Cognitive behavioural therapy (CBT-E) for eating disorders

What place is there for CBT?

For children and adolescents, most professional organisations recommend a family-based approach for anorexia and for bulimia (which is what most of this website supports), rather than CBT.

But CBT is still a valid option if a family-based approach doesn't work for you. It's strongest on binge eating disorder and bulimia, and seems pretty weak with anorexia.

What is CBT for eating disorders like?

With both FBT and CBT, there's an emphasis on changing the mind through restoring nutrition and changing behaviours.

Rather than talking about change or working on thoughts so that feelings and behaviours change (which is the emphasis on regular CBT), CBT for eating disorders seeks to improve behaviours (such as regular eating) to get physiological benefits, and this is, in turn, expected to improve thoughts/beliefs and feelings.

People have to keep an ongoing record of their eating or purging behaviours, thoughts, emotions and triggers ('homework'). They must be willing to talk and must be capable of rational thinking to take in information, to recognise the downsides of the illness, and to gain the motivation to experiment with new behaviours.

With a family-based approach like FBT, parents are briefed and empowered to make the behaviour modifications (such as regular eating) happen. A CBT therapist, on the other hand, will expect your child to be both willing and capable of making changes themselves.

CBT books imply that if your child can't do that, they must be discharged. And indeed, in studies, a big proportion of participants do not complete treatment. If that happens with your child, you'll have to move to another kind of treatment. As I'll discuss on this page, you'll then need your child to accept your help again — even if it's just to find them another treatment — after weeks or months of messaging that everything is their own decision.

CBT has been shown to be slower on average, especially if there is a lot of weight to regain, or if your child's brain is too affected to engage with a therapist, to do 'homework' or to access any sense of motivation. Think of that if your child is howling over every bite on their plate and hiding food in their pockets: will a weekly CBT session be able to reverse the rapid downward trend of the illness?

Another way of using CBT is as a follow-on to FBT. (I describe individual therapies in general here). That might give you the best of all worlds, though on this page I suggest things to check, to ensure your child gets benefits and no harm.

The CBT model is that anorexia, bulimia and binge eating disorder all present similar mechanisms. The only distinction it makes is that those who are underweight get a longer treatment.

There are manuals for eating-disorder-focused CBT. You'll find differences between the authors, and even bigger differences between therapists: these often seem to conduct CBT as part of a mix of approaches, based on their experience, preferences and their assessment of a person's needs.

Not underweight? A brief version of CBT

There is now an interesting variation on CBT for eating disorders, called CBT-T. The 'T' stands for Ten sessions. The clinician manual for this approach is 'Brief Cognitive Behavioural Therapy for Non-Underweight Patients'. Glenn Waller wrote to me in 2023 that 'it was designed for adults, but we are finding that a lot of children and young people's services are adopting it, especially if a patient has had FBT, has regained weight, but the eating and body concerns are not shifting. It has also been tried successfully with adolescents in a study in Australia, with more to come.'

As CBT is often offered to our children, I'm going to tell you more about what it is, how well it works and doesn't work, what the risks are and how to manage them. I hope it will help you decide if you want to go down this path at any stage. Note that I won't comment on CBT-T as I don't know enough about it.

Make sure it's CBT specialised for eating disorders

Cognitive behavioural therapy (CBT) is a widely available treatment for depression or anxiety. Many therapists list it as one of their approaches to treating eating disorders, and it is essential that you satisfy yourself that they’re not offering general CBT, but are trained[i] in evidence-based CBT for eating disorders – in other words, CBT that is specially adapted and tested for eating disorders (in the UK it’s called CBT-ED).

From conversations with parents, I gather a lot of CBT given to their child does not follow the principles I see in the CBT-for-eating-disorders manuals (Waller, Fairburn or Dalle Grave). The result could suit the child very well, or it could mean they are getting a haphazard treatment that plods along even when there is no engagement or progress.

From here on, when I talk of CBT, I will be referring to one of the evidence-based forms that have been developped for eating disorders (bulimia, binge eating disorder and anorexia).

Does CBT work for adults with an eating disorder?

CBT-E has been designed for adults with a BMI between 15 and 40. It can be delivered via self-help and in groups but it is more effective in individual therapy.

