Why should you consider offering CBT-T?

Background

The origins of CBT-T lie in a number of strands that were coming together at the same time:

• Long waiting times for many eating disorder patients, and the need for faster access to assessment and treatment (e.g., the FREED model in the UK).

• Limited treatment resources and funding, for example:

  • The Medicare arrangement in Australia

  • Limited periods of insurance cover

  • Patients without the resources to pay for long periods in therapy

• Effective ‘rationing’ of treatments, by focusing those services on the care of anorexia nervosa patients and failing to offer treatment to those patients who are ‘not ill enough’, such as those with bulimia nervosa, binge-eating disorder, many anorexia nervosa cases and atypical cases.

• Services for other disorders delivering effective treatments over shorter periods of therapy. The Talking Therapies (IAPT) model in the UK is an example.

• Evidence that clinicians working with eating disorders often use ineffective methods and take far longer than recommended to treat patients. When the recommended length of treatment is 20 sessions but the mean number of sessions offered is over twice that, fewer patients can be seen.

• Cognitive-behavioural therapy for eating disorders (CBT-ED) was shown to have a strong evidence base for most eating disorders (NICE, 2017).

All of these factors led us to use our clinical experience and the evidence base to devise a faster version of CBT-ED – ten sessions long (CBT-T).

Principles

CBT-T has the following principles, as outlined and explained in the manual:

• Includes clinical techniques that work.

• Does not include approaches that are ineffective or unproven.

• Addresses central cognitive features and relapse risk factors.

• Focuses on achieving early behavioural change.

• Monitors progress and responds to any ‘stuckness’.

Of course, a much shorter therapy (half the recommended length) means that it is considerably less expensive to deliver, and more patients can be seen as a result. This approach can be used to reduce your waiting times, and deliver effective treatment to patients whose financial resources or insurance would not cover much longer (but no less effective) therapies. The additional financial consideration is that we were able to deliver this with clinicians who were far less expensively trained.

So, CBT-T is faster and less expensive to deliver than existing therapies. However, that is not much help to you if CBT-T does not work well. Therefore, we developed an evidence base to support CBT-T, and found that a significant proportion achieve a good outcome if they complete the treatment according to this manual. The papers that show this are listed on this website.

Summary

CBT-T

• works as well as 20-session CBT-ED

• can be delivered by less expensive clinicians (eg. psychology assistants, PhD students) under supervision

• is effective in everyday clinical practice

• is acceptable to patients (high uptake when offered CBT-T; no difference in attrition rates compared with longer therapies)

• is described positively by patients

• reduces comorbid states, such as anxiety and depression

• works in different settings, including public and private health care

All of this means that you can use CBT-T in your routine clinical practice and, as long as you use it as recommended, you can get the same results as you could get from longer, more expensive therapies.