doesn ‘ t just happen with weight loss; we also see it when kids stop making the gains in height or weight we’d expect based on their age,” says Dr. Lebow. Additional physiological warning signs can include:

* Changes to or even the loss of a period in girls.

* Abnormal lab values or negative change to vital signs.

* A stress fracture or other injury that indicates loss of bone strength.

Those symptoms occur frequently, but an eating disorder may still be present even if things look clinically normal.

Behaviorally, disordered eating often presents as inflexibility or rigidity around diet and exercise. For example:

* Are eating or exercise habits so rigid that they interfere with normal activities or functioning?

* Does the thought of eating certain foods provoke anxiety or fear?

* Can all different kinds of foods be enjoyed without significant guilt or overthinking?

Impairment or impact on life is key to look for. Although physiological markers also can be present in adults, someone is likely to be quite ill by the time they show up.

How can I address my concern about their eating with a family member or friend?

“There’s no guarantee it’s going to go well. That doesn’t mean you shouldn’t say something if you are worried,” states Dr. Lebow. She emphasizes the ideal approach should be free of blame or judgement, as eating disorders often are characterized by a lot of shame and suffering for the people who have them. Concerned friends and family should take a compassionate, respectful and direct approach. For example: “I’m concerned. I’m noticing you’re not eating very much. Do you think it might be a good idea to talk to your doctor about this?” This type of conversation, of course, depends on your relationship. If it is a child you’re concerned about, talk to their parent or guardian privately first.

What does treatment look like?

If you or a family member believes you may need treatment for an eating disorder, start with your primary care provider. They should be able to make an assessment, ensure your medical stability and determine the best treatment type. Treatment for eating disorders may occur in an outpatient, day treatment, inpatient or residential setting. Seek out a therapist and a registered dietitian who specializes in eating disorders. Eating disorder treatment is not something all therapists and dieticians are trained to do.

In children, family-based treatment (FBT) is the first line treatment for anorexia nervosa, while bulimia nervosa may be addressed through family-based treatment (FBT), enhanced cognitive behavioral therapy (CBT-E), dialectical behavior therapy (DBT), and acceptance and commitment therapy (ACT). For adults with anorexia nervosa, there are unfortunately no evidence-based outpatient approaches. Many adults with anorexia nervosa need to be treated in higher levels of care, like day treatment or residential programs. For adults with bulimia nervosa or binge-eating disorder, options include enhanced cognitive behavioral therapy (CBT-E), dialectical behavior therapy (DBT), acceptance and commitment therapy (ACT), or integrative cognitive-affective therapy (ICAT). Intervention options and recommendations are dependent on age, diagnosis, health status and severity.

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Supporting Homework Compliance in Cognitive Behavioural Therapy: Essential Features of Mobile Apps

1 Discipline of Psychiatry, Department of Medicine, Memorial University of Newfoundland, St. John's, NL, Canada

David Kreindler

2 Division of Youth Psychiatry, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

3 Centre for Mobile Computing in Mental Health, Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

4 Department of Psychiatry, University of Toronto, Toronto, ON, Canada

Cognitive behavioral therapy (CBT) is one of the most effective psychotherapy modalities used to treat depression and anxiety disorders. Homework is an integral component of CBT, but homework compliance in CBT remains problematic in real-life practice. The popularization of the mobile phone with app capabilities (smartphone) presents a unique opportunity to enhance CBT homework compliance; however, there are no guidelines for designing mobile phone apps created for this purpose. Existing literature suggests 6 essential features of an optimal mobile app for maximizing CBT homework compliance: (1) therapy congruency, (2) fostering learning, (3) guiding therapy, (4) connection building, (5) emphasis on completion, and (6) population specificity. We expect that a well-designed mobile app incorporating these features should result in improved homework compliance and better outcomes for its users.