The most recent thorough review of all treatments comes from England’s NICE guidance. The outcome is that CBT is recommended for adults but is not the first choice for young people.

It has been well researched on adults with bulimia and binge-eating disorder, and to a lesser extent, on adults with anorexia, and works better than most other individual therapies[ii]. According to Christopher Fairburn, who developed CBT ‘enhanced’ for eating disorders (CBT-E), ‘two-thirds of adult patients who complete treatment make an excellent response’, though the ‘outcome is less good’ in adults with a BMI under 17.5.[iii]

Please take note of the phrase 'who complete treatment' (a phrase that keeps coming up in CBT-E studies). A significant proportion do not complete treatment, and you should think about what that might mean for your child.

You might be interested in how Lock and Le Grange (authors of the FBT parent's book, 2025) summarise recent CBT-E research for anorexia in adults: 'It was helpful for some, but the overall response was not impressive. Other studies of adults with anorexia nervosa comparing CBT-E found no difference in outcome among randomized treatment groups and most patients were still significantly ill'.

Does it work for teens?

For children and adolescents with anorexia or bulimia, the best evidence indicates that a family-based approach is superior and should be the first port of call. After a thorough review of the research, the NICE guidance (2017) in the UK clarified that CBT may be used only if a family approach is ‘unacceptable, contraindicated or ineffective’: the only valid reason to start off with CBT is when parents are unable or unwilling to give their child the level of support, supervision and uncritical acceptance that family therapy requires.

For binge eating disorder, NICE recommends CBT for both adults and adolescents.

I'm going to stress how small the research is. It's so small that if didn't have the solid base of cognitive-behavioural therapy for other mental health issues (depression etc), I'd put it into the 'experimental' or 'alternative' category. But I want to keep the door open for you to look into CBT for yourself. Clearly it worked for some youngsters, even some who started off underweight. It might be wonderful for your child.

To give you a sense of the scale of CBT studies on youngsters, it looks like there was one with 46 kids, one with 68, one with 49 and one with 97. I'm not sure if some of those studies refer to the same kids. They're discussed as a group in this 2019 paper. Participants were aged 11 to 19 and there was no distinction according to the eating disorder (anorexia, bulimia or binge eating disorder). In the results, you will see an 'underweight' category, which we can assume is for anorexia. Underweight patients get 40 sessions (so about a year of therapy) rather than 20.

After those 40 sessions, success is marked by 'a significant increase in weight, as well as a marked reduction in eating-disorder symptoms, general psychological features, and clinical impairment', according to the study's authors. That success is for 60% of the participants who completed treatment: 'Findings from these studies showed that in patients with anorexia nervosa who complete the treatment (60–65%) about 60% achieved a full response (i.e., BMI centile corresponding to an adult BMI of ≥18.5 kg/m² and an eating disorder examination interview score within one standard deviation of population means).'

So more than 35% of the kids in those studies dropped out at some stage.

That 2019 paper also states that the 'findings provide compelling evidence not only that CBT-E is even more effective in adolescent patients, but also that positive outcomes may be achieved in a shorter time frame than that required by adults.' The implication, I imagine, is that we can look at the bigger number of adult studies and hope results will be better with adolescents. Please remember that for anorexia in adults, CBT-E has not shown to be a resounding success.

Look into the details of that 2019 paper and you'll see that only one-third of participants reached a weight close to their ideal body weight — and 'close' is, in my view, still risky: the average was below the median BMI for their age. Dalle Grave seems to have a low, blanket threshold for recovery weight similar to Fairburn's, considering a BMI of 18.5 in adults a good result.

The research on CBT versus FBT in adolescents

One 2019 study compared FBT (family-based treatment) with CBT-E in adolescents with a range of eating disorders. Overall, conclusions are in line with NICE guidance (2017), that CBT-E has a place in some situations, but for youngsters with anorexia, FBT is the first-line treatment. Le Grange, one of the study's authors, writes in writes in the FBT parents' book (2025) that for adolescents with anorexia, CBT 'may best be described at this time as a potentially effective approach that requires further systematic study (including randomized comparison treatments and different study sites) before it can be called an effective treatment for the disorder in this age group'.

