Concept

The Four Stages of Enhanced Cognitive Behavioral Therapy (CBT-E) for Eating Disorders

  1. Starting Well: The patient meets with the clinician twice a week to share relevant information about their condition as well as their primary symptoms (e.g., distorted thought patterns, maladaptive coping mechanisms, purging or restricting behaviors, etc.). The clinician develops and explains the treatment plan to the patient based on this data as well as introduces them to weekly weigh-ins, self-monitoring records, and other forms of 'homework'. Both the patient and clinician collaborate to acknowledge the internal and external conflicts that contribute to the patient's eating-disorder pathology.

  2. Taking Stock: The patient and clinician review the progress the patient has made throughout Stage One. Together, they determine strategies that can successfully be implemented when the patient encounters obstacles to recovery, some of which may include low self-esteem, interpersonal challenges, and clinical perfectionism. Based on this review, the clinician identifies the main focus areas that will be integrated into the treatment plan for Stage Three.

  3. Addressing Maintaining Factors: Whereas Stages One and Two were targeted at acknowledging the patient's general eating disorder symptoms and incrementally monitoring their overall progress towards recovery, Stage Three specifically targets each major symptom, adopting a patient-specific, individualized approach. Through identifying the underlying pathological cause/origin of each symptom, teaching the patient how to notice when a particular symptom has or is about to manifest, and training the patient to respond proactively, the thought/emotion/behavior sustaining the symptom can be eliminated. The clinician and patient meet once a week throughout Stage Three.

  4. Ending Well: The clinician assists the patient in gradually phasing out of formal treatment by providing them with a short-term maintenance plan, permitting the patient to slowly habituate to the independent maintenance of their weight and self-monitoring for symptoms. The clinician and patient meet every other week for a total of three sessions during Stage Four.

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Updated 2023-01-12

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Clinical Practice of Psychology