Enhancing Outcomes in Eating Disorder Treatment: Cognitive Behavioural Therapy for Eating Disorders (CBT-E)

United Kingdom · CPD points & talks · Psychologists

Over the past several months, I’ve had the opportunity to deliver a training series on Cognitive Behavioural Therapy for eating disorders (CBT-E) through Calabash. The webinars focused on each stage of the model, aiming to support clinicians in developing confidence and competence in applying this evidence-based approach in their practice.

CBT-E has become one of the most widely recommended treatments for eating disorders in adults, with strong empirical support and a clear, structured framework. At the same time, its flexibility allows it to be adapted to the individual needs of each client — something I’ve found especially important in clinical work where diagnostic labels rarely capture the complexity of someone’s lived experience.

Below, I’ve outlined some key reflections and clinical considerations that emerged through the training.

Why CBT-E?

One of the core strengths of CBT-E is its transdiagnostic nature — it focuses less on labels and more on what is maintaining the eating disorder. Whether someone presents with anorexia nervosa, bulimia nervosa, binge eating disorder, or mixed/atypical features, the model guides clinicians to explore shared maintaining mechanisms such as over-evaluation of shape and weight, dietary restraint, and mood intolerance.

For clinicians, this offers clarity in formulation and direction, even when working with presentations that don’t fit neatly into one diagnostic category.

Stage One: Starting Well

The early stages of treatment are all about engagement, building a strong therapeutic relationship, and helping the client begin to take steps towards change. Motivation is never assumed — and in fact, ambivalence is expected. If you have ever working with clients presenting with disordered eating, you will know that one of the greatest barriers to change is their struggle with motivation to change because the disorder feels safe or necessary, even while it's harmful. We spend time exploring readiness, using motivational interviewing techniques and personalised psychoeducation to try and shift this and to support our clients to connect with their own reasons for recovery and build readiness to take meaningful steps toward it.

The establishment of regular eating, supported by self-monitoring, is a core behavioural goal in this phase. These early behavioural changes are not just about symptom interruption — they are a foundation for re-establishing structure and fostering a sense of agency for the client.

Stage Two: Taking Stock

Often brief, Stage Two serves as a moment to pause and reflect. Has regular eating become more stable? Is the client more engaged and able to collaborate in treatment? What are the emerging barriers to progress?

This is also the stage where we begin planning the more intensive work that follows, including identifying the maintaining mechanisms that will be addressed next. It’s a good reminder that CBT-E is not a one-size-fits-all approach — it’s responsive to what is most relevant for the person sitting in front of us.

Stage Three: Tackling What Maintains the Eating Disorder

This stage is the heart of treatment. It targets the specific factors that are keeping the eating disorder going, and is always informed by the shared formulation developed earlier.

Some of the most common targets include:

Over-evaluation of shape and weight, addressed through body image work, mirror exposure, and expanding self-evaluation beyond appearance.
Dietary rules and food avoidance, approached with behavioural experiments and gradual reintroduction of feared foods.
Mood intolerance, where we help clients identify emotional triggers and develop alternative coping strategies.
Low self-esteem or perfectionism, where we begin to explore deeper beliefs that drive disordered behaviour.

Pacing is key here — it's easy to feel pressure to "do everything," but prioritising what is most relevant and manageable helps keep the work meaningful and contained.

Stage Four: Ending Well

The final phase focuses on consolidating progress, preparing for setbacks, and supporting clients to take ownership of their recovery.

Relapse prevention isn’t about preventing all future difficulty — it’s about building confidence and flexibility. We review the tools that have helped, develop response plans for setbacks, and encourage clients to reflect on their journey in a way that strengthens their sense of agency.

Ending treatment is a significant process in itself, especially for clients who have been defined by their eating disorder for many years. A well-thought-through ending can be a powerful moment of affirmation.

Reflections on Clinical Application

One of the things I appreciate most about CBT-E is its clarity of structure paired with its emphasis on individualisation. It gives us a map — but it doesn’t assume that all clients need the same route. The emphasis on collaborative formulation and behavioural change, guided by real-time feedback from the client’s experience, keeps the work alive and dynamic.

In delivering the training, I was reminded of how often we as clinicians encounter common challenges: a lack of motivation, difficulty with self-monitoring, resistance to body image work, or shame around setbacks. CBT-E doesn’t provide quick fixes for these — but it offers a consistent, grounded way to stay in the work and keep moving forward with clients, even when progress feels slow.

Closing Thoughts

Working with eating disorders is some of the most complex and rewarding clinical work we can do. It asks us to hold hope, stay curious, and be both structured and flexible. CBT-E has been a central part of my practice for many years now, and I continue to find it one of the most effective and compassionate models for supporting people in recovery.

If you’re beginning to use CBT-E in your practice, I encourage you to stay close to the structure while allowing space for adaptation. The model is rich, research-backed, and deeply human when applied thoughtfully.

And if you joined the training — thank you for taking the time to be part of it. It’s been a privilege to share this work with you.