Homework Non-Compliance in CBT

Cognitive behavioral therapy (CBT) is an evidence-based psychotherapy that has gained significant acceptance and influence in the treatment of depressive and anxiety disorders and is recommended as a first-line treatment for both of these [ 1 , 2 ]. It has also been shown to be as effective as medications in the treatment of a number of psychiatric illnesses [ 3 - 6 ]. Homework is an important component of CBT; in the context of CBT, homework can be defined as “specific, structured, therapeutic activities that are routinely discussed in session, to be completed between sessions” [ 7 ]. Completion of homework assignments was emphasized in the conception of CBT by its creator, Aaron Beck [ 8 ]. Many types of homework are prescribed by CBT practitioners, including symptom logs, self-reflective journals, and specific structured activities like exposure and response prevention for obsessions and compulsions. These can be divided into the following 3 main categories: (1) psychoeducational homework, (2) self-assessment homework, and (3) modality-specific homework. Psychoeducation is an important component in the early stage of therapy. Reading materials are usually provided to educate the client on the symptomatology of the diagnosed illness, its etiology, as well as other treatment-relevant information. Self-assessment strategies, including monitoring one’s mood using thought records, teach the patients to recognize the interconnection between one’s feelings, thoughts, and behaviors [ 8 ]. For example, depressed patients may be asked to identify thinking errors in daily life and document the negative influences these maladaptive thinking patterns can produce on their behaviors. Various psychiatric disorders may require different types of modality-specific homework. For example, exposure to images of spiders is a treatment method specific to arachnophobia, an example of a “specific phobia” in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) [ 9 ]. Homework is strategically created by the therapist to correct and lessen the patient’s psychopathology. The purpose of these exercises is to allow the patients to practice and reinforce the skills learned in therapy sessions in real life.

Homework non-compliance is one of the top cited reasons for therapy failure in CBT [ 10 ] and has remained a persistent problem in the clinical practice. Surveys of practitioners have suggested rates of non-adherence in adult clients of approximately 20% to 50% [ 10 , 11 ] while adherence rates in adolescents have been reported to be approximately 50% [ 12 ]. Many barriers to homework compliance have been identified in the literature; to facilitate discussions, they can be divided into internal and external factors. Internal factors originate from a client’s own psychological environment while external ones are created by external influences. Internal factors that have been identified include lack of motivation to change the situation when experiencing negative feelings, the inability to identify automatic thoughts, disregard for the importance or relevance of the homework, and the need to see immediate results [ 12 - 14 ]. Various external factors have also been identified, including the effort associated with pen-and-paper homework formats, the inconvenience of completing homework because of the amount of time consumed, not understanding of the purpose of the homework, lack of instruction, and failure to anticipate potential difficulties in completing the homework [ 14 - 16 ]. There is strong evidence suggesting that homework compliance is integral to the efficacy of CBT in a variety of psychiatric illnesses. In the treatment of depression with CBT, homework compliance has been correlated with significant clinical improvement and shown to predict decreases in both subjective and objective measures of depressive symptoms [ 17 - 23 ]. Similarly, homework compliance is correlated with short-term and long-term improvement of symptoms in anxiety disorders, including generalized anxiety disorder (GAD), social anxiety disorder (SAD), hoarding, panic disorder, and post-traumatic stress disorder (PTSD) [ 17 , 24 - 32 ]. Fewer studies have been done on homework compliance in other psychiatric conditions, but better homework compliance has been correlated with significant reductions in pathological behaviors in psychotic disorders [ 33 , 34 ], cocaine dependence [ 35 , 36 ], and smoking [ 37 ]. Two meta-analyses further support the notion that greater homework adherence is associated with better treatment outcomes in depression, anxiety-related disorders, and substance use [ 38 , 39 ].

