Enhanced Cognitive Behavior Therapy (CBT-E) for Patients with Anorexia Nervosa

Abstract

Anorexia nervosa (AN) and bulimia nervosa (BN) share a core psychopathology characterized by an excessive preoccupation with body weight, shape, and control. Multiple randomized controlled trials have demonstrated the effectiveness of enhanced cognitive behavior therapy (CBT-E) for AN, which is internationally recommended as the first-line treatment for adults with this disorder. CBT-E typically comprises 40 sessions for AN, whereas BN treatment involves 20 sessions. This difference arises from the need for weight restoration during AN treatment, which is time-consuming. Due to the extreme fear of weight gain that characterizes AN, the early phase of treatment incorporates modules specifically designed to enhance motivation. In particular, the collaborative formulation process is crucial for emphasizing the necessity of weight restoration. Once sufficient motivation is established, treatment sets a target body mass index of approximately 19 kg/m² and focuses on facilitating weight recovery. The patients are encouraged to adopt a structured eating pattern that includes morning and afternoon snacks. When necessary, supplementary nutrition is provided to support weight gain. Throughout the treatment, core psychopathology is addressed through therapeutic sessions, similar to BN treatment. Once the target weight is achieved, the focus shifts to the weight maintenance phase, in which therapists help patients accept their new weight and engage in activities enabled by this change. Finally, relapse-prevention strategies are implemented before the conclusion of treatment. This paper provides an overview of CBT-E for AN.