A similar note of caution comes from Glenn Waller,[vii] author of my favourite books and teachings on CBT, and one of the experts behind the NICE guidelines:

“CBT should be considered as an alternative that can be used only where FBT is not possible or indicated or where FBT has failed to be effective.”

You'll see a rather different message from CBT-E authors Riccardo Dalle Grave and Carine el Khazen. In their book for parents, they write that 'FBT and CBT-E are equally as effective' (pages 66-67). Details are in this 2020 (reprinted 2022) publication.

You should appreciate that in this 2020 study comparing CBT-E with FBT, the number of low-weight patients who chose the CBT-E route was just sixteen (yes — participants could choose between the two methods — so the groups were rather different from the very start). Of those, ten did not complete treatment (what happened to them?)

So if you're trying to decide between CBT and FBT for your low-weight child, and you base your decision only on this study, be aware you're effectively looking at results on six — yes six — young people. The numbers of patients following the FBT route were similarly low.

Did each of those six persistent youngsters recover? I can't find that information in the paper — only averages, and as I'll show below, those are underwhelming.

So, CBT or FBT? The authors conclude in the 2020 paper (the one that ends up with six participants): 'While tentative, it would seem appropriate to recommend CBT-E rather than FBT for lower weight patients who present with either lower levels of depression, are older, not living in their family of origin, or have no previous psychiatric hospitalizations.'

For adolescents with bulimia, there is only one randomised controlled study comparing FBT with CBT. Both produce similar outcomes 12 months post-treatment but FBT produces improvements sooner,[vi] which may be why FBT is NICE’s top recommendation.

What about weight and psychological changes?

When you look at studies, be aware that what's considered an improvement may be far below what you want. From the 2020 paper, you'll see that among the six low-weight patients who completed the 40 weeks of treatment, the average weight they reached was less than 95% of the median BMI (95% weight for height). That makes me think that all or most of them stayed underweight, and most experts would agree that this prevents full recovery from anorexia. For the tiny number of five who were available to be re-assessed at 12-month follow-up (so, roughly 2 years after start of treatment), weight had crept up but was still below 97% of median BMI. And by that time, all results were roughly similar to those in the FBT group.

Table 2 in the paper reports not just on weight but on various psychological measures. There's acronyms I'm not familiar with, so I haven't spent any more time on it, given we're looking at what was, ultimately, just six participants with anorexia.

When is CBT indicated… or to be ruled out?

Fairburn indicates that CBT-E may not be suitable for those below the age of 15 and is rarely appropriate for children under 14 years old. I can't see a recommended age in Riccardo Dalle Grave and Carine el Khazen's book for parents. The adolescent studies Dalle Grave refers to in papers mention participants age 11 to 18.

The CBT-E manual indicates a number of criteria that rule out the approach. If your youngster has lost a lot of weight (more than 20 per cent or so), or presents a health risk or a suicide risk, or has co-existing psychiatric problems, or refuses to engage in individual treatment, you cannot use CBT-E outpatient treatment right away. The manual recommends a preliminary intervention such as family therapy. If your child has clinical depression as well as an eating disorder, the therapist might want that to be treated first.

I haven't seen any particular attention to autism or ADHD in the CBT manuals. I don't think I've seen anything on the crossover with OCD either, but I wonder if that is OK as there might be plenty in common between OCD treatment and CBT for eating disorders.

If there are no major obstacles to your child having CBT and if you’ve already completed a course of family therapy, CBT might help your child deal with any eating disorder beliefs or habits that haven’t successfully been addressed in family therapy. It might help him learn more about relapse prevention and take responsibility for maintaining behaviours that will keep him safe.

Above: manuals aimed at therapists, by Waller, then Fairburn, followed by self-help books by Waller, then Fairburn

Above: CBT-E books by Dalle Grave: a parents' guide, and an treatment manual

My experience with CBT

I convinced my daughter to visit a CBT therapist after FBT had run its course. She was still suffering from an internal tension to keep her weight low. I came to regret entrusting my girl to this therapist. I had chosen them carefully, discussed our situation, made agreements about how we'd communicate, and was happy to know they'd had their training directly from Glenn Waller, whom I respect.

