CBT-E is an outpatient CBT program designed for adults with eating disorders. It is a structured and time-limited therapy that involves an initial assessment session, followed by 20 therapy sessions across 20 weeks. The number of sessions is sometimes adjusted to suit each person’s needs.
CBT-E uses cognitive and behaviour therapy techniques with the aim of helping people develop new ways of coping and reduce eating disorder behaviours. It involves:
The key features of CBT-E are:
CBT-E was developed by Christopher Fairburn and his colleagues at the Centre for Research on Eating Disorders Oxford. It adapts and expands CBT strategies to specifically target eating disorders and their maintaining cognition and behaviours. CBT-E grew out of CBT for Bulimia Nervosa (CBT-BN), which Fairburn developed in the 1980s, and was adapted in the 2000s for all eating disorders.
In the medical model, different types of eating disorders (such as Bulimia Nervosa, Binge Eating disorder etc.) are viewed as distinct conditions, each needing its own form of therapy.
In contrast, CBT-E holds a transdiagnostic view of eating disorders. This means, it views the processes that maintain:
as largely the same. Consequently, the therapy is the same (with minor modifications) regardless of the diagnosis.
At Exhale Psychology Centre, we hold the transdiagnostic view of eating disorders, focusing on what each person is experiencing (e.g. urges to restrict, purging) rather than on the specific eating disorder diagnosis.
That said, we recognise that some eating disorders can be quite different in nature and require a different approach, such as with Avoidant/Restrictive Food Intake Disorder (ARFID).
CBT-E is a well-researched therapy, and has shown promising results for adolescents (1). In one trial, around two-thirds of people met criteria for remission after 20 sessions of CBT-E, and these improvements tended to be maintained (2). This is significant given how hard eating disorders can be to shift.
People who received CBT-E for bulimia have reported significant reductions in depression and anxiety (3).
Although CBT-E is viewed as the gold standard therapy for eating disorders, it does not work for everyone, and roughly 25% of people stop early (4).
CBT-E does not target other significant difficulties that can keep eating disorders going, such as treatment-resistant depression, trauma or ADHD. At present, there is not enough evidence to show that people with complex presentations benefit from CBT-E. People with other significant mental health conditions tend to be excluded from research studies (due to the complex variables), and when they are included, dropout rates are high and outcomes are less positive (5).
Part of the foundation of CBT-E is the view that most of a person’s difficulties will ease once their weight is restored, their eating disorder behaviours reduce or their eating becomes more regular.
This is often not the case for people with several co-occurring conditions, where the eating disorder seems to be a way of coping with other difficulties rather than the main concern.
At Exhale Psychology Centre, we mainly work with people who:
For people who have tried CBT-E or have complex co-occurring conditions, we offer:
We do not offer a one size fits all but instead see each client as a whole person requiring an individualised approach.
View our servicesOur psychologists and dietitian are skilled in the areas of neurodivergence, eating disorders, & complex trauma.
Meet the teamOur approach is neurodiversity affirming, trauma-informed, weight neutral, and intersectional.
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