The Utility of Technology in Enhancing CBT Homework

Despite its demonstrated efficacy, access to CBT (as well as other forms of psychotherapy) remains difficult due to the limited number of practicing psychotherapists and the cost of therapy sessions [ 40 ]. With the rise of mass-market mobile communication devices such as the iPhone or other kinds of mobile devices with app capabilities (smartphones), new solutions are being sought that will use these devices to provide therapy to patients in a more cost-effective manner. Mobile phones with app capabilities are portable devices that combine features of a cellphone and a hand-held computer with the ability to wirelessly access the Internet. Over time, ownership of mobile phones in North America has grown [ 41 , 42 ] and progressively lower prices have further reduced barriers to their use and ownership [ 43 , 44 ]. As more and more people acquire mobile phones, the acceptance of and the demand for mobile health solutions have been on the rise [ 45 ]. Boschen (2008), in a review predating the popularization of the modern mobile phone, identified the unique features of the mobile telephone that made it a potentially suitable vehicle for adjunctive therapeutic applications: portability, acceptability, low initial cost, low maintenance cost, social penetration and ubiquity, “always on,” “always connected,” programmability, audio and video output, keypad and audio input, user-friendliness, and ease of use [ 46 ]. Over the last decade, modern mobile phones have supplanted the previous generation of mobile telephones; progressive increases in their computing power, ongoing advances in the software that they run and interact with (eg, JAVA, HTML5, etc.), common feature sets across different operating systems such as Google Inc.'s Android or Apple Inc.'s iOS, and adoption of common hardware elements across manufacturers (eg, touch screens, high-resolution cameras, etc) have enabled the development of platform-independent apps for mobile phones, or at least apps on different platforms with comparable functionality (eg, apps written for Apple's HealthKit or the apps written for Microsoft's HealthVault).

The popularization of the smartphone presents a unique opportunity to enhance CBT homework compliance using adjunctive therapeutic applications such that well-designed mobile software may be able to diminish barriers to CBT [ 40 ] by making CBT therapists' work more cost-effective. However, there are no guidelines and no existing research that directly address the design of mobile phone apps for this purpose. Given this gap in the literature, we searched MEDLINE (1946 to April 2015) and PsycINFO (1806 to April 2015) for all articles related to “cognitive behavioral therapy”, “homework”, “mobile applications” and “treatment compliance or adherence”, and reviewed articles related to (1) mobile technologies that address homework completion, (2) essential features of therapy, or (3) barriers to homework completion in CBT. In this article, we propose a collection of essential features for mobile phone-based apps that will optimally support homework compliance in CBT.

A Proposed List of Essential Features for Mobile Apps That Optimally Support CBT Homework Compliance

In order to be effective for patients and acceptable to therapists, an optimal mobile phone app to support CBT homework compliance should conform to the CBT model of homework while addressing barriers to homework compliance. Tompkins (2002) provides a comprehensive guideline on the appropriate ways to provide CBT homework such that homework should be meaningful, relevant to the central goals of therapy, salient to focus of the session, agreeable to both therapist and client, appropriate to sociocultural context, practiced in session to improve skill, doable, begin small, have a clear rationale, include written instructions, and include a backup plan with homework obstacles [ 47 ]. In addition, the therapist providing the homework needs to be curious, collaborative, reinforce all pro-homework behavior and successful homework completion, and emphasize completion over outcome [ 47 ]. By combining Tompkins' guidelines with the need to reduce barriers to homework compliance (as described above), we obtained the following list of 6 essential features that should be incorporated into mobile apps to maximize homework compliance: (1) congruency to therapy, (2) fostering learning, (3) guiding therapy, (4) building connections, (5) emphasizing completion, and (6) population specificity.

Congruency to Therapy

Any intervention in therapy needs to be relevant to the central goals of the therapy and salient to the focus of the therapeutic session. A mobile app is no exception; apps have to deliver useful content and be congruent to the therapy being delivered. There are different types of homework in CBT, including (1) psychoeducational homework; (2) self-assessment homework; and (3) modality-specific homework. Which types are assigned will depend on the nature of the illness being treated, the stage of treatment, and the specific target [ 48 ]. An effective app supporting homework compliance will need to be able to adjust its focus as the therapy progresses. Self-monitoring and psychoeducation are major components in the early stage of therapy. Thought records can be used in depression and anxiety while other disorders may require more specific tasks, such as initiating conversation with strangers in the treatment of SAD. Therefore, the treatment modules delivered via mobile phones should meet the specific needs of therapy at each stage of therapy, while also providing psychoeducation resources and self-monitoring capabilities.