Nevertheless, this person naively believed and endorsed everything my daughter told them. My daughter presented so well outside the home! Bright and enthusiastic, and seemingly free of anorexia. Four sessions in, without consulting us, the therapist endorsed my girl’s pleas to join a gym and to stop any weight gain. My husband and I were unhappy that a therapist should make decisions on our behalf, with so little knowledge of the fact and so little communication. We ended the therapy and slowly worked on undoing the damage.

That’s only my experience, but if you’re considering CBT, I recommend you first read the books written for therapists so as to know what to expect, and what to check when you interview them.[viii] (I did all that but sadly, in my case, it was not enough.)

What is the parents' involvement?

Young people, according to Fairburn, need to develop autonomy and will be helped to make choices and take appropriate control. With all this in mind, Fairburn wants therapists to be clear that they work exclusively on the youngster’s behalf and not on behalf of the parents. Parents are involved at the outset and there are regular joint meetings, but the bulk of the CBT-E therapy is between the young person and the therapist.

On the other hand, Waller gives examples of greater parent involvement and an intelligent approach to confidentiality. He emphasises that a therapist only spends an hour a week with a patient, and that the real therapy happens in the young person’s real world, where they are part of a family and benefit from their parents’ support. Waller told me that he was researching adaptations involving parents, and would not give advice until the research was completed.

This means that so far, when it comes to youngsters, the main publications are from Riccardo Dalle Grave.

Dalle Grave's message to parents: 'Don't interfere'

If you're considering CBT for your child I would recommend you look at Ricardo Dalle Grave's books as they are based on Fairburn's CBT-E, applied to teens. There's a clear 'Don't interfere, our child decides' message which I think is at odds with what Waller suggests in his books.

Dalle Grave writes, 'Naturally, parents are not excluded from participating in their child’s treatment, but their involvement is limited to helping create a family environment conducive to recovery.'

The Parents' Guide by Riccardo Dalle Grave and Carine el Khazen will make you understand quite how hands-off you will be expected to be. And it's not as though you can rely on the therapist to make wise decisions, because all decisions will be made by your physically and mentally ill teen. That sends shivers down my spine.

From the book: 'Remember that they are at an age now when they need to learn to take responsibility for themselves and don't give in to the temptation to interfere'. More alarm bells for me. I've followed so many parents by now, and this kind of talk is so often premature. I am not alone in saying that age is irrelevant; the question is, does this person have the capacity to make wise decisions, and the ability to carry them through?

So what is our role, according to the book? To 'create a calm environment at home, and show your teen all the love and understanding you feel — the rest will be up to them.' More specifically, you'll get just a few brief meetings, during which you'll be told to support your child to do whatever your child agreed upon with the therapist. What will your support look like? Well, I see words like 'gently', 'encourage', 'remind', 'suggest'. We are warned not to push more than planned.

More from the parents' book

The Dalle Grave and el Khazen parents' book gives you a flavour of the amount of talk and education that takes place between your child and the therapist, aiming to create an agreement to change. It's very logical. I don't see the work on exposure and on setting up experiments, which are more visible in Waller's books.

This makes me think that if your child is to get CBT, it's worth finding out who trained the therapist, as there are going to be major variations. And independently of who trained a therapist, they may have their own ideas and preferences. So ask questions!

Addressing the beliefs and behaviours that maintain the eating disorder

CBT treats disorders as ‘cognitive disorders’ (i.e. disorders related to how we think, perceive, remember, judge or learn). It focuses on the behaviours that maintain the disorder in the present rather than look for causes, though it may look at the past to help the person avoid sliding back into a problem once they have recovered. The theory is that all eating disorders share a core psychopathology: the over-evaluation of shape and weight and their control.

There can be some views on causation, though. In his CBT-E manual, Fairburn suggests that a younger patient’s refusal to engage in treatment may be a way of asserting identity and independence and that girls may turn to controlling their eating, shape and weight as a way of boosting their self-esteem and enhancing peer approval. The model in Dalle Grave's book for parents is that an eating disorder starts with either a 'need to feel in control of life' or a person internalizing 'the thin ideal'.

