A pragmatic effectiveness study of 10‐session cognitive behavioural therapy (CBT‐T) for eating disorders: Targeting barriers to treatment provision

Abstract

Objective: Ten-session cognitive behavioural therapy (CBT-T) for transdiagnostic eating disorders targets several barriers to treatment, including cost, therapist expertise, and lengthy wait lists.Method: We used a case series design to investigate the effectiveness of CBT-T delivered by trainee psychologists in a postgraduate training clinic.Participants were randomly allocated to commence treatment either immediately or after a 4-week waitlist period. CBT-T was delivered to 52 patients, by six different trainees under supervision. Measures of eating disorder cognitions and behaviours, quality of life, and general psychopathology were examined in completer and intention-to-treat analyses using multilevel modelling. Last observation carried forward was applied for abstinence, remission, and good outcome analyses to aid comparison with prior studies.Results: Significant improvements, associated with medium to large effect sizes, were found for eating disorder cognitions, behaviours quality of life, and negative affect from baseline to posttreatment, and at 1-and 3-month followup. Attrition (38.5%) was comparable with other treatment studies.Conclusion: Results provide evidence for the effectiveness of CBT-T delivered by trainee psychologists for transdiagnostic eating disorder patients, thus tackling some important barriers for treatment. Longer follow-up, randomised controlled trial designs, and moderator analyses will provide more robust evidence about which patients do best with a shorter therapy.

Outcomes of brief and enhanced cognitive‐behavioural therapy for adults with non‐underweight eating disorders: A non‐randomized comparison

“…This study has compared clinical outcomes from two forms of CBT‐ED for non‐underweight patients with eating disorders, to determine whether or not the longer version (CBT‐E; 20 sessions) has stronger outcomes than the shorter version (CBT‐T; 10 sessions). The two forms of CBT‐ED had very similar outcomes to each other, as well as to those found in the wider literature (Byrne et al, 2011; Fairburn et al, 2009; Pellizzer et al, 2019a; Pellizzer et al, 2019b; Turner et al, 2015; Waller et al, 2018). EDE‐Q scores fell significantly between the beginning, middle and end of therapy, and remained low at 6‐month follow‐up, with mean levels below the suggested clinical cut‐off for approximately 60% of the patients.…”

“…This 10‐session approach (CBT‐T) is based around core, evidence‐based elements of CBT‐ED (e.g., focus on early change) and relatively novel methods from the field of CBT (e.g., an inhibitory learning approach to exposure; Craske, Treanor, Conway, Zbozinek, & Vervliet, 2014; Reilly, Anderson, Gorrell, Schaumberg, & Anderson, 2017). Initial case series have demonstrated that CBT‐T is an effective approach (Pellizzer, Waller, & Wade, 2019a, 2019b; Waller et al, 2018). Outcomes from the first case series (Waller et al, 2018) indicated levels of effectiveness in routine clinical settings that were comparable to those of existing, longer forms of CBT‐ED, such as enhanced CBT (CBT‐E; Byrne, Fursland, Allen, & Watson, 2011; Fairburn et al, 2009).…”

Development of consensus‐based guidelines for outpatient dietetic treatment of eating disorders: A Delphi study

“…Specialist competencies for dietitians and mental health care professionals have been developed by ANZAED to guide requirements for ED treatment providers, including dietitians (Australia & New Zealand Academy for Eating Disorders, 2019). However, the role of non‐specialists under the supervision of specialist clinicians in assessing and treating EDs is emerging as an option to deliver timely and cost‐effective psychotherapy (Pellizzer, Waller, & Wade, 2019), and such work needs to be investigated in dietetics as well.…”

ANZAED eating disorder treatment principles and general clinical practice and training standards

“…[32,33]. It is important, however, to note that expert supervision of novice therapists can produce similar outcomes to those of experienced therapists [34].…”