How does CBT-ED work?

CBT-ED is focused on the here and now. The therapy helps individuals understand the current patterns that keep their eating disorder going, and focuses on actively changing those behaviours and beliefs.

Treatment typically includes:

• Establishing regular and adequate eating
• Challenging unhelpful thoughts and rules around food, weight, and body image
• Addressing behaviours such as dietary restriction, bingeing, compensatory behaviours (like vomiting, laxative use), or over-exercise
• Exploring maintaining factors like perfectionism, low self-esteem, or emotional avoidance
• Developing personalised strategies to reduce the risk of relapse
  
  

CBT-ED is an active, collaborative therapy. You won’t just be talking about the problem. Your therapist will support you to take practical steps toward recovery, both during and between sessions.

What does CBT-ED involve?

CBT-ED is a structured therapy, usually delivered weekly over a course of 20 to 40 sessions, depending on individual needs and severity of symptoms.

Some key elements of CBT-ED include:

• Regular weighing: Usually at the start or middle of sessions, with open discussion to explore reactions and fears.
• Food diaries: Tracking food intake and associated thoughts and feelings helps identify patterns and promote behavioural change.
• Active tasks between sessions: You’ll work on agreed goals between appointments, such as trying new foods, reducing unhelpful behaviours, or challenging rules. These tasks are very important and will need to be given priority. CBT-ED considers the work done between sessions to be one of the most important factors that determines the effectiveness of treatment.
• Physical monitoring: Where necessary, physical health will be monitored alongside therapy (e.g., weight, blood tests) to ensure safety and wellbeing.
  
  

If needed, a dietitian may also be involved in your care, and parents or carers may be included in parts of treatment to support progress and improve understanding of the eating disorder.

Phases of CBT-ED

1. Early Phase: You’ll begin by developing an understanding of what keeps the eating disorder going. Together with your therapist, you’ll start working on practical changes, such as eating more regularly, restoring nutritional balance, and reducing harmful behaviours like vomiting or over-exercise.
2. Middle Phase: Focus shifts to building confidence in eating a wider variety of foods, reducing food-related anxiety, and addressing issues such as body image concerns, perfectionism, or low self-esteem. You may also be encouraged to try eating in social situations or challenge long-standing dietary rules.
3. Ending Phase and Relapse Prevention: As therapy progresses, sessions may become less frequent. The final phase focuses on maintaining progress, preventing relapse, and supporting a confident transition out of treatment. Weighing may be reduced or stopped at this stage, depending on your goals for recovery.
   
   

Is CBT-ED right for me?

CBT-ED is suitable for both young people and adults. It is especially helpful if you:

• Want a practical, goal-focused approach to recovery
• Are ready to work on behavioural change (even if it feels scary or overwhelming)
• Prefer individual therapy with structured, tailored support
  
  

A note on body image work

Many individuals are eager to commence body image work early in treatment. However, research suggests that meaningful change in body image often comes after improvements in eating behaviour and nutritional health.

• For this reason, body image work is usually introduced in the middle or later phases of CBT-ED, once regular eating is in place.
  
  

Parental or carer involvement

While CBT-ED is usually delivered individually, involving parents or carers, partners or a trusted friend in some sessions can be very helpful. This can be particularly relevant for younger people. You may want loved ones to join parts of sessions or be invited to reviews to understand how best to support recovery and reinforce progress outside of therapy.

Supporting Lasting Recovery

CBT-ED is more than just treating symptoms. We feel this therapy empowers individuals to reclaim life from their eating disorder, develop healthier relationships with food and their bodies, and build a life where the eating disorder no longer dominates.

If you would like more information about CBT-ED, or would like to speak with a therapist offering this approach at Maudsley Health, please get in touch.