Challenges and opportunities for enhanced cognitive behaviour therapy (CBT-E) in light of COVID-19

Abstract

In the past few weeks, coronavirus disease 2019 (COVID-19) has dramatically expanded across the world. To limit the spread of COVID-19 and its negative consequences, many countries have applied strict social distancing rules. In this dramatic situation, people with eating disorders are at risk of their disorder becoming more severe or relapsing. The risk comes from multiple sources including fears of infection and the effects of social isolation, as well as the limited availability of adequate psychological and psychiatric treatments. A potential practical solution to address some of these problems is to deliver enhanced cognitive behaviour therapy (CBT-E), an evidence-based treatment for all eating disorders, remotely. In this guidance we address three main topics. First, we suggest that CBT-E is suitable for remote delivery and we consider the challenges and advantages of delivering it in this way. Second, we discuss new problems that patients with eating disorders may face in this period. We also highlight potential opportunities for adapting some aspects of CBT-E to address them. Finally, we provide guidelines about how to adapt the various stages, strategies and procedures of CBT-E for teletherapy use in the particular circumstances of COVID-19. Key learning aims (1) To appreciate that CBT-E is suitable for remote delivery, and to consider the main challenges and potential advantages of this way of working. (2) To identify and discuss the additional eating disorder-related problems that may arise as a result of COVID-19, as well as potential opportunities for adapting some aspects of CBT-E to address them. (3) To learn how to adapt CBT-E for remote delivery to address the consequences of COVID-19. Specifically, to consider adaptations to the assessment and preparation phase, the four stages of treatment and its use with underweight patients and adolescents.

Exploring the impact of the COVID-19 pandemic and UK lockdown on individuals with experience of eating disorders

“…In addition to ensuring equality of access, our findings highlight other barriers to effective remote treatment, such as how to monitor health and recovery progress without having a detrimental impact on mental wellbeing. This includes not requiring weighing scales within the individual's household, and providing alternatives to technologies, such as video-calling software, which may inadvertently make users critical of their appearance (this supports previous findings (e.g., [8,10]). In other instances, software may have the required functions available -such as an option to 'hide self-view' -but users may not be aware of this; increasing awareness or setting this option as a default should be considered.…”

“…As a result of the pandemic, healthcare organisations also find themselves suddenly relying more heavily on virtual methods to deliver treatment and support. Research is already underway to identify how therapy for EDs can be translated to online delivery [8,9]. Despite these efforts, healthcare organisations -and those receiving treatmentmay face significant challenges with the move to remote healthcare [4].…”

2019 Novel Coronavirus (COVID-19) Pandemic; Transmission of SARS-CoV-2 Effectiveness of Infection Control and Prevention: Precautions in California

“…However, this has not been efficient towards the containment of the disease [5]. There should be an advanced approach that would literary be an improvement of the current strategies [6]. One of the most effective strategies that would just act as reinstatement to the current isolation strategies is enhanced educative and awareness creation among the citizens.…”

The Impact of the COVID-19 Pandemic on Individuals With Eating Disorders: the Role of Emotion Regulation and Exploration of Online Treatment Experiences

“…The impact of the pandemic on treatment has varied across localities; treatment in some ED services may have been paused or reduced if there was a requirement to redeploy staff into essential areas of the NHS, whereas other services have been able to continue offering treatment by branching into telehealth, for instance video-conferencing. This kind of remote psychological treatment was already effectively employed in areas where geographical distance can make it di cult for individuals to access face-to-face healthcare (29), but does require additional considerations, such as access to adequate internet connectivity, a quiet, con dential space, and in the case of eating disorders, navigating how to conduct insession weighing (30,31).…”

“…Though the NHS remains in a state of ux and differences are still present across localities, the importance of "business as usual" and clear, practical guidance around how to establish the same have since been disseminated (18,30,31,84,85). For example, with reference to issues around engagement, motivation and openness, clinicians have been recommended to thoroughly and openly explore the patient's previous experiences of and attitudes towards remote treatment; to discuss and plan the practical implementation of the therapy and develop contingency plans for issues such as connection problems; to use the full power of audiovisual technology to create openness and connection; and to, as much as possible, involve the patient as an active collaborator in therapy (18,30,31). It is likely that positive appraisals around convenience and ease of access, in our participants and those of the previous study (10), might remain; these were identi ed as advantages of telehealth interventions prior to Covid-19 (29,86,87).…”