I’m guessing that some of those theories would make my daughter rather cross, along with all the parents of the previously happy 9-year-olds who got anorexia.

I note that Glenn Waller’s book does not make such assumptions, and the focus is on the factors that maintain the eating disorder. It’s an example of how you can sound out therapists in order to find the best match for your child.

The main thrust of CBT is for patients to understand the factors that maintain their eating disorder, such as over-evaluating their shape and weight, calorie-counting and following strict dietary rules, being underweight, and reacting in certain ways to events and emotions.

The patient must self-monitor throughout the day by noting their behaviour around food, purging, body-checking, their mood and any triggering event. In sessions, patients get to see the mechanisms that maintain the eating disorder, they become conscious of the effect the eating disorder has on their life, and the therapist works on their motivation to make steps towards recovery. There is work to do on interpretations (what you see in the mirror, for instance, is not you; when you ‘feel’ fat, it does not mean you are fat) and there are instructions to follow each week (for example, no more eating between meals; no more weighing at home).

Regular eating and weight recovery

The process is collaborative, though there is a clear structure for each session.

Fairburn's CBT-E manual specifies one essential requirement right from the start: patients must eat five to six times a day.

Regular eating helps underweight patients regain weight, of course, but it also helps avoid binges and this, in turn helps put a stop to purging.

With underweight patients, the decision to regain weight will come from them rather than be imposed by the therapist. And there's 4 weeks of sessions before the issue of weight is addressed. The patient –not the parents, not the therapist — has to reach the conclusion that they need to attend to their low weight. If they don't agree, the treatment is usually aborted.

Patients are weighed at each session and educated about normal weight fluctuations. If they are labelled 'obese', the agreement is usually to treat the eating disorder first, then consider weight change (please note that more and more eating disorder specialists work on acceptance of current weight rather than weight loss). If they are underweight, then with CBT-E they have a standard BMI or weight-for-height bracket to aim for or to maintain. (In the Dalle Grave book for parents, it looks like there is no individualisation of recovery weight, and I explain the problem with that here).

Weight regain, if it is needed, is a priority and is top of the agenda at each session. In the Dalle Grave and el Khazen book, you'll see that this will be being on Week 5. Will your child be stable enough for that delay? Ask questions.

In the CBT-E manual, healthy exercise is encouraged even in underweight patients on the basis of its psychological and physical benefits. (This is controversial, given the compulsive element often present in exercise.)

How long does it take?

For people who are not significantly underweight, treatment consists of around 20 outpatient sessions over 20 weeks. For non-underweight people there is also evidence in favour of a 10-session intensive version (CBT-I).[ix] For those who are very underweight (adults with a BMI of 15 to 17.5), CBT normally requires 40 outpatient sessions over 40 weeks. The additional sessions address weight restoration as well as the problem that patients may have little motivation to change.

I see a hazard with determining 'underweight' according to your child's BMI. Your child may come up as 'normal' weight on a BMI chart, yet you know that they have lost a lot of weight. If so, it's most likely they need to recover all or most of it, so your child may need to 40-session course, which is twice as long as the standard FBT treatment. Make sure clinicians are aware of this, and treat your child as they would someone in the 'underweight' category. (I say more on BMI issues here).

More to do after end of treatment

Towards the end of treatment, people will not have fully recovered but their thinking and behaviours will have normalised and the risk of relapse will be lower. The therapist and patient draw up a maintenance plan and a plan for dealing with setbacks. The person is by then able to be their own therapist, and may involve their family as co-therapists. Once treatment ends, the person is expected to continue maintaining progress. There is a review session 20 weeks or so after the end of treatment to assess any further needs.

CBT in an inpatient setting

CBT can take place in conjunction with inpatient treatment if patients are unable to make necessary changes to their eating or purging without intensive support.

My point of view

As a parent, wondering whether to send your teen with anorexia or atypical anorexia to CBT, what should you take into account? Well, I recommend you stick to the standard recommendation (from professional organisations worldwide) to go for FBT unless you have a good reason not to.

As we've seen, many conclusions have been drawn about CBT based on a tiny number of studies with very few participants. FBT also suffers from small samples, but not that small. By 2025 there's been '10 randomized clinical trials with a total of 1008 adolescent participants'.