Psychoeducational Homework

While there are large amounts of health-related information on the Internet, the majority of information is not easily accessible to the users [ 49 ]. Mobile apps can enhance psychoeducation by delivering clear and concise psychoeducational information linked to the topics being covered in therapy. As psychoeducation is seen as a major component of mobile intervention [ 50 ], it has been incorporated into several mobile apps, some of which have been shown to be efficacious in treating various psychiatric conditions, including stress [ 51 ], anxiety and depression [ 52 ], eating disorders [ 53 ], PTSD [ 54 ], and obsessive compulsive disorder (OCD) [ 55 ]. For example, Mayo Clinic Anxiety Coach is a mobile phone app “designed to deliver CBT for anxiety disorders, including OCD” [ 55 ]. The app contains a psychoeducational module that teaches the user on “the use of the application, the cognitive-behavioral conceptualization of anxiety, descriptions of each anxiety disorder, explanations of CBT, and guidance for assessing other forms of treatment” [ 55 ]. The benefits of delivering psychoeducation via a mobile phone app are obvious: the psychoeducational information becomes portable and is easily accessed by the patient. Furthermore, the information is also curated and validated by proper healthcare authorities, which builds trust and reduces the potential for misinformation that can result from patient-directed Internet searches. However, psychoeducation on its own is not optimal. Mobile interventions that also incorporate symptom-tracking and self-help interventions have resulted in greater improvement when used for depression and anxiety symptoms than those that deliver only online psychoeducation [ 50 ].

Self-Assessment Homework

In contrast to conventional, paper-based homework, mobile apps can support in-the-moment self-assessments by prompting the user to record self-report data about the user’s current state [ 56 ]. While information collected retrospectively using paper records can be adversely affected by recall biases [ 57 ], mobile apps enable the patient to document his or her thoughts and feelings as they occur, resulting in increased accuracy of the data [ 58 ]. Such self-assessment features are found in many mobile apps that have been shown to significantly improve symptoms in chronic pain [ 59 , 60 ], eating disorders [ 61 ], GAD [ 62 ], and OCD [ 55 ]. Continuing with the previous example, the Mayo Clinic Anxiety Coach offers a self-assessment module that “measures the frequency of anxiety symptoms” with a self-report Likert-type scale [ 55 ]. The app tracks users’ progress over time based on the self-assessment data; users reported liking the record of daily symptom severity scores that the application provides.

Modality-Specific Homework

Evidence suggests that a variety of modality-specific homework assignments on mobile apps are effective, including relaxation practices, cognitive therapy, imaginal exposure in GAD and PTSD [ 54 , 57 ], multimedia solutions for skill learning and problem solving in children with disruptive behavior or anxiety disorders [ 63 ], relaxation and cognitive therapy in GAD [ 62 ], or self-monitoring via text messages (short message service, SMS) to therapists in bulimia nervosa [ 61 ]. Mayo Clinic Anxiety Coach, for example, has a treatment module for OCD that “guides patients through the use of exposure therapy” [ 55 ]; patients can use this to build their own fear hierarchies according to their unique diagnoses. Users reported liking the app because it contains modality-specific homework that can be tailored to their own needs. Novel formats, such as virtual reality apps to create immersive environments, have been experimented with as a tool for facilitating exposure in the treatment of anxiety disorders with mostly positive feedback [ 64 - 66 ]. Apps that provide elements of biofeedback (such as heart rate monitoring via colorimetry of users' faces using the mobile phone's camera), have recently begun to be deployed. So-called ”serious games,“ (ie, games developed for treatment purposes), are also showing promise in symptom improvement in certain cases [ 51 , 67 , 68 ].

Fostering Learning

Doing CBT homework properly requires time and effort. As noted above, any sense of inconvenience while doing the homework may hamper a patient’s motivation to complete the homework. While patients may appreciate the importance of doing homework, they often find the length of time spent and the lack of clear instructions discouraging, resulting in poor engagement rates [ 49 , 52 ]. Therefore, it makes sense that the tasks should be simple, short in duration to begin with, and include detailed instructions [ 47 ], since homework completion rates have been shown to be correlated with patients’ knowing exactly what to do [ 33 , 69 ]. Many apps incorporate text messaging-based services or personalized feedback to encourage dynamic interactions between the therapist and the client [ 59 ]. However, the types of homework delivered by these apps are fixed. An app that adapts the contents to the user’s progress in learning homework tasks would be more engaging and effective since therapy should be a flexible process by nature. Ideally, the app would monitor and analyze the user’s progress and adjust the homework's content and difficulty level accordingly. While the effectiveness of this type of app has not been studied, a similar app has been described in the literature for treating GAD [ 62 ]. This app, used in conjunction with group CBT, collected regular symptom rating self-reports from patients to track anxiety. Based on patients’ ratings, the app would respond with encouraging comments and invite patients to practice relaxation techniques or prompt the patient to complete specific built-in cognitive therapy modules if their anxiety exceeded a threshold rating. Despite the simple algorithm used to trigger interventions, use of the app with group CBT was found to be superior to group CBT alone.

