Keynote: “Cognitive behavior therapy for eating disorders: Past, present and future”
The Past. In 1981 Fairburn publishes a paper describing a new cognitive behaviour treatment for bulimia nervosa (CBT-BN), a disorder described in the same year by Russell. CBT-BN addressed the disorder with a strategic sequence of counterintuitive changes to the way that patients ate, coupled with the addressing of their concerns about shape and weight. By 2004 over 30 RCTs had been conducted and CBT-BN was found to be consistently more effective than all the treatments it had been compared with 40% to 50% of patients made a complete response which appeared to be well maintained. In 2004 NICE published clinical guidelines on the treatment of eating disorders and CBT-BN was strongly endorsed.
The Present. In 2003, Fairburn et al. developed the transdiagnostic theory of eating disorders and a new ‘enhanced’ form of CBT (CBT-E) addressing eating disorder psychopathology (rather than the DSM diagnosis. The theory and the treatment derived by the observation that many of the clinical features present in BN are also present in anorexia nervosa and the other eating disorders and that the underlying maintaining processes (targeted by CBT-BN) also operate in the other eating disorders. Though the treatment was originally developed for adult outpatients, later adaptations developed in Italy by Dalle Grave et al. targeted also younger people and more intensive care settings. CBT-E showed to be more effective than interpersonal psychotherapy and psychoanalytic psychotherapy in adult patients not significantly underweight, and equally effective of other psychological treatments in underweight adult patients. CBT-E also obtained promising results in young patients and in those treated in inpatient and real-world settings. On the basis of these results, in 2017 NICE recommended CBT-E for all eating disorders seen in adults and as an alternative to family-based treatment (FBT) for adolescents.
The Future. CBT-E will have to address three main challenges: (i) to clarify the place of FBT and CBT-E in the treatment of adolescents; (ii) to maximise CBT-E’s availability by training more therapists and by making the treatment more scalable; and (iii) to make the treatment more effective.