Eating disorders are complex mental health issues, and modalities like Enhanced Cognitive Behavior Therapy (CBT-E) can be an effective approach for long-lasting recovery. The behaviors and root causes associated with them can differ from one person to the next, which means a conventional, one-size-fits-all treatment method might not prove beneficial for everyone.
What’s more, less than 30 percent of adults maintain long-term recovery, and at least 50 percent will eventually relapse, according to the Journal of Eating Disorders. Folks with co-occurring medical or mental health conditions, as well as those in marginalized communities, exhibit a higher risk of relapse, the journal continues.
Sustainable treatment protocols must be tailored to the specific underlying factors of each unique eating disorder case. That’s where CBT-E therapy comes in—let’s discuss why this intervention works and how to incorporate it into eating disorder recovery.
CBT-E Therapy: An Overview
Enhanced Cognitive Behavior Therapy (CBT-E) is an eating disorder treatment that takes the transdiagnostic aspects of this illness into account. Transdiagnostic means that various causes and co-occurring issues will often contribute to both the development and maintenance of an eating disorder. Here are some common examples of these co-occurring issues:
- Childhood abuse or trauma
- Genetic history of eating disorders
- Sexual harassment or assault
- Other mental illnesses (anxiety, depression, etc.)
- Autoimmune or chronic health conditions
- High prevalence of food insecurity
- Cultural body stigmas or beauty ideals
- Gender, racial, or sexuality discrimination
- Participation in elite athletics
It’s crucial to treat the eating disorder holistically at its source—which means digging into these co-occuring issues. This allows you to identify how the illness originated, why it continues to persist, and what actions you can take to heal from the inside out.
So, how does CBT-E promote this holistic recovery? Rather than focusing only on behavioral modification or weight restoration to neutralize your surface-level symptoms, CBT-E rewires the brain to change your entire relationship with these behaviors.
Patients who undergo a consistent CBT-E therapy intervention are much more likely to recover long-term than those who don’t finish the program or receive another course of treatment, according to the Journal of Eating Disorders.
How CBT-E Therapy Works
CBT-E interventions take place in four stages over 20 sessions because it is a time-limited therapy. In other words, it’s designed to be efficient and quick, rather than a long-term therapy. Due to the highly personalized nature of this treatment model, there is also room for flexibility to accommodate each patient’s needs, level of progression, and current mental health.
Generally, however, the progression of CBT-E is as follows.
Stage 1: Starting Well
In the first stage of this process, a licensed CBT-E therapist will conduct a thorough evaluation of your eating disorder. This creates a mutual understanding of the beliefs, emotions, traumas, insecurities, or societal messages that caused your behaviors, so the therapist can customize a holistic treatment plan for you.
Stage One usually requires two sessions a week for one month, and the objectives are to establish a trusted clinical relationship, stabilize nutrition and exercise habits, and unpack body image-related concerns.
Stage 2: Taking Stock
The second stage is brief—only a couple of sessions over 1–2 weeks—but it lays a foundation to create, refine, and utilize strategies that work for you. In this stage, the therapist will review the progress you have made since starting CBT-E, help you determine which obstacles make it hard to implement further changes, and form an action plan to confront these obstacles.
You can revisit Stage Two at any point in treatment to adjust your strategies, recommit to your goals, and ensure that your needs are being met.
Stage 3: Setbacks & Mindsets
The third stage is where most of your therapeutic work unfolds—on average, the sessions will occur once a week for about 8–10 weeks. Your therapist will focus on both the cognitive and behavioral issues that cause your eating disorder to persist.
This makes it easier to reframe dysfunctional thoughts around size, shape, weight, food, or exercise. It also helps you deal with setbacks such as self-esteem issues, interpersonal difficulties, or other stressful events that could lure you back to harmful coping mechanisms.
Stage 4: Ending Well
The final stage is a culmination of all the growth you achieved in this process, while also looking ahead with a maintenance plan for long-term recovery. This stage emphasizes the need to both celebrate progress and cultivate resilience for future challenges.
In bi-weekly sessions over a month, you’ll learn how to identify high-risk situations for relapse and hone the skills you need to navigate these circumstances without an eating disorder. The primary goal is to be responsible and accountable for your own healing.
3 Ways to Practice CBT-E in Eating Disorder Recovery
CBT-E therapy is most effective when it’s done with culturally sensitive, trauma-informed clinicians who are trained in this modality. However, you can also practice aspects of CBT-E at any time—both during a session and in the normal rhythms of life. Here are three techniques from licensed therapist and CBT-E expert Ashley Ellis to incorporate into your eating disorder recovery.
Relaxation Techniques
Research shows that meditation, journaling, breathwork, progressive muscle relaxation, or other mindfulness practices reduce cortisol levels and soothe the autonomic nervous system. This will ground your awareness in the present and increase mental clarity to process intense emotions, anxious thoughts, or unresolved traumas instead of numbing out from the pain with your eating disorder or restrictive eating behaviors.
Not only do relaxation techniques promote inner calm, they also help locate the source of emotional distress, so you can confront and move through it.
Cognitive Restructuring
Cognitive restructuring is a process that teaches you how to reframe harmful thoughts or beliefs into more adaptive, flexible, and healthier thinking patterns. This will help you learn to spot any cognitive distortions about food, weight, exercise, and body image, as well as some of the emotions connected to them. From there, you can question the accuracy of those beliefs and explore a more compassionate lens to see yourself through.
The more you practice cognitive restructuring, the more it rewires your brain over time to create positive habits around how you view, treat, nourish, and interact with yourself.
Hunger & Fullness Check-Ins
Eating disorder behaviors often repress the ability to detect internal hunger or fullness cues. This makes it tough to differentiate between physical and emotional hunger, which can lead to habitual food restriction or overconsumption.
Hunger and fullness check-ins help you restore those natural cues by tuning into the sensations you feel before, during, and after each meal. This practice can alleviate food-related anxieties and reinforce intuitive eating, in which nourishment is based on physical needs rather than emotional influences.
Recover Using CBT-E Therapy With Kindful Body
It’s hard work to heal from the complex behaviors and root causes of an eating disorder, but help is available. Schedule a free 15-minute consultation with our team here at Kindful Body to find the ideal clinician who can use CBT-E and other restorative modalities to customize your treatment plan. Sustainable, long-term recovery is possible—and you deserve to pursue it.
Interested in learning more about Kindful Body? Visit our website, read our blog or follow us on Instagram, Facebook, LinkedIn, and YouTube.
