Cognitive behaviour therapy for adolescents with eating disorders: An effective alternative to the disease-based treatments

Abstract

Several clinical services offer eclectic multidisciplinary treatments with no evidence of efficacy and effectiveness for adolescents with eating disorders. These treatments are usually based on the ‘disease model’ of eating disorders. The model postulates that eating disorders are the result of a specific disease (i.e., anorexia nervosa, bulimia nervosa or other eating disorders), and patients are considered not to have control of their illness. Therefore, they need the external control of parents and/or health professionals. In this model, the patients adopt a passive role in the treatment. On the contrary, enhanced cognitive behaviour therapy (CBT-E) for adolescents is based on a ‘psychological model’ of eating disorders. Patients are helped to understand the psychological mechanisms that maintain their eating disorder and are ‘actively’ involved in the recovery process. Clinical studies showed that more than 60% of adolescent patients who complete the treatment achieve a full response at 12-month follow-up. The treatment is well accepted by young people and their parents, and its collaborative nature is well suited to ambivalent young patients who may be particularly concerned about control issues and for parents who cannot participate in all treatment sessions.

Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap

“…Cognitive behavior therapy—Enhanced (CBT-E) has been proposed as an alternative treatment for youth with AN when FBT is not feasible [ 67 , 68 ]. CBT-E actively involves patients to achieve a healthy weight and target the psychopathology that underlies their ED [ 68 ].…”

“…Cognitive behavior therapy—Enhanced (CBT-E) has been proposed as an alternative treatment for youth with AN when FBT is not feasible [ 67 , 68 ]. CBT-E actively involves patients to achieve a healthy weight and target the psychopathology that underlies their ED [ 68 ]. Parents are involved in the initial stages of the treatment and their role is to support their child in individual treatment [ 68 ].…”

“…CBT-E actively involves patients to achieve a healthy weight and target the psychopathology that underlies their ED [ 68 ]. Parents are involved in the initial stages of the treatment and their role is to support their child in individual treatment [ 68 ]. A recent study that evaluated CBT-E in a clinical setting found that it was a suitable treatment for youth with AN and resulted in positive outcomes [ 69 ].…”

Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder: a non-randomized effectiveness trial

“…The efficacy of CBT-E for adult eating disorders is well established (Byrne et al, 2017 ; Poulsen et al, 2014 ), and as described above, has been adapted for an adolescent patient population (Dalle Grave & Calugi, 2020 ) with promising outcomes (Dalle Grave et al, 2013 ). An obvious next step, and the primary goal of the present study, was to compare the relative effectiveness of FBT and CBT-E on measures of weight and eating disorder symptomatology among adolescents presenting with a DSM-5 eating disorder diagnosis [excluding Avoidant/ Restrictive Food Intake Disorder (ARFID)].…”

Are the Effects of Malnutrition on the Gut Microbiota–Brain Axis the Core Pathologies of Anorexia Nervosa?

“…At this stage, the patients often express a wish to control their situation. Unfortunately, the attempts to take control usually imply taking control of food intake and other weight-regulating activities such as excessive exercise [ 7 , 9 ]. Some patients start to vomit after meals and may report relief after having emptied their stomachs.…”