CBT & Eating Disorder Treatment: What You Need to Know

Woman standing on river rocks

Cognitive Behavioral Therapy (CBT) is an evidence-based practice that has been used for decades to treat mental health conditions and more recently, eating disorders.

Initially, it was designed for the treatment of depression and anxiety but is currently used more widely with other mental issues.

CBT: What It Is

There are three phases of treatment with CBT. The behavioral phase, cognitive phase, and maintenance/relapse phase [1]. The behavioral phase is where the client and clinician build therapeutic rapport and trust.

Typically an individual talks about issues and problems at hand and learn to identify negative patterns in thinking, emotions, and behaviors. Together, a treatment plan is created by the clinician and client to progress forward in treatment.

Within the therapeutic process, the therapist-client will address and reduce negative behaviors that are associated with the eating disorder. The clinician will provide education and awareness to healthier eating, behaviors, and cognitive processes.

Coping strategies are typically developed for managing negative emotions. Usually, distraction, prolonging urges, and stopping thoughts are some of the skills taught to cope with overwhelming triggers and feelings [1].

The cognitive phase involves cognitive restructuring technique where individuals are encouraged to challenge their internal thought process and identify unhealthy treatment-interfering thoughts. New, healthy thoughts replace unhealthy ones to help shift perspectives.

CBT requires being able to overcome distorted thoughts about self, body image, and self-esteem and how it relates to the eating disorder.

It also involves changing interpersonal relationships and how thoughts and emotions affect communication with others. Hope is a part of CBT as it helps identify positive changes and strengthens motivation for recovery.

The last phase, the Maintenance and Relapse Prevention phase, focuses on the skills learned in previous stages and create a comprehensive relapse and recovery plan.

This plan involves improving self-confidence as individuals become more comfortable with learned skills and being able to identify triggers to help prevent deterioration.

Another part of the CBT process is nutritional counseling. It is a necessary part of eating disorder treatment and education around nutritional needs, as well as planning for and monitoring food choices [2].

CBT: What Treatment Looks Like

Treatment teams typically involve a nutritionist, therapist, physician, and psychiatrist. For some, treatment can be done on an outpatient basis, but most often, individuals need a higher level of care at some point in the recovery process.

Different clinicians at any level use various therapies for treatment. Each treatment works differently for each person depending on their stage of recovery. The primary first goal at the start of treatment is to reduce the eating disorder symptoms.

CBT: Eating Disorders

CBT helps to normalize eating behaviors and responses to food [3]. It helps with regulating thoughts, emotions, and actions when eating disorder symptoms are present.

Woman going through CBTIt can improve a person’s self-esteem, perfectionistic tendencies, mood shifts or intolerance, and interpersonal difficulties.

CBT works by setting short-term goals and modifying as needed until each goal is reached. It is typically 20 weeks in duration and focuses on both the behavioral and cognitive changes to create healthy functioning.

Use of homework, assignments, and worksheets are assigned during and outside of session.

Most clinicians ask for a thought log to be kept to help identify any distorted thoughts or critical thinking. Sessions are active in nature as well as engaging.


Enhance Cognitive Behavioral Therapy (CBT-E) is best used with sufferers who are at a minimal weight of their body weight range or higher. The therapeutic process involves an initial assessment, followed by 20 sessions over 20 weeks.

If a person is coming to CBT-E with Anorexia and is underweight, sessions can go for 40 weeks, depending on the needs of the person [4].

CBT-E is individualized and is designed for the person and their progress. Four stages are a part of this therapy:

  • Stage 1: Focus is on a mutual understanding of the eating disorder and modifying and stabilizing eating patterns. There is psychoeducation about eating disorder pathology, and often sessions are twice a week at this stage.
  • Stage 2: Progress is reviewed during this stage, and treatment goals are set
  • Stage 3: Weekly sessions are held, and the focus is on the eating disorder behaviors and symptoms. Work is concentrated on daily functioning and moods.
  • Stage 4: focuses on the future and managing setbacks. Typically relapse prevention plan is completed during this final stage.

CBT: Levels of Treatment

Treatment includes various levels. An individual will often shift between the phases of care as treatment progress or worsens.

Residential treatment is the highest level, and the person stays at the facility and receives 24-hour support.

Partial Hospitalization Program (PHP) treatment is when a person gets all the benefits of residential treatment but is allowed to go home at night.

Woman on the shoreAll meals for both levels are provided, and the individual will meet with their therapist, psychiatrist, nutritionist weekly and engage in group therapy.

Intensive Outpatient Program (IOP) is therapy designed for the person who is ready to step down from a higher level of care. They attend group therapy up to 6 days per week for 3 hours at a time.

Meals are provided by the individual but checked by the facility staff to ensure it meets their nutritional guidelines. Treatment duration can last varying amounts of time depending on the progression of recovery.

Overall, CBT and CBT-E are evidence-based therapies that are effective for eating disorders. Many clinicians use this type of treatment to help promote increased well-being among clients and promote freedom from eating disorder behaviors.

Image of Libby Lyons and familyAbout the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.

Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.


[1] Cognitive Behavioral Therapy & Binge Eating Disorder: 8 Key Treatment Benchmarks. (n.d.). Retrieved December 27, 2017, from https://www.waldeneatingdisorders.com/cognitive-behavioral-therapy-binge-eating-disorder-8-key-treatment-benchmarks/
[2] Treatment. (n.d.). Retrieved December 27, 2017, from https://www.nationaleatingdisorders.org/learn/general-information/treatment
[3] Cognitive behavior therapy for eating disorders versus normalization of eating behavior. (2017, March 16). Retrieved January 08, 2018, from https://www.sciencedirect.com/science/article/pii/S0031938416308824
[4] What Is CBT-E? (n.d.). Retrieved January 11, 2018, from http://www.credo-oxford.com/4.1.html

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on February 14, 2018.

Published on EatingDisorderHope.com