And we have a lot of everyday experiences of a family-based approach, how to help it work (which is what my resources are all about), how to modify it (quite a few variants have been researched) and what pitfalls to avoid.

I see three possible side effects of the CBT 'medicine'. To make sure that CBT will be fantastic for your child, you could ask questions about those:

1. Parents being sidelined

Parents' involvement may be very small. From parents' accounts, I see wide variations. And you can see variations from different authors of manuals: Glenn Waller seems the most empathic to parents and appreciative of their contributions, whereas Christopher Fairburn or Riccardo Dalle Grave seem to want parents or family members to take no more than a light supporting role — if any.

I really appreciate how, with FBT, the parents are part of the team. To me that's the most effective ingredient in recovery, and it's the strength of a family-based approach. It means that however flawed the application of FBT may be with your treatment team, if you're worried about the direction it's taking, you will not be helpless and heartbroken, but empowered to steer changes. With CBT, depending on how much the therapist is ready to keep you in the loop, you maybe be unable — forbidden even — from intervening. Read Dalle Grave's parent book to understand how severely they keep parents out of the loop.

Because CBT makes it your child's decision whether to engage with treatment, consider how you will feel when you are asked not to intervene when you see them skipping meals, over-exercising, and failing to keep truthful logs. How will you feel about continuing to be left out of decisions, given minimal communication, and asked to trust the therapist's (or the method's) efficacy?

You need to know that part of CBT is that if the patient doesn't agree to weight gain, or doesn't manage it, they're to be discharged, and presumably another treatment is then recommended. I'm very concerned that in the meantime, parents have been disempowered. That seems like a huge risk. I wonder what happened with all the CBT study participants who did not complete treatment. Maybe some deteriorated and needed hospital.

If the treatment fails, will your disempowerment be reversible? Think about how your child is going to need either you or a hospital to take over what they couldn't do by themselves with CBT. Even just getting them into another treatment will be hard if they've internalised that everything is up to them. You'll need to undo messages like: 'You're old enough to make your own decisions, you need to take responsibility for your health; your parents are not to intervene.' Does a CBT therapist re-empower parents before discharging an ill child? I haven't seen that in the books. But that could be something you check with them before committing to what is still, really (given the tiny numbers involved in research), an experimental treatment.

I'm not catastrophising, when I suggest you think of CBT treatment failing. A fair number of people do not complete CBT treatment. That's in the research, and also in my experience of kids being urgently moved from a private CBT therapist to NHS treatment. Less dramatic 'failed to complete' situations are because treatment can only proceed if a patient accepts to be weighed, to eat a certain amount and to gain weight. They have to engage. They've got to be willing to talk honestly about their behaviours, thoughts and feelings and to keep daily logs of this — and of food and exercise.

Even when a child achieves the kind of improvements that, with CB, might qualify as success, I believe that everyone continues to benefit from a safety net for several years. Whatever their age, surely you want to keep the loving power to comment on any odd behaviours or early signs of relapse. Take the example of your child leaving home for college: with such a major change in their life — think of the shopping, the eating, the emotional ups and downs — parents should not be tiptoeing around relapse prevention. Another reason to reinforce supportive family bonds rather than break them in the name of autonomy.

If you think it's normal that parents help their child with financial and legal affairs, if you expect to help your child through heartbreaks or loss or cancer, then why would you silence yourself over something as serious as an eating disorder? Interview your potential CBT therapist carefully if you care about keeping an appropriate parental role.

2. A slow rate of progress

With CBT, improvements are generally slow (that's in the research and also very much in my experience of following parents). If they're too slow, your child might deteriorate faster than they improve.

True, according to the (tiny) amount of research, after a couple of years, your child might do just as well as with FBT. But if you've been through this, as a parent, you'll know how with slow progress come big risks. I am thinking of all the parents I've followed, whose child was severely affected by weight loss, to the extent that life seemed unbearable to all in the family. Yet within a few weeks of prompt refeeding and rapid weight gain, the worst of it is over. With CBT, all of that could take much, much longer. That's a lot for children and their families to bear, and a lot of risk.