Guiding Therapy

Therapists have a number of important roles to play in guiding and motivating clients to complete homework. First, the therapist needs to address the rationale of the prescribed homework and work with the client in the development of the treatment plan [ 47 ]. Failure to do this has been identified as a barrier to homework compliance. Second, the therapist should allow the patient to practice the homework tasks during the therapy sessions [ 47 ] in order to build confidence and minimize internal barriers, such as the failing to identify automatic thoughts. Lastly, the therapist has to be collaborative, regularly reviewing homework progress and troubleshooting with the patients [ 47 , 70 ]; this can be done during or in between homework assignments, either in-person or remotely (ie, via voice or text messaging) [ 60 , 71 ].

Reviewing and troubleshooting homework has been seen as a natural opportunity for apps to augment the role of therapists. Individualized guidance and feedback on homework is found in many Internet-based or mobile apps that have been shown to be effective in treating conditions such as PTSD [ 72 ], OCD [ 55 ], chronic pain [ 59 , 60 ], depression and suicide ideation [ 71 ], and situational stress [ 73 ]. Moreover, providing a rationale for homework, ensuring understanding of homework tasks, reviewing homework, and troubleshooting with a therapist have each individually been identified as predictors of homework compliance in CBT [ 74 , 75 ]. However, despite incorporating a variety of features including self-monitoring, psychoeducation, scheduled reminders, and graphical feedback [ 52 ], automated apps with minimal therapist guidance have demonstrated elevated homework non-completion rates of up to 40%, which is less than ideal.

Building Connections

The effects of technology should not interfere with but rather encourage a patient’s ability to build meaningful connections with others [ 76 ]. The therapeutic alliance between the therapist and the client is the strongest predictor of therapeutic outcome [ 77 ] and has been suggested to predict level of homework compliance as well [ 78 ]. While there is no evidence so far to suggest that technology-based interventions have an adverse effect on the therapeutic alliance [ 79 , 80 ], this conclusion should not be generalized to novel technologies as their impact on therapeutic alliance has not been well studied [ 81 ].

An arguably more significant innovation attributable to technology has been its potential to allow patients to form online communities, which have been identified as useful for stigma reduction and constructive peer support systems [ 82 ]. Online or virtual communities provide patients with a greater ability to connect with others in similar situations or with similar conditions than would be possible physically. Internet-delivered CBT that includes a moderated discussion forum has been shown to significantly improve depression symptoms [ 83 ]. Furthermore, professional moderation of online communities increases users’ trust of the service [ 84 ]. Therefore, including social platforms and online forums in a mobile app may provide additional advantages over conventional approaches by allowing easier access to social support, fostering collaboration when completing homework, and enabling communication with therapists.

Emphasizing Completion

A patient’s need to see immediate symptomatic improvement is an impediment to homework compliance since the perception of slow progress can be discouraging to the user [ 35 ]. To address this issue, it is important for both therapists and mobile apps to emphasize homework completion over outcome [ 47 ]. While a therapist can urge the client to finish uncompleted homework during the therapy session to reinforce its importance [ 47 , 85 ], there is little a therapist can do in between therapy sessions to remind clients to complete homework. In contrast, a mobile app can, for example, provide ongoing graphical feedback on progress between sessions to motivate users [ 52 , 86 ], or employ automatic text message reminders, which have been demonstrated to significantly improve treatment adherence in medical illnesses [ 87 ]. These features have previously been incorporated into some technology-based apps for homework adherence when treating stress, depression, anxiety, and PTSD [ 52 , 54 , 88 ] with significant symptom improvement reported in one paper [ 71 ].

