CBT-Enhanced (CBT-E)
An evidence-based approach to eating disorder recovery
What is CBT-E?
Cognitive Behavioural Therapy-Enhanced (CBT-E) is a specialised form of CBT developed specifically for eating disorders. It is based on the understanding that our thoughts, feelings, and behaviours are closely connected and influence one another.
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Eating disorders are often characterised by a preoccupation with weight and shape, alongside difficulties managing emotions or adverse life events. This can lead to unhelpful patterns around food, such as restricting the amount or type of food eaten, binge eating, overeating, purging, or compensatory behaviours. Over time, these patterns tend to feed into anxiety, low mood, and reduced self-worth.
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The aim of CBT-E is to identify and address these maintaining cycles, so that behaviour around food can change, thoughts about body shape and weight become more flexible, and self-worth can be strengthened.
Why CBT-E?
The most recent NICE guidelines (2017) recommend CBT-ED as an evidence-based treatment for eating disorders. CBT-E is one of the main specialist therapies within this umbrella and currently has the strongest evidence base supporting its effectiveness.
There is a large body of research suggesting that CBT-E can help individuals achieve full and lasting recovery from eating difficulties.
For this reason, CBT-E is the primary approach I use in my work. Where helpful, I may also integrate elements from other therapeutic approaches, depending on individual needs and goals.
What does CBT-E involve?
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Early sessions focus on:
Developing a shared understanding of what keeps difficulties going
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Monitoring eating patterns, thoughts, feelings, and relevant events in real time
Developing a clearer understanding of weight and health
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Introducing a pattern of regular eating across the day​
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Please also note: Knowing your weight is part of CBT-E, and we would talk openly about any concerns you may have around this, at a pace that feels manageable.
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As therapy progresses, focus may include:
Improving body image and reducing appearance-related concerns
Eating more flexibly while maintaining a sense of choice and control
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Developing ways of coping with life situations that influence eating
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Strengthening self-worth beyond food, weight, or shape
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Final sessions focus on:
Reviewing progress and learning across sessions
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Creating a plan to build on the progress made in therapy
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Developing a clearer understanding of relapses and how to manage them
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Addressing any fears or questions about long-term progress maintenance and next steps
Additional considerations
Structure and length of therapy
CBT-E typically lasts around 20 sessions over approximately 20 weeks, with a follow-up check-in later on. Treatment often begins with two sessions per week, moving to weekly sessions after the first month, and then gradually spacing out towards the end. This structure may vary depending on individual circumstances, though consistency and minimising breaks is generally encouraged.
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Safety considerations
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For safety reasons, I’m unable to offer therapy to individuals with a BMI below 18.5, as this level of risk is best supported through a multidisciplinary team.
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If you're struggling right now or feel unsafe with your thoughts, please reach out for immediate help. Below is a link with services that can help.
Please note that I am unable to provide crisis or emergency support. If you need emergency or crisis intervention, contact NHS 111 or go to your nearest A&E.
