FBT is a highly effective, evidence-based approach for treating a variety of eating disorders, particularly in children & adolescents. 

How does it work?

• This therapy empowers caregivers to take an active role in their child's recovery by overseeing their eating habits, normalizing their weight, and gradually restoring their autonomy.

• FBT fosters a collaborative environment, ensuring the entire family supports the individual through their recovery journey

Empirical Support:

• FBT is the most evidence-based intervention for eating disorders (particularly Anorexia Nervosa & Bulimia Nervosa) amongst children and adolescents (Gkintoni et al., 2024).

My Take:

• EDs are self-perpetuating, brain disorders with high lethality rates. I cannot over-emphasize the power of family and renourishment in the recovery process. 

• This is a powerful, first-line treatment for most medically stable, younger clients, and can also be extremely appropriate for those returning home from a higher level of care.

Enhanced Cognitive-Behavioral Therapy (E-CBT) is a specialized form of CBT designed to address eating disorders (with the exception of ARFID). 

How does it work?

• E-CBT focuses on understanding and changing the behaviors and thought patterns associated with disordered eating. 

• It addresses not only the symptoms but also the underlying factors that contribute to the disorder, such as perfectionism, low self-esteem, and interpersonal difficulties, aiming for a holistic recovery.

• Caregivers/supporters are included in treatment, but not to the same degree as in FBT.

Empirical Support

• There is data to support applicability of CBT-E for treatment of eating disorders in adolescents and adults (Gkintoni et al., 2024).

• Meta analyses indicate E-CBT is particularly effective for treating Bulimia Nervosa (Monteleone et al., 2022).

My Take:

• I value what CBT-E brings to the table as a “transdiagnostic” treatment method, especially as eating disorders can appear like “shape shifters” at different points in life.

CBT-AR is a manualized treatment tailored to specific needs of individuals with ARFID. 

How does it work?

• CBT-AR helps individuals identify and challenge their fears and avoidant behaviors related to food. By gradually exposing them to a variety of foods in a controlled manner, CBT-AR works to reduce anxiety and avoidance, promoting a more balanced and health-promoting relationship with food.

• Goals for treatment can vary depending on an individual’s specific presentation(s) of ARFID. These goals can include:

  • Improving tolerance of larger volumes of food

  • Increasing awareness of hunger and fullness cues

  • Decreasing food-related fears

  • Improving psychosocial functioning impacted by ARFID

• Treatment can be individual in some cases, but family support is highly recommended if clients are children, teens, and/or have significant weight to gain.

Empirical Support:

• There are fewer studies evaluating ARFID-specific treatment approaches than with other eating disorders, and many of these studies have small sample sizes and/or focus on pediatric treatment outcomes (Willmott et al., 2023). 

• In fact, the American Psychiatric Association (APA’s) Practice Guidelines note this limited clinical data, and therefore hasn’t made a statement endorsing a specific treatment for ARFID. 

• The APA recognizes that medical stabilization and nutritional rehabilitation may be required for Pts with ARFID, and recommend engaging in some form of psychobehavioral therapy.

• CBT-AR is a relative new, but promising treatment modality, with evidence of effectiveness from ages 10-55 (Thomas et al., 2019).

My take:

• When I think of CBT-AR, I love how collaborative the treatment planning process is, and how every individual's journey is unique.

• At the end of treatment, individuals still may not display what is considered “normative” eating. Food variety may still be restricted, but this does not mean treatment must continue indefinitely! Treatment is successful if individuals (and their supporters) see improvement in ARFID symptoms and feel increased confidence with information and skills that they learn during the course of CBT-AR.

Item Exposure & Response Prevention Therapy (ERP) is a powerful technique primarily used to treat OCD. 

How does it work?

• ERP involves exposing individuals to their fears or obsessions in a safe and controlled way while preventing the compulsive behaviors that typically follow. 

• Over time, this method helps individuals build tolerance to anxiety and reduces the urge to engage in compulsive actions, leading to significant improvements in their daily functioning.

Empirical Support:

• This treatment has the most research for OCD to date.

• Meta-analyses support ERP as the first therapy choice when treating OCD in adult (Reid et al., 2021), and pediatric populations (McGuire et al., 2015)

My take:

• When I think about ERP, I think about the importance of tolerating uncertainty.

• I'm a big believer in the power of integrating ACT with ERP, so that personal values can provide guidance and motivation for this work.

I-CBT is an innovative approach to treating OCD. 

How does it work?

• I-CBT addresses the reasoning processes that lead to obsessive thoughts and compulsive behaviors. 

• By correcting faulty inferences and promoting more accurate perceptions of reality, I-CBT helps individuals reduce the impact of OCD on their lives.

Empirical Support:

I-CBT has modest research support (when compared to ERP), but leaders in the field suggest this may be an appropriate option for specific subgroups, for example:

• individuals who have not had success with ERP

• Those who exposure exercises may go against an individual’s values (e.g., blasphemy).

My Take:

• *While I do not yet have formal I-CBT training, I have attended workshops, am familiar with the literature and mechanisms of change, and am excited to pursue more learning opportunities in the near future.

ACT is a values-based approach with broad applicability.

How Does it Work?

• ACT aims to increase psychological flexibility.

• It encourages individuals to:

  • Accept their thoughts and feelings (vs. fighting or avoiding them)

  • Clarify their values (e.g., what’s truly important to them)

  • Committing to living by their values in order to bring them closer to the life that they want (in spite of the discomfort this might bring).

• ACT can be a standalone treatment, but is also frequently used to complement another modality if integrated thoughtfully.

Empirical Support:

• • ACT does have empirical support as a standalone treatment for anxiety disorders, depression, stress, and impoving quality of life (Han & Kim, 2022).

  • There is preliminary support for ACT in treating eating disorders (Juarascio et al., 2017). However, much of the research conducted has been on ACT-informed treatments (vs. ACT-only treatment).

  • There is also evidence of ACT as a treatment for OCD (Evey & Steinman, 2023), but the support is modest when compared to ERP for OCD.

  • Leaders in the field suggest that ACT may be especially helpful for individuals with high levels of experiential avoidance. 

  • ACT works best if an individual has at least moderate insight into their symptoms, and if they are able to think abstractly (e.g., understanding metaphors)

My Take:

• I find ACT very valuable to integrate with another treatment approach.

• I love that ACT encourages use of metaphor and can’t understate the transformative power of personal values.

DBT skills are practical techniques that help individuals manage emotions, improve relationships, and cope with stress.

How does it work?

• These skills fall into 4 main categories:

  • Mindfulness - Enhancing awareness and acceptance of the present moment.

  • Distress Tolerance - Building resilience and coping strategies for difficult situations.

  • Emotion Regulation - Identifying and managing intense emotions effectively.

  • Interpersonal Effectiveness - Improving communication and relationship skills.

• I’ve been trained to incorporate DBT skills to complement our primary treatment approach.

• This is not the same as comprehensive DBT - which involves group participation and coaching calls.

Empirical Support:

• DBT has robust support for disorders characterized by high levels of  emotional instability, including : suicidal ideation & self-harm behaviors (Kothgassner et al., 2021), and a variety of  eating disorders (Solmi et al., 2024).

• There is also data to support the use of modified, skills-only DBT for individuals with eating disorders (Wisniewski & Ben-Porath, 2015), as well as evidence for similar DBT skills in helping individuals manage the emotional dysregulation and distress that can accompany OCD (Ahovan et al., 2016).

My Take:

• I see the integration of DBT skills into sessions a natural complement for many, especially when our emotions (or our loved ones’ emotions) are heightened.