Population Specificity

Homework apps should, where relevant or useful, explicitly be designed taking into account the specific characteristics of its target audience, including culture, gender, literacy, or educational levels (including learning or cognitive disabilities). One example of how culture-specific design features can be incorporated can be found in Journal to the West, a mobile app for stress management designed for the Chinese international students in the United States, which incorporates cultural features into its game design [ 89 ]. In this game, breathing activity is associated with the concept of “Qi” (natural energy) in accordance with Chinese traditions; the name of the game itself references to a famous Chinese novel and the gaming environment features inkwash and watercolor schemes of the East Asian style, making the experience feel more “natural” as reported by the users. A different approach to tailoring design is taken by the computer-based games described by Kiluk et al [ 68 ] that combine CBT techniques and multi-touch interface to teach the concepts of social collaboration and conversation to children with autism spectrum disorders. In these games, the touch screen surface offers simulated activities where children who have difficulties with peer engagement can collaborate to accomplish tasks. Children in this study demonstrated improvement in the ability to provide social solutions and better understanding of the concepts of collaboration. Although the population-specific design is intuitively appealing, the degree to which it can enhance homework compliance has yet to be investigated.

Other Considerations

There are several additional issues specific to mobile apps that should be carefully considered when developing mobile apps for homework compliance. Because of screen sizes, input modes, the nature of electronic media, etc, standard CBT homework may need to be translated or modified to convert it into a format optimal for delivery via a mobile phone [ 47 ]. The inclusion of text messaging features remains controversial, in part because of concerns about client-therapist boundary issues outside the therapy sessions [ 90 ]. One potential solution is to use automated text messaging services to replace direct communication between the therapist and the client so the therapist can't be bombarded by abusive messages [ 52 , 61 , 91 , 92 ]. Privacy and security issues are also real concerns for the users of technology [ 93 ], although no privacy breaches related to text messaging or data security have been reported in studies on mobile apps so far [ 88 , 94 - 98 ]. Designers of mobile apps should ensure that any sensitive health-related or personal data is stored securely, whether on the mobile device or on a server.

Finally, while this paper focused on “essential” features of apps, this should not be misunderstood as an attempt to itemize all elements necessary for designing a successful piece of software. Good software design depends on many important elements that are beyond the scope of this paper, such as a well-designed user interface [ 99 ] that is cognitively efficient relative to its intended purpose [ 100 ] and which makes effective use of underlying hardware.

The popularization and proliferation of the mobile phone presents a distinct opportunity to enhance the success rate of CBT by addressing the pervasive issue of poor homework compliance. A variety of barriers exist in traditional, paper-based CBT homework that can significantly hamper clients’ motivation to complete homework as directed. The 6 essential features identified in this paper can each potentially enhance homework compliance. Therapy congruency focuses the features of the app on the central goal of therapy and fostering learning eases engagement in therapy by reducing barriers. Apps should help the therapist guide the client through therapy and not hinder the therapeutic process or interfere with patient’s building connections with others. It is crucial that homework completion be emphasized by the app, not just homework attempting. Population-specific issues should also be considered depending on the characteristics of targeted users.

As an example of how this applies in practice, “Mental Health Telemetry-Anxiety Disorders” (MHT-ANX) is a new mobile app developed by the Centre for Mobile Computing in Mental Health at Sunnybrook Health Sciences Centre in Toronto that helps patients monitor their anxiety symptoms using longitudinal self-report. The symptom log is therapy congruent to the practice of CBT since it promotes patients' awareness of their anxiety symptoms and the symptoms’ intensity. The simplicity of the app makes it easy for patients to learn to use, consistent with the need for fostering learning and increasing compliance. The MHT-ANX app was designed to share patient data with their clinicians, helping clinicians guide patients through therapy and more readily engage in discussion about symptom records, thus potentially enhancing the therapeutic relationship. Homework completion is emphasized both by automated text message reminders that the system sends and by questions presented by MHT-ANX that focus on how homework was done. While there are few population-specific design issues obvious at first glance in MHT-ANX, the focus groups conducted as part of our design process highlighted that our target group preferred greater privacy in our app rather than ease of sharing results via social media, and prioritized ease-of-use. While not yet formally assessed, reports from staff and early users suggest that MHT-ANX has been helpful for some patients with promoting homework compliance.

