Cognitive Behavioral Therapy (CBT) for Eating Disorders

Table of ContentsView AllTable of ContentsHistoryEating DisordersTreatmentHow Effective Is CBT for Eating Disorders?When CBT Doesn’t Work

Table of ContentsView All

View All

Table of Contents

History

Eating Disorders

Treatment

How Effective Is CBT for Eating Disorders?

When CBT Doesn’t Work

Cognitive-behavioral therapy (CBT) is the leading evidence-based treatment for eating disorders.CBT is a psychotherapeutic approach that involves a variety of techniques. These approaches help an individual to understand the interaction between their thoughts, feelings, and behaviors. It also helps them to develop strategies to change unhelpful thoughts and behaviors to improve mood and functioning.

At a GlanceCognitive behavioral therapy is a first-line treatment of eating disorders.CBT focuses on helping people identify and change the thought patterns that play a role in the onset and maintenance of their condition. It also addresses areas including coping skills, low self-esteem, interpersonal problems, and perfectionism that also make eating disorder recovery more complex.CBT can be an effective treatment for adults with bulimia, binge eating disorder, and other specified eating disorder (OSFED). However, it is essential to note that eating disorders are complex, and each person’s needs are different. Other treatments, including hospitalization and residential treatment, may also be necessary.

At a Glance

Cognitive behavioral therapy is a first-line treatment of eating disorders.CBT focuses on helping people identify and change the thought patterns that play a role in the onset and maintenance of their condition. It also addresses areas including coping skills, low self-esteem, interpersonal problems, and perfectionism that also make eating disorder recovery more complex.CBT can be an effective treatment for adults with bulimia, binge eating disorder, and other specified eating disorder (OSFED). However, it is essential to note that eating disorders are complex, and each person’s needs are different. Other treatments, including hospitalization and residential treatment, may also be necessary.

Cognitive behavioral therapy is a first-line treatment of eating disorders.CBT focuses on helping people identify and change the thought patterns that play a role in the onset and maintenance of their condition. It also addresses areas including coping skills, low self-esteem, interpersonal problems, and perfectionism that also make eating disorder recovery more complex.

CBT can be an effective treatment for adults with bulimia, binge eating disorder, and other specified eating disorder (OSFED). However, it is essential to note that eating disorders are complex, and each person’s needs are different. Other treatments, including hospitalization and residential treatment, may also be necessary.

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History of CBT for Eating Disorders

Cognitive behavioral therapy itself is not a single distinct therapeutic technique, and there are many different forms of CBT that share a common theory about the factors maintaining psychological distress.Acceptance and Commitment Therapy(ACT) andDialectical Behavior Therapy(DBT) are examples of specific CBT treatments.

CBT for Eating Disorders

Enhanced CBT (CBT-E)

In 2008, Fairburn published an updatedtreatment manual for Enhanced Cognitive Behavioral Therapy (CBT-E)designed to treat all eating disorders. CBT-E comprises two formats:

Other CBT Settings and Formats

CBT has been successfully applied inself-help and guided self-helpformats for the treatment of bulimia nervosa and binge eating disorder. It can also be provided in group formats and higher levels of care, such asresidential or inpatient settings.

More recent adaptations include the use of technology to widen the range of people who have access to effective treatments such as CBT.

What Is Cognitive Behavioral Therapy (CBT) and How Does It Work?

Cognitive Model of Eating Disorders

The cognitive model of eating disorders posits that the core maintaining problem in all eating disorders is overconcern with shape and weight. The specific way this overconcern manifests can vary. It can drive any of the following:

Further, these components can interact to create the symptoms of an eating disorder. Strict dieting—including skipping meals, eating small amounts of food, and avoiding forbidden foods—can lead to low weight and/or binge eating. Low weight can lead to malnutrition and also can lead to binge eating.

Bingeing can lead to intense guilt and shame and a renewed attempt to diet. It can also lead to efforts to undo the purging through compensatory behaviors. Patients typically get caught in a cycle.

Components of CBT for Eating Disorders

CBT is a structured treatment. In its most common form, it consists of 20 sessions. Goals are set. Sessions are spent weighing the patient, reviewing homework, reviewing the case formulation, teaching skills, and problem-solving.

Cognitive behavioral therapy for eating disorders typically includes the following components:

Other Key ComponentsOther components commonly included:Cessation of body checkingChallenge of the eating disorder mindsetDevelopment of new sources of self-esteemEnhancement of interpersonal skillsReduction of body avoidance

Other Key Components

Other components commonly included:Cessation of body checkingChallenge of the eating disorder mindsetDevelopment of new sources of self-esteemEnhancement of interpersonal skillsReduction of body avoidance

Other components commonly included:

Coping With Anorexia

Cognitive behavioral therapy is widely considered to be the most effective therapy for the treatment of bulimia nervosa and should, therefore, usually be the initial treatment offered at the outpatient level.

Research suggets CBT is effective for bulimia nervosa and binge-eating disorders, although there is less evidence of its efficacy for treating anorexia nervosa.

One study compared five months of CBT (20 sessions) for women with bulimia nervosa with 2 years of weekly psychoanalytic psychotherapy.Seventy patients were randomly assigned to one of these two groups.

After 5 months of therapy (the end of the CBT treatment), 42% of patients in the CBT group and 6% of the patients in the psychoanalytic therapy group had stopped binge-eating and purging. At the end of 2 years (completion of the psychoanalytic therapy), 44% of the CBT group and 15% of the psychoanalytic group were symptom-free.

At post-treatment, 66% of the CBT-E participants met criteria for remission, compared with only 33% of the IPT participants. Over the follow-up period, the CBT-E remission rate remained higher (69% versus 49%).

A 2018 systematic review concluded that CBT-E was an effective treatment for adults with bulimia nervosa, BED, and OSFED. It also noted that CBT-E for bulimia nervosa is highly cost-effective compared with psychoanalytic psychotherapy.

Good Candidates for CBT

Adults withbulimia nervosa,binge eating disorder, andother specified eating disorder(OSFED) are potentially good candidates for CBT. Older adolescents with bulimia and binge eating disorder may also benefit from CBT.

Patient Responsiveness to Treatment

Therapists conducting CBT aim to introduce behavioral change as early as possible. Research has shown that patients who are able to make early behavioral changes such as establishing more regular eating and reducing the frequency of purging behavior are more likely to be successfully treated at the end of treatment.

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CBT is often recommended as a first-line treatment. If a trial of CBT is not successful, individuals can be referred forDBT(a specific type of CBT with greater intensity) or to ahigher level of caresuch as partial hospitalization or residential treatment program.

If you or a loved one are coping with an eating disorder, contact theNational Eating Disorders Association (NEDA) Helplinefor support at 1-800-931-2237.For more mental health resources, see ourNational Helpline Database.

If you or a loved one are coping with an eating disorder, contact theNational Eating Disorders Association (NEDA) Helplinefor support at 1-800-931-2237.

For more mental health resources, see ourNational Helpline Database.

The Best Online Therapy and Support Services for Eating Disorders

9 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders.Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004Kaidesoja M, Cooper Z, Fordham B.Cognitive behavioral therapy for eating disorders: A map of the systematic review evidence base.Int J Eat Disord. 2023;56(2):295-313. doi:10.1002/eat.23831Murphy R, Straebler S, Cooper Z, Fairburn CG.Cognitive behavioral therapy for eating disorders.Psychiatr Clin North Am. 2010;33(3):611-27. doi:10.1016/j.psc.2010.04.004Waller G, Turner H, Tatham M, Mountford VA, Wade TD.Brief Cognitive Behavioral Therapy for Non-Underweight Patients: CBT-T for Eating Disorders. London: Routledge; 2019.De jong M, Schoorl M, Hoek HW.Enhanced cognitive behavioural therapy for patients with eating disorders: a systematic review.Curr Opin Psychiatry. 2018;31(6):436-444. doi:10.1097/YCO.0000000000000452Fairburn CG, Bailey-straebler S, Basden S, et al.A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders.Behav Res Ther. 2015;70:64-71. doi:10.1016/j.brat.2015.04.010Poulsen S, Lunn S, Daniel SI, et al.A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa.Am J Psychiatry. 2014;171(1):109-16. doi:10.1176/appi.ajp.2013.12121511Agras WS.Cognitive behavior therapy for the eating disorders.Psychiatr Clin North Am. 2019;42(2):169-179. doi:10.1016/j.psc.2019.01.001Waller G, Tatham M, Turner H, et al.A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: Outcomes from a case series of nonunderweight adult patients.Int J Eat Disord. 2018;51(3):262-269. doi:10.1002/eat.22837Additional ReadingWaller, Glenn, Helen Cordery, Emma Corstorphine, Hendrik Hinrichsen, Rachel Lawson, Victoria Mountford, and Katie Russell. 2013.Cognitive Behavioral Therapy for Eating Disorders. Cambridge: Cambridge University Press.

