CBT-E

Enhanced CBT (CBT-E)

 

What is CBT-E?
CBT-E is the abbreviation for “enhanced cognitive behaviour therapy.” This term refers to a highly specific form of CBT, one which is designed to treat any eating disorder of clinical severity. The treatment was developed in the late 1990s by me and my CREDO colleagues Zafra Cooper and Roz Shafran.

 

The Development of CBT-E

The thinking behind the development of CBT-E was as follows:

  1. Bulimia nervosa (BN) is treatable (in most cases) using the form of CBT (CBT-BN) that I had developed in the late 1970s in Edinburgh.

  2. In other words CBT-BN is capable of addressing the clinical features seen in BN: namely, recurrent binge eating; rigid dieting and other extreme weight-control behaviour; and the over-evaluation of shape and weight and its expressions (body checking and avoidance, feeling fat).

  3. Therefore CBT-BN is not a treatment for "BN" as such.  It is a treatment for the clinical features seen in BN.

  4. CBT-BN should be capable of addressing these same features wherever they occur.

  5. These same clinical features characterise anorexia nervosa (AN) and the other eating disorders.

  6. Suitably adapted, CBT-BN should be capable of treating AN and the other eating disorders.

Accordingly, we adapted CBT-BN to make it "transdiagnostic" in its clinical range (i.e., suitable for any form of eating disorder).  At the same time we refined the treatment as it was clear that it could be improved in various ways (e.g., by being better at addressing the over-evaluation of shape and weight; and, in certain cases, by addressing accompanying problems such as extreme perfectionism).  The resulting treatment we termed "enhanced CBT" or CBT-E.

Fairburn et al 2003.PNG

Our first paper on CBT-E focused on the thinking behind the new transdiagnostic treatment (Fairburn, Cooper and Shafran, 2003). The paper has proved to be highly influential both within and outside the eating disorder field as the line of argument is a general one which can be applied to other mental disorders.

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In 2009 we published a detailed guide for therapists wanting to practise CBT-E (Fairburn, 2009).  

The Current Standing of CBT-E

There is now a website specifically devoted to CBT-E (link to cbte.co). It describes the treatment in outline, summarises its research standing, and informs therapists how to obtain training in the treatment, as well as covering many other CBT-E-related matters.

The main developments since the initial CBT-E paper was published are as follows:

  • CBT-E has been shown to be effective across the adult eating disorders (i.e., it truly is a "transdiagnostic" treatment). It has proved to be as effective, or more effective, than all the other leading treatments for eating disorders.

  • My Italian colleague, Riccardo Dalle Grave, has shown that it is also effective in the treatment of young people with an eating disorder.  

  • Given its wide clinical range, CBT-E is proving an attractive alternative to diagnosis-specific eating disorder treatments.

  • CBT-E was endorsed by NICE in 2017. (NICE is a highly respected independent body that evaluates the evidence supporting clinical interventions.)  

  • CBT-E is being increasingly advocated by health service policy makers (in the UK and elsewhere).

  • There is an online training programme for therapists wanting to learn how to deliver CBT-E (see web-based training in CBT-E).

  • There is also a simplified digital version of CBT-E. It is being tested (see digital CBTe).