Limitations and Future Challenges

The feature list we have compiled is grounded in current technology; as technology evolves, this list may need to be revised. For example, as artificial intelligence [ 101 ] or emotional sensing [ 102 ] develops further, we would expect that software should be able to dynamically modify its approach to the user in response to users' evolving emotional states.

This paper presents our opinion on this topic, supported by a survey of associated literature. Our original intention was to write a review of the literature on essential features of apps supporting CBT homework compliance, but there was no literature to review. The essential features that are the focus of this article are summaries of key characteristics of mobile apps that are thought to improve homework compliance in CBT, but randomized trials assessing the impact of these apps on homework compliance have not yet been done. We would anticipate synergistic effects when homework-compliance apps are used in CBT (eg, if measures of progress collected from an app were used as feedback during therapy sessions to enhance motivation for doing further CBT work), but the actual impact and efficacy of therapy-oriented mobile apps cannot be predicted without proper investigation.

Abbreviations

Conflicts of Interest: None declared.

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Am Fam Physician. 2024;109(2):185-187

Author disclosure: No relevant financial relationships.

Key Points for Practice

• Anorexia nervosa is best treated by monitored renourishment with psychotherapy. Most patients without worsening symptoms can receive outpatient treatment, especially with family support.

• Bulimia nervosa is best treated with CBT and fluoxetine, 60 mg daily.

• Binge-eating disorder is best treated with CBT or interpersonal psychotherapy with antidepressant medications or lisdexamfetamine when pharmacotherapy is indicated. Lisdexamfetamine has been studied mostly in patients who have obesity.

From the AFP Editors

Eating disorders affect nearly 2% of Americans during their lifetime and are more common in women and individuals in the LGBTQ+ community. Eating disorders commonly occur in patients with diabetes mellitus, depression, anxiety, post-traumatic stress disorder, substance use disorders, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder, all of which increase mortality risk. These disorders can be difficult to recognize, and the American Psychiatric Association (APA) has released guidelines aimed to reduce the harm from eating disorders.

The U.S. Preventive Services Task Force reports insufficient evidence for routine screening for eating disorders in adolescents and adults. The American Academy of Pediatrics recommends asking all adolescents about eating patterns and body image. The APA recommends screening as part of an initial psychiatric evaluation.

People with eating disorders often lack insight into the presence or severity of disease, and physicians may overlook an eating disorder in patients with a normal body mass index. Single-question screening or the SCOFF questionnaire (two positive responses suggests an eating disorder) is recommended when there is not time for a formal screening questionnaire ( Table 1 ) .

Physicians should ask about maladaptive eating, including food changes and behaviors, eating rituals, binge eating, and purging. Patients with eating disorders often report abdominal discomfort with eating, constipation, early satiety, bloating, nausea, and heartburn, which are often signs of starvation and disordered eating rather than gastrointestinal disease. Menstrual irregularities are common with disordered eating.

Because patients often underreport symptoms, family members may notice concerning behaviors first. The degree of weight loss should be noted, based on growth-chart curves for children, because of risks of refeeding. Patients may have bradycardia, hypotension, or hypothermia. Physical examination may show proximal or temporal muscle wasting, ankle and pedal edema, lanugo hair, hair loss, dry skin, vitamin deficiencies, parotid gland enlargement, dental erosions, callouses on the dorsum of the hand, or evidence of self-injurious behaviors.

Laboratory analysis should include a complete blood count, electrolytes, liver enzymes, and renal function tests, but normal results do not necessarily exclude an eating disorder. Electrocardiography is recommended for all patients with restrictive eating disorder or severe purging behavior and in those taking medications known to prolong QTc intervals.

Most patients can be monitored with outpatient care, where they can remain with their families and continue with school or work. Careful monitoring should include an office weight check at least weekly after voiding and with shoes and outerwear removed. To ensure patients are not artificially increasing weight with water, checking urine-specific gravity should be considered. Patients with indications suggesting a worsening course should be moved to a higher level of care ( Table 2 ) .

