The current status of cognitive behavioral therapy for eating disorders: Marking the 51st Annual Convention of the Association of Behavioral and Cognitive Therapies

Abstract

evidence that we can take CBT-ED into our everyday practice with very similar results to those from the RCTs, as long as we deliver the same therapy. That includes work in specialist eating disorder services (Calugi et al., 2016;Waller et al., 2014) as well as non-specialist services (Rose & Waller, in press).A further consideration is whether CBT-ED is just too narrow, failing to address the wider range of problems that our patients experience. Some of the papers cited in this Virtual Issue show that CBT-ED has much broader effects, reducing anxiety, depression, and more.However, we should draw particular attention to the way that CBT-ED has positive impacts on quality of life-indeed, a greater impact than many other therapies (Linardon & Brennan, 2017). However, we should not be complacent about the use of exposure, as it is a treatment technique that is on the move more broadly. Reilly, Anderson, Gorrell, Schaumberg, and Anderson (2017) point to ways in which we can use a more contemporary model of exposure therapy to increase its impact.As well as techniques, we should think about the timing of change.It is always tempting to take it easy at first, to acculturate the patient to therapy. A key paper in this field is that of Raykos, Watson, Fursland, Byrne, and Nathan (2013), who have shown that early change in CBT-ED has substantial clinical impact-a finding that has been replicated extensively in other centers and across therapies (e.g., Linardon, Brennan & de la Piedad Garcia, 2016;Vall & Wade, 2015). This work demonstrates that we should be using CBT-ED intensively from the beginning, as change by 4-5 weeks is a key predictor of outcome.That early symptom change has another impact, but one that is different in CBT-ED to other therapies. Graves et al. (2017) have shown that the usual assumption of the early alliance driving therapeutic change in the eating disorders might be true of other therapies, but is not true of CBT-ED. Again, the most effective early element of CBT-ED appears to be early symptom change, which results in the development of a better alliance. | SU M M A R YThe papers included in this Virtual Issue have been chosen to reflect the state of our clinical science-what is best in CBT-ED? While we hope that you find them useful, we would like to draw your attention to one point that emerged when selecting these papers-their global origins. The teams undertaking this research come from Australia, Canada, Denmark, Italy, the United Kingdom, and the United States of America. While this was not a strategic choice, we hope that you share our view that this Virtual Issue reflects the truly international nature of the IJED. There were many more papers from IJED that we could have included in this Virtual Issue, but we obviously could not include them all. We have selected papers that reflect the range of recent research that IJED has published, but go online and search through the journal and you will see far more research that relates to CBT-ED and many other topics related to eating disorders.Plea...

Cognitive behavioral therapy for eating disorders: A map of the systematic review evidence base

“…In addition, evidence supporting cognitive behavioral therapy (CBT) for these disorders has accumulated from randomized controlled trials (RCTs) and has been synthesized in a number of systematic reviews (e.g., Bulik, Berkman, Brownley, Sedway, & Lohr, 2007; Hay, 2013 ; Linardon et al, 2017e ). Further support has come from the use of evidence supported CBT in real world settings (Weissman et al, 2017 ).…”

“…CBT is now recommended by the majority of evidence‐based national guidelines (Hilbert et al, 2017 ) as the first line of treatment for bulimia nervosa (BN) and binge eating disorder (BED), and to a lesser extent (due to less robust evidence) for the other specified feeding and eating disorders (OSFED) (this DSM‐5 diagnosis partially overlaps with the previously used DSM IV category, “eating disorder not otherwise specified” [EDNOS]). While CBT is clearly regarded as the treatment of choice for these latter disorders that do not involve significantly low weight (Weissman et al, 2017 ), it is one amongst a number of options for the treatment of adults with anorexia nervosa (AN) (Mulkens & Waller, 2021 ). Three main approaches are currently recommended for the treatment of AN (e.g., National Institute for Health and Care Excellence [NICE], 2017 ) specialist supportive clinical management (SSCM; Carter et al, 2011 ; McIntosh et al, 2006 ; Touyz et al, 2013 ); the Maudsley model AN treatment for adults (MANTRA; Schmidt et al, 2015 ) and CBT (CBT‐E; Fairburn et al, 2013 ).…”

Experiences when implementing enhanced cognitive behavioral therapy as a standard treatment for anorexia nervosa in outpatients at a public specialized eating-disorder treatment unit

“…A crucial question is whether results from research settings can be transferred into real-world situations [ 9 ]. Challenges in everyday practice might include balancing a flexible enough adjustment to patients’ preferences and needs, and at the same time preventing drift from core aspects of the treatment protocol [ 10 , 11 ].…”