how we helpEating Disorders Treatment
Family-Based Treatment (FBT)
FBT is a therapeutic approach primarily used for treating adolescents with anorexia nervosa. Sessions involve all members of the family in weekly sessions. FBT emphasises the active involvement of the family in the treatment process, with the goal of empowering parents to take charge of their child’s recovery. Treatment aims to restore healthy eating behaviours and emotional well-being within the home environment. Parents are not seen as the cause of the disorder, but as a vital part of the solution. FBT focuses strongly on weight restoration rather than the psychological aspects of this illness. A young person needs to regain weight to address the immediate physical effects of the eating disorder and the negative impact that starvation has on mental health.
Research has shown FBT to be one of the most effective treatments for adolescent eating disorders and more effective particularly with younger adolescents.
It is structured around three phases,
Phase 1 involves weight restoration and re-establishing normal eating patterns. Parents are given the responsibility of supervising meals, ensuring the child eats appropriately, supporting their child through distress, and making decisions about food.
Phase 2 focuses on returning control over eating back to the adolescent while maintaining parental support. Autonomy is gradually reintroduced over food choices and eating behaviours, while maintaining a supportive family environment.
Phase 3 involves helping the individual return to healthy adolescent development and building their identity away from the eating disorder. The family works on long-term maintenance and preventing relapse.
Particularly during phase 1, the responsibility of re-feeding a child can be emotionally and physically draining for parents. There can be little time away from ensuring all food is eaten, preventing self-destructive behaviours, and supporting through distress. FBT supports parents in being a united front against the eating disorder.
Specialist Supportive Clinical Management (SSCM)
Specialist supportive clinical management (SSCM) for anorexia nervosa is a treatment approach initially developed as a control treatment. It has since proven to be just as effective as other evidence-based therapies and is recently being adapted for other eating disorder presentations. SSCM provides a comprehensive framework for managing eating disorders by integrating clinical management and supportive psychotherapy.
The clinical management component of SSCM prioritises establishing normal eating patterns, achieving weight restoration, and reducing harmful behaviours associated with the disorder. Psychoeducation is a key tool used to connect eating disorder behaviours to one’s level of functioning and challenges. A multidisciplinary approach is used to assess and monitor medical stability and symptoms.
In addition, supportive psychotherapy within SSCM allows clients and clinicians to address other significant life issues. This flexible, client-cantered approach helps individuals explore and resolve personal concerns beyond the eating disorder itