Enhanced cognitive behaviour therapy for adolescents with eating disorders: development, effectiveness, and future challenges

Abstract

Eating disorders can significantly impact the psychosocial functioning and physical health of adolescents. Early and effective treatment is crucial to prevent long-lasting and potentially devastating adverse effects. The National Institute for Health and Care Excellence has recommended cognitive behaviour therapy (CBT) for eating disorders in adolescents when family therapy is unacceptable, contraindicated, or ineffective. This recommendation was primarily based on the review of promising results from the enhanced version of CBT (CBT-E) adapted for adolescents with eating disorders aged between 12 and 19 years. A non-randomized effectiveness trial has also shown that CBT-E achieved a similar outcome to family-based treatment (FBT) at 6- and 12-months. CBT-E has several advantages. It is acceptable to young people, and its collaborative nature suits ambivalent young patients who may be particularly concerned about control issues. The transdiagnostic scope of the treatment is an advantage as it can treat the full range of disorders that occur in adolescent patients. It is an individual one-on-one treatment that does not necessitate the full involvement of the family. This approach is particularly beneficial for families that can only provide limited support. Future challenges include clarifying the relative efficacy of CBT-E and family therapy for the treatment of adolescent patients with eating disorders in a randomized control trial and increasing its effectiveness, identifying the reasons for the lack of response, and modifying the treatment accordingly.

Keywords: Adolescents; Anorexia nervosa; Bulimia nervosa; Cognitive behaviour therapy; Eating disorders; Family-based treatment; Outcome; Treatment.

Fig. 1

Example of personal formulation of an adolescent patient with an eating disorder highlighting how the effects of significantly low weight maintain the eating problem. 1, being underweight, strict dieting and excessive exercising are not seen as a problem but as achievements; 2, food concerns make the dieting even more extreme, rigid and difficult to modify; 3. feeling full in interpreted as having eaten too much and prompts intensification of dieting; 4, social isolation prevents experiences that can help reduce the importance attributed to shape, weight, and eating control