Anorexia Nervosa

After medical stabilization in patients with anorexia nervosa, nutritional rehabilitation and weight restoration are critical components of treatment. If consistent weight increases can be maintained, outpatient weight restoration is appropriate with the support of family. A nurturing emotional environment is important for renourishment.

Individualized target weights should be established with the patient, despite likely patient hesitancy to accept this goal. An initial body mass index target of 20 kg per m 2 is often used for adults, whereas adolescent targets depend on growth-chart curves. Weight restoration normally takes several months, and a goal of gaining 1 to 2 lb per week is realistic in outpatient programs. Consultation with and direction from a registered dietitian are important during renourishment.

Refeeding syndrome is the most serious complication of renourishment and may present with rhabdomyolysis, hemolytic anemia, seizures, cardiac arrhythmias, and sudden death. Hypophosphatemia is a characteristic marker of refeeding syndrome. Initial calorie prescriptions of 1,500 to 2,000 kcal per day and eventual intake of 3,000 to 4,000 kcal per day are effective and do not appear to lead to refeeding syndrome.

Although changes in body shape and function during renourishment can be distressing for the patient, these can be offset by improvement in psychological complications of semi-starvation. Physical activity is important but may have to be limited early in renourishment and when compulsive exercise is an element of weight-control behaviors.

Medications do not aid weight gain. Selective serotonin reuptake inhibitors (SSRIs) are effective for psychological comorbidities but do not improve weight gain. Olanzapine (Zyprexa) may be helpful, but its effectiveness is limited by adverse effects. Bupropion and medications that prolong QTc intervals should be avoided if there are purging behaviors. Hormonal treatments do not appear to improve weight gain.

Psychotherapy can be moderately effective in normalizing eating and weight-control behaviors. Cognitive behavior therapy (CBT) focuses on cognitive distortions surrounding food and weight and implementing an experimental model of change. Enhanced CBT uses a more formalized, manual-based program. Focal psychodynamic therapy places a greater focus on relationships and insight rather than cognitions and behaviors. Supportive management by other health care professionals using workbooks and telephone coaching can be beneficial. For adolescents, family-based therapy involving caregiver education is recommended.

Bulimia Nervosa

For bulimia nervosa, eating disorder–focused CBT should be combined with an SSRI. Use of fluoxetine, 60 mg daily, has the most evidence, including in patients who have symptoms that do not improve with psychotherapy. Other SSRIs can be used if fluoxetine is not tolerated, but bupropion and citalopram should be avoided.

CBT can be delivered individually or in a group. Some evidence suggests that guided self-help using a manual or the internet can be helpful. Family-based therapy can be beneficial for adolescents or adults who live with a caregiver or family member who can participate in treatment.

Binge-Eating Disorder

Patients with binge-eating disorder can also benefit from therapy and medication. Antidepressant medications reduce binge eating even in the absence of depressive or anxiety symptoms. Lisdexamfetamine (Vyvanse) has been associated with modest short-term benefit in patients with binge-eating disorder who are obese. Topiramate can reduce binge eating but leads to more adverse effects than other medications.

Eating disorder–focused CBT and interpersonal psychotherapy are effective for binge-eating disorder. Interpersonal psychotherapy involves evaluating past and current symptoms and relating them to the patient's interpersonal and social context.

Guideline source: American Psychiatric Association

Published source: Crone C, Fochtmann LJ, Attia E, et al. The American Psychiatric Association Practice Guideline for the Treatment of Patients with Eating Disorders. Fourth edition . American Psychiatric Association; 2023.

Available at:  https://psychiatryonline.org/doi/book/10.1176/appi.books.9780890424865

The views expressed are those of the author and do not necessarily reflect the official policy or position of the Naval Undersea Medical Institute, Uniformed Services University of the Health Sciences, U.S. Navy, U.S. Department of Defense, or U.S. government.

Coverage of guidelines from other organizations does not imply endorsement by AFP or the AAFP.

This series is coordinated by Michael J. Arnold, MD, associate medical editor.

A collection of Practice Guidelines published in AFP is available at https://www.aafp.org/afp/practguide .

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