Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment (original) (raw)
Related papers
2017
The present article aims to present a transdiagnostic approach to eating disorders (anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified) using the example of two relatively new types of therapy: Cognitive Behavior Therapy (CBT), based on Fairburn’s model, and Acceptance and Commitment Therapy (ACT). Theoretical frameworks, psychopathology, proposed change mechanisms, as well as objectives and selected therapeutic techniques are discussed for both approaches. Directions for further research comparing the efficacy of the two approaches, the factors that moderate their outcomes, and the possibilities of integrating the two models are also suggested.
Cognitive and Behavioral Practice, 2011
In recent years there has been widespread acceptance that cognitive behavior therapy (CBT) is the treatment of choice for bulimia nervosa. The cognitive behavioral treatment of bulimia nervosa (CBT-BN) was first described in 1981. Over the past decades the theory and treatment have evolved in response to a variety of challenges. The treatment has been adapted to make it suitable for all forms of eating disorder-thereby making it "transdiagnostic" in its scope-and treatment procedures have been refined to improve outcome. The new version of the treatment, termed enhanced CBT (CBT-E) also addresses psychopathological processes "external" to the eating disorder, which, in certain subgroups of patients, interact with the disorder itself. In this paper we discuss how the development of this broader theory and treatment arose from focusing on those patients who did not respond well to earlier versions of the treatment. IN recent years there has been widespread acceptance that cognitive behavior therapy (CBT) is the treatment of choice for bulimia nervosa (National Institute for Health and Clinical Excellence, 2004; Wilson, Grilo, & Vitousek, 2007; Shapiro et al., 2007). The cognitive behavioral treatment of bulimia nervosa (CBT-BN) was first described in 1981 (Fairburn, 1981). Several years later, Fairburn (1985) described further procedural details along with a more complete exposition of the theory upon which the treatment was based (Fairburn, Cooper, & Cooper, 1986). This theory has since been extensively studied and the treatment derived from it, CBT-BN (Fairburn, Marcus, & Wilson, 1993), has been tested in a series of treatment trials (e.g., Agras, Crow, et al., 2000; Agras, Walsh, et al., 2000; Fairburn, Jones, et al., 1993). A detailed treatment manual was published in 1993 (Fairburn, Jones, et al., 1993). In 1997 a supplement to the manual was published (Wilson, Fairburn, & Agras, 1997) and the theory was elaborated in the same year (Fairburn, 1997a). CBT-BN has evolved over the past decade in response to a variety of challenges: Its procedures have been refined, particularly those addressing patients' overevaluation of shape and weight, and it has been adapted to make it suitable for all forms of eating disorder, thereby making it "transdiagnostic" in its scope (see Fairburn, 2008; Fairburn, Cooper, & Shafran, 2003). The new version of the treatment, termed enhanced CBT (CBT-E), also addresses psychopathological processes "external" to the eating disorder, which, in certain subgroups of patients, interact with the disorder itself. In this paper we discuss how the development of this broader theory and treatment arose from focusing on those patients who did not respond well to earlier versions of the treatment.
European Eating Disorders Review, 2009
Background: Anorexia nervosa (AN) and bulimia nervosa (BN) are classified as separate and distinct clinical disorders. Recently, there has been support for a transdiagnostic theory of eating disorders, which would reclassify them as one disorder. Objective: To determine whether AN and BN are a single disorder with one cause or separate disorders with different causes. Method: Hill's Criteria of Causation were used to test the hypothesis that AN and BN are one disorder with a single cause. Hill's Criteria of Causation demand that the minimal conditions are needed to establish a causal relationship between two items which include all of the following: strength of association, consistency, temporality, biological gradient, plausibility, coherence, experimental evidence and analogy. Results: The hypothesis that AN and BN have a single cause did not meet all of Hill's Criteria of Causation. Strength of association, plausibility, analogy and some experimental evidence were met, but not consistency, specificity, temporality, biological gradient, coherence and most experimental evidence. Conclusions: The hypothesis that AN and BN are a single disorder with a common cause is not supported by Hill's Criteria of Causation. This argues against the notion of a transdiagnostic theory of eating disorders.
Severe and Enduring Eating Disorders: Concepts and Management
Intech Open, 2019
The concept of severe and enduring mental illness was introduced in 1999 in order to direct resources to patients suffering from long-term serious disorders , and was suggested for eating disorders in 2009. However, the term is still restricted to patients with long-term psychosis. In this chapter, the concept of severe and enduring eating disorder (SEED) is described and its relevance to anorexia nervosa (AN) and bulimia nervosa (BN) is explored. The recovery curve for anorexia nervosa seems to follow an exponential pattern with an asymptote that approaches but does not meet the horizontal, suggesting that recovery is always possible. Symptoms of AN but not BN seem to worsen after 3 years of illness, perhaps a significant threshold. Symptoms of severe and enduring AN (SEED-AN) are debilitating and longstanding as well as potentially fatal. Symptoms of severe and enduring BN (SEED-BN) are also debilitating, especially in social adjustment. In both conditions, family difficulties are prominent. A clinical approach to SEED is described based on improving quality of life, the recovery approach, (rather than cure) for sufferers and their families is described, although full symptomatic recovery can occur at any stage and clinicians should be alert to the possibility in all patients.
Cognitive Behaviour Therapy for Eating Disorders
Behavioural and Cognitive Psychotherapy, 2008
The eating disorders provide one of the strongest indications for cognitive behaviour therapy (CBT). This bold claim arises from two sources: first, the fact that eating disorders are essentially cognitive disorders and second, the demonstrated effectiveness of CBT in the treatment of bulimia nervosa, which has led to the widespread acceptance that CBT is the treatment of choice. In this paper the cognitive behavioural approach to the understanding and treatment of eating disorders will be described. A brief summary of the evidence for this account and of the data supporting the efficacy and effectiveness of this form of treatment will be provided. Challenges for the future development and dissemination of the treatment will be identified.
Eating disorders: Efficacy of pharmacological and psychological interventions
Clinical Psychology Review, 1996
Estimates of the prevalence of eating disorders are less than 1% for anorexia nexvosa (AN), l-3% for bulimia nervosa (BN), and between 2 and 5% for binge eating disorder (BED). While these estimates reflect the proportion of community populations satisfying formal diagnostic criteria, the prevalence of caloric restriction, binge eating, purging, and other pathogenic weight control behaviors (PWCBs) is much higher, ranging from 15 to 40% (Schlundt &Johnson, 1990, Spitzer et al., 1992). Eating disorders have profound health, economic, and personalsocial consequences. AN is associated with a significant mortality (5-15%), and BN is closely related to depression and various Correspondence should be addressed to 457 458 W G. Johnson, J. I! Tsoh, and II J. Varnado