The effectiveness of enhanced cognitive behavioural therapy for eating disorders

It is said that "a chronic disruption of eating or eating-related behavior resulting in changed intake or absorption of food that substantially compromises physical health" (DSM-5, 5th ed., APA, 2013, p. 329) as an indicator of an ED (American Psychiatric Association (APA), 2013). There are three types of eating disorders: anorexia, bulimia, and binge-eating disorder (BED) (APA, 2013). Avoidant restrictive food intake disorder (ARFID), a new addition to the DSM-V, is characterized by a lack of solid food intake, resulting in malnutrition (APA, 2013). A diagnosis of ED not otherwise specified (ED-NOS) may be made for individuals who do not fit all of the criteria for one of the aforementioned disorders but who are nevertheless suffering severe distress or impairment (Fairburn et al., 2008).

Enhanced Cognitive-Behavioral Therapy:

It wasn't until recently that CBT-E was developed to treat all three types of eating disorders at the same time: refeeding for anorexia, CBT-BN (for binge eating), and CBT-BED (for anorexia with anorexia) (National Collaborating Centre for Mental Health, 2004). Transdiagnostic treatment of EDs has been proposed by Fairburn, Cooper, and Safran (2003). 'Enhanced' CBT (CBT-E) was created by Fairburn et al. (2008) to treat any kind of eating problem. CBT-Ef, which focuses on the particular pathology of ED, or CBT-Eb, which addresses the psychosocial issues that are likely to contribute to or sustain ED pathology, may be utilized to provide this treatment (Fairburn et al., 2008). The targeted version is referred to as "ED-focused CBT" in NICE (2017, NICE) recommendations (CBT-ED).

CBT-E is an outpatient treatment for adults with clinically severe ED that is based on the transdiagnostic theory of CBT (Murphy, Straebler, Cooper, & Fairburn, 2010). Overweight patients typically get 20 sessions over 20 weeks of treatment, whereas underweight individuals receive 40 sessions over 40 weeks. Guest Posting Websites Patients with severe clinical perfectionism, poor self-esteem, or interpersonal issues should utilize the wide version, which is reserved for the majority of patients (Murphy et al., 2010). Stage one begins with collaborative weekly weigh-ins, self-monitoring, education, and regular eating after a collaborative evaluation includes a personalized formulation or case conceptualization. In the second stage, difficulties and obstacles that have persisted are handled in a transitional period. Key cognitive processes, such as over-evaluation of form and weight and adherence to food guidelines, are addressed in the major body of therapy in stage three. Additionally, CBT-Eb addresses clinical perfectionism, poor self-esteem, and interpersonal issues. The last phase of the process is making plans to keep things moving forward. Modifications are made for underweight patients to address motivation, weight restoration via a nutrition program and, if required, the involvement of other family members. First, CBT-Ef and CBT-Eb were tested on overweight and obese patients with either BN, BED, or an eating disorder. Patients with an eating disorder were excluded from the study (Fairburn et al., 2009). Participants were randomly randomized to either an immediate start or an 8-week wait period for the two types of CBT. On the other hand, only around half of the individuals who received either therapy had their symptoms improve to within one standard deviation of the average in the population. An exploratory study found that CBT-Eb worked better for people with more complicated psychopathology, while CBT-Ef worked better for those with simpler psychopathology. Because of this, it was suggested that patients with ED utilize the concentrated form, and only those with more complicated psychological issues should use the wider version. Patients with BN, BED, or ED-NOS in another research who compared CBT-Ef with interpersonal psychotherapy (IPT) had considerably greater remission after CBT-Ef than after IPT (Fairburn et al., 2015). 60 percent of patients with AN with a BMI of 15.0 to 17.5 who were treated with CBT-E completed the program, and of those, 60 percent had a positive outcome with a low relapse rate. These are the results of the initial three-site research (Fairburn, 2009). Two-thirds of individuals who completed therapy, or 40% of the sample, obtained full remission in the first open study to cover all ED, including AN (Byrne, Fursland, Allen, & Watson, 2011). A further look into the high dropout rates in that research indicated three predictors: a lengthy waitlist, a history of very low weight, and a desire to avoid feeling any emotion (Carter et al., 2012). Most individuals who finished their program found the therapy to be beneficial; the biggest challenge was a lack of desire.

An RCT evaluating the effectiveness of 10 months of CBT-E, focused psychodynamic therapy (FPT), and optimal treatment as usual (outpatient psychotherapy with organized care from a doctor) in 727 individuals with AN found that all three therapies were similarly successful in returning BMI to normal (Zipfel et al., 2014). CBT-E resulted in quicker weight gain and improved ED psychopathology, although FPT demonstrated superior recovery after 12 months of follow-up. During 40-week CBT-E research conducted in two countries, 99 persons with AN who were able to complete therapy showed considerable weight gain and BMI improvement, as well as better ED symptoms (Fairburn et al., 2013). For teenagers with anorexia nervosa (AN), a pilot trial with 49 patients found that CBT-E might be an alternative to family-based treatment; two-thirds finished the program and considerably raised their weight while lowering ED pathology; (Dalle Grave, Calugi, Doll & Fairburn, 2013). At 6- and 12-month follow-up, all of the 26 (out of 27) patients who completed a CBT-E treatment for severe anorexia exhibited substantial changes in weight and ED characteristics, as well as in general psychopathology (Dalle Grave, Calugi, El Ghoch, Conti, & Fairburn, 2014). CBT-E seems to be at least as effective as the other treatments now indicated, according to the available data. CBT-E may be a potential therapy for anorexia nervosa (AN), notwithstanding the need for more rigorous studies comparing CBT-E to other treatments.

No RCTs have been undertaken with ARFID and no randomized controlled trials have been conducted with BN, according to a comprehensive review of RCTs examining the efficacy of existing therapies for EDs (Hay, 2013). Although two trials found CBT to be less successful than other kinds of therapy, they did not include CBT-E. Small sample sizes and high attrition rates plague AN studies (Murphy et al., 2010). Research volunteers are hard to come by, dropout rates are high, and desire to change is low, as is AN's strong resistance to therapy (Fairburn et al., 2013; Murphy et al., 2010). Smaller studies were required to support bigger RCTs due to the lack of compelling evidence for AN therapies (Fairburn et al., 2013).