3. That pesky weight recovery goal

My third concern with CBT, depending on who is providing, is if your child is allowed to stay slightly underweight — something I am concerned about when reading Fairburn and Dalle Grave. More on this page of mine.

It could be soooo good!

As you read this page, you might think I'm terribly negative about CBT. Not so. When I read the books, I am transported by hope and enthusiasm: 'Oh, that makes so much sense, and how great that a professional can inject so much logic into a child, and make them want to beat the illness. How wonderful that even an underweight youngster will become willing and able to eat and change their behaviours. And isn't it what all parents want at the start of this illness: that a professional can do all the work, that parents can trust their child is in good hands, and that together they can just have lovely times, free of conflict and stress!' Seriously, even though a family-based type of treatment worked for us, I'd be delighted for another method to come along and prove to be better.

So while reading CBT books gives me an injection of hope, I remember how dangerous and tricky and illogical an eating disorder is, and I look at how small the evidence base is, and how almost a third of subjects did not complete treatment, and of those who did complete, one-third did not recover (pages 66-67 of the book). What happened to them? What was it like for their parents, who had dutifully put their trust in the process and fought their instincts to step in? What is it like for therapists to take on such a huge responsibility, for such a serious illness, with so little evidence?

And so I want to be very cautious. A method can come to the fore based on the excellent interpersonal skills of a professional — these people who see patients, publish research and then write manuals. I bet Waller and Dalle Grave and el Khazan are really inspiring to their patients. But to what extent will it all work in the hands of your child's therapist?

In my ideal world, CBT would be strengthened by collaboration with parents. Some therapists do that, and the parents I talk to are very satisfied. I hope you get clarity on what's on offer for your family.

Where CBT's strengths are attractive

CBT is much less of a gamble if you use it for your fully weight-restored child after FBT has run its course. Hopefully you will have a better experience than I did. I would also think CBT might be a great option if your adolescent is already motivated, wanting to collaborate or to own their recovery. That's more likely to be the case with someone who's functioned with anorexia for a long time, and is quite mature and self-aware.

And I'd think that if your teen as binge-eating disorder or bulimia, and again is quite mature and self-aware and wanting to move on, then CBT in good good hands is attractive.

Where to next?

Glenn Waller explains CBT for eating disorders in this excellent webinar:

Read about many different psychotherapy approaches in this post.

Read about Adolescent-Focused Therapy in this post, as just like CBT, it may be useful after a family-based approach has run its course.

References

[i] Therapists offering CBT-E may go through certification with Christopher Fairburn but if they already know general CBT and are experienced in dealing with eating disorders, they may also learn the approach from his manual. Glenn Waller delivers training on demand.

[ii] Glenn Waller (2016) ‘Recent advances in psychological therapies for eating disorders’

[iii] This statistic comes from Christopher G. Fairburn’s book "Cognitive Behavior Therapy and Eating Disorders"

See also Hollon and Wilson (2014) 'Psychoanalyis of Cognitive-Behavioral Therapy for Bulimia Nervosa'

[vii] Glenn Waller (2016) ‘Recent advances in psychological therapies for eating disorders’

[viii]

Fairburn's CBT-E manual for therapists is 'Cognitive Behavior Therapy and Eating Disorders' (brown and white cover above). It lays out the approach’s protocol, is easy for parents to read and has a chapter on patients in their late teens. Patients are normally asked to read Christopher Fairburn’s book Overcoming Binge Eating (the last book pictured above).

I found it very useful to contrast the CBT-E manual with Waller's highly readable book for therapists (blue cover), which presents detailed guidance rather than a strict protocol. Authors are Waller, G., Cordery, H., Costorphine, E., Hinrichsen, H., Lawson, R., Mountford, V., Russel, K. (2007) Cognitive Behavioral Therapy for Eating Disorders: Comprehensive Treatment Guide There is a chapter on children and adolescents.

[ix]

Glenn Waller and colleagues (2016): a new ten-session version of CBT (CBTi – for intensive) for non-underweight cases. ‘We have just completed and reported on a case series of about 100 patients, and we get results that are nearly as good as the 20 session evidence-based versions, like CBT-E and others.’ Update: the research is now published and the method is in use.