9 Sources

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders.Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004Kaidesoja M, Cooper Z, Fordham B.Cognitive behavioral therapy for eating disorders: A map of the systematic review evidence base.Int J Eat Disord. 2023;56(2):295-313. doi:10.1002/eat.23831Murphy R, Straebler S, Cooper Z, Fairburn CG.Cognitive behavioral therapy for eating disorders.Psychiatr Clin North Am. 2010;33(3):611-27. doi:10.1016/j.psc.2010.04.004Waller G, Turner H, Tatham M, Mountford VA, Wade TD.Brief Cognitive Behavioral Therapy for Non-Underweight Patients: CBT-T for Eating Disorders. London: Routledge; 2019.De jong M, Schoorl M, Hoek HW.Enhanced cognitive behavioural therapy for patients with eating disorders: a systematic review.Curr Opin Psychiatry. 2018;31(6):436-444. doi:10.1097/YCO.0000000000000452Fairburn CG, Bailey-straebler S, Basden S, et al.A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders.Behav Res Ther. 2015;70:64-71. doi:10.1016/j.brat.2015.04.010Poulsen S, Lunn S, Daniel SI, et al.A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa.Am J Psychiatry. 2014;171(1):109-16. doi:10.1176/appi.ajp.2013.12121511Agras WS.Cognitive behavior therapy for the eating disorders.Psychiatr Clin North Am. 2019;42(2):169-179. doi:10.1016/j.psc.2019.01.001Waller G, Tatham M, Turner H, et al.A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: Outcomes from a case series of nonunderweight adult patients.Int J Eat Disord. 2018;51(3):262-269. doi:10.1002/eat.22837Additional ReadingWaller, Glenn, Helen Cordery, Emma Corstorphine, Hendrik Hinrichsen, Rachel Lawson, Victoria Mountford, and Katie Russell. 2013.Cognitive Behavioral Therapy for Eating Disorders. Cambridge: Cambridge University Press.

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders.Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004Kaidesoja M, Cooper Z, Fordham B.Cognitive behavioral therapy for eating disorders: A map of the systematic review evidence base.Int J Eat Disord. 2023;56(2):295-313. doi:10.1002/eat.23831Murphy R, Straebler S, Cooper Z, Fairburn CG.Cognitive behavioral therapy for eating disorders.Psychiatr Clin North Am. 2010;33(3):611-27. doi:10.1016/j.psc.2010.04.004Waller G, Turner H, Tatham M, Mountford VA, Wade TD.Brief Cognitive Behavioral Therapy for Non-Underweight Patients: CBT-T for Eating Disorders. London: Routledge; 2019.De jong M, Schoorl M, Hoek HW.Enhanced cognitive behavioural therapy for patients with eating disorders: a systematic review.Curr Opin Psychiatry. 2018;31(6):436-444. doi:10.1097/YCO.0000000000000452Fairburn CG, Bailey-straebler S, Basden S, et al.A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders.Behav Res Ther. 2015;70:64-71. doi:10.1016/j.brat.2015.04.010Poulsen S, Lunn S, Daniel SI, et al.A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa.Am J Psychiatry. 2014;171(1):109-16. doi:10.1176/appi.ajp.2013.12121511Agras WS.Cognitive behavior therapy for the eating disorders.Psychiatr Clin North Am. 2019;42(2):169-179. doi:10.1016/j.psc.2019.01.001Waller G, Tatham M, Turner H, et al.A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: Outcomes from a case series of nonunderweight adult patients.Int J Eat Disord. 2018;51(3):262-269. doi:10.1002/eat.22837

Agras WS, Fitzsimmons-craft EE, Wilfley DE.Evolution of cognitive-behavioral therapy for eating disorders.Behav Res Ther. 2017;88:26-36. doi:10.1016/j.brat.2016.09.004

Kaidesoja M, Cooper Z, Fordham B.Cognitive behavioral therapy for eating disorders: A map of the systematic review evidence base.Int J Eat Disord. 2023;56(2):295-313. doi:10.1002/eat.23831

Murphy R, Straebler S, Cooper Z, Fairburn CG.Cognitive behavioral therapy for eating disorders.Psychiatr Clin North Am. 2010;33(3):611-27. doi:10.1016/j.psc.2010.04.004

Waller G, Turner H, Tatham M, Mountford VA, Wade TD.Brief Cognitive Behavioral Therapy for Non-Underweight Patients: CBT-T for Eating Disorders. London: Routledge; 2019.

De jong M, Schoorl M, Hoek HW.Enhanced cognitive behavioural therapy for patients with eating disorders: a systematic review.Curr Opin Psychiatry. 2018;31(6):436-444. doi:10.1097/YCO.0000000000000452

Fairburn CG, Bailey-straebler S, Basden S, et al.A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders.Behav Res Ther. 2015;70:64-71. doi:10.1016/j.brat.2015.04.010

Poulsen S, Lunn S, Daniel SI, et al.A randomized controlled trial of psychoanalytic psychotherapy or cognitive-behavioral therapy for bulimia nervosa.Am J Psychiatry. 2014;171(1):109-16. doi:10.1176/appi.ajp.2013.12121511

Agras WS.Cognitive behavior therapy for the eating disorders.Psychiatr Clin North Am. 2019;42(2):169-179. doi:10.1016/j.psc.2019.01.001

Waller G, Tatham M, Turner H, et al.A 10-session cognitive-behavioral therapy (CBT-T) for eating disorders: Outcomes from a case series of nonunderweight adult patients.Int J Eat Disord. 2018;51(3):262-269. doi:10.1002/eat.22837

Waller, Glenn, Helen Cordery, Emma Corstorphine, Hendrik Hinrichsen, Rachel Lawson, Victoria Mountford, and Katie Russell. 2013.Cognitive Behavioral Therapy for Eating Disorders. Cambridge: Cambridge University Press.

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