Decoding CBT-E

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Happy Friday! This is an informative article about CBT-E and related therapy by Melissa Gerson, LCSW, Clinical Director, Columbus Park Collaborative.  CPC is currently collaborating with Project HEAL to offer free treatment grants to our applicants, which you can read more about at the end of the article.

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CBT-E: decoding acronyms in the service of accessing the help you deserve If you are even remotely familiar with eating disorder treatment you have probably scratched your head a few times confronting the acronyms that abound: DBT, FBT, CBT-BN, CBT-BED, CBT-E. Eating disorder treatment relies heavily on these grouping of three letters, all shorthand for carefully studied EBT… that is, evidence-based treatment. Evidence-based treatment simply means therapy treatments that have been studied and clinically proven to be significantly effective. It does not mean the treatment guarantees a successful outcome, but it promises to give you the best chance possible to make desired change. You want to work with a therapist who has a good knowledge base of the EBT and refers to the latest research developments to guide her practice. The current gold standard for treatment of adults with Bulimia Nervosa and Binge Eating Disorder – and some success with Anorexia Nervosa – is an enhanced version of Cognitive Behavioral Therapy — AKA, CBT-E. CBT-E is a “transdiagnostic model” which means that it can be used to treat a full range of eating disorders diagnoses; previous versions of CBT for eating disorders were designed more specifically for Bulimia (CBT-BN) or Binge Eating Disorder (CBT-BED).

While we know that eating disorders present through the use of very different symptoms (i.e. restriction, binging, purging or any combination thereof), there is persuasive evidence to suggest that the conditions or beliefs that maintain the behaviors have a lot in common. For example, Jane and John might both struggle with extreme body dissatisfaction and obsessive thoughts about their weight and shape. As a result of this shared belief both Jane and John might engage in strict dieting in attempt to control their body weight. Let’s say this extreme behavior leads Jane to then engage in binge eating, as she is in a starvation state, and potentially then purging behavior to compensate for the binge. While John’s strict dieting, on the other hand, results in significant weight loss, and potential secondary medical complications. We might then diagnose Jane as Bulimic and John as Anorexic, but they share the same underlying psychopathology.

Because CBT-E seeks to help people challenge the core beliefs that keep their eating disorders going, one treatment (CBT-E) is thought to be efficacious for a range of diagnoses. Identifying your “obstacles to change” is at the heart of all cognitive behavioral therapies. In your therapy you will identify those things in your life that are keeping you from reducing or extinguishing destructive behaviors. Through the process you might identify obstacles such as the over-evaluation of achieving and achievement (also known as clinical perfectionism), low self-esteem, and/or interpersonal difficulties (Murphy et al., 2010). CBT-E addresses these issues, as they are quite common to many people struggling with eating disorders, again, no matter what your specific diagnosis.

So what does CBT-E look like? CBT-E is offered in two doses: 20 weeks or 40 weeks, depending on whether or not your therapist feels weight restoration is an essential part of your recovery process (including weight restoration may involve the longer term of treatment). In both cases sessions are more frequent for the first two months (twice weekly) and then gradually spread out over time. Homework, including self-monitoring of all that you eat and drink, is essential to the process. Increased awareness of eating behavior, achieved through self-monitoring, is an essential first step towards behavioral change and will provide you and your therapist with rich material to unpack in your individual sessions. You will also be weighed by your therapist in session, which can be uncomfortable at first. This is one of the most important aspects of this treatment and sets CBT-E apart from other therapies that avoid transparency around the sensitive issue of the scale.

A trained CBT-E therapist will be able to deftly use this intervention to help you explore the way you think and feel about your weight and how these specific cognitions may be maintaining your eating disorder. If you are searching for a therapist to help you overcome your eating disorder you have already taken the most important step — acknowledging that you need help. Be an informed consumer of help and make sure you ask prospective providers what their theoretical orientation is. Don’t be afraid to ask if they are familiar with EBT or to let them know that you now know a thing or two about the potential benefits of CBT-E.

 

Columbus Park Collaborative (CPC) is New York’s premier outpatient treatment center for eating disorders. They offer tailored, flexible, expert treatment for adults, children and adolescents with eating disorders.

CPC is currently partnering with Project HEAL to offer outpatient Cognitive Behavioral Therapy (a 20-session treatment) for individuals with bulimia or binge eating disorder. Project HEAL applicants should be over 18-years old and from the New York Tri State Area. Candidates must be medically stable, at a minimum of 90% ideal body weight, and cannot have current substance or alcohol abuse or be actively suicidal or self-injurious. For more information about the program please visit: http://www.columbusparkcollaborative.com

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