Enhanced Cognitive Behavior Therapy: A Single Treatment for All Eating Disorders

Abstract

Eating disorders are serious mental illnesses affecting a significant proportion of women and a smaller number of men. Approximately half of those with an eating disorder (ED) will not meet the criteria for anorexia or bulimia nervosa, and will be diagnosed with an eating disorder not otherwise specified (EDNOS). Until recently, there were no recommended treatments for EDNOS. This article provides an overview of enhanced cognitive behavior therapy, a validated treatment for all forms of EDs.

Testing the cognitive-behavioural maintenance models across DSM-5 bulimic-type eating disorder diagnostic groups: a multi-centre study

“…This last finding supports our hypothesis and suggests that the added hypothesized maintenance variables in the CB model improved its explanatory utility. The direct path from interpersonal problems to the other three maintaining factors, and the results regarding how each maintenance factor is inter-related with each other, as well as their associations with OSW, all are in accordance with previous findings across individuals with different DSM-IV ED diagnosis, included individuals with threshold and sub-threshold AN [15], and together provide support for the trans-diagnostic nature of the maintenance factors as they pertain to OSW [7,12,13,23]. The finding indicating that clinical perfectionism, interpersonal problems, and core low self-esteem impacted dietary restraint through OSW, highlights the importance of dysfunctional cognitions amongst bulimic-type ED patients and are consistent with CB-E theory and past research [8, 13, 17-20, 48, 51].…”

“…The final maintenance factor of mood intolerance (i.e. inability to appropriately cope with adverse affective states followed by dysfunctional impulsive behaviours) [13] is believed to directly affect and maintain binge eating [12,17,[21][22][23][24]. The CB-E approach is consistent with research that documented two subtypes of patients with BN and binge eating disorder (BED) based on purely dietary restraint (i.e.…”

“…Although there is evidence that initial dietary restraint levels predict future onset of binge eating among asymptomatic individuals [24,56,57], as in this study, prior research using clinical interviews or ecological momentary assessment failed to support the dietary restraint-binge eating relationship among bulimic-type ED patients [9,[58][59][60]. Although, the impact of dietary restraint on binge eating deserves further elucidation, the direct paths from interpersonal problems and mood intolerance to binge eating lend some credence to scholars' suggestion that factors other than restraint may play a more critical role in the maintenance of binge eating among clinical samples [21,47,48,54,55], and highlight the importance of their inclusion in the CB-E theory, assessment, and target [12,13,21,23,28]. Moreover, the present study indicated that the dietary restraint-binge eating relationship is fully mediated and explained by mood intolerance.…”

“…The enhanced CB treatment (CBT-E) approach [7] that derives from the CB-E theory [13] has attracted the interest of clinicians because it is an individual and "modular" form of CBT, in which specific modules may address one or more of the four particular maintaining mechanisms operating in the individual patient's case [23]. Although recent randomized control trials provided support for its efficacy in any form of eating disorder (ED) [27,28], this does not necessarily provide evidence for the adequacy of the CB-E theoretical model on which the treatment is based.…”

“…In fact, the only study with a clinical sample of individuals with DSM-IV-including sub-threshold-anorexia nervosa (AN), and BN investigated only the mutual relationships between each maintenance factor, and their associations with OSW [15]. Moreover, since the CB-E model was developed to expand and improve the original CB model [13], an empirical comparison of the two CB models, in an attempt to evaluate whether the predictive ability of the original model would be improved by the inclusion of the four additional maintenance factors (CB-E model), could potentially have implications for understanding the persistence of bulimic-type EDs and provide indirect support for the utility of the CBT-E [7,15,17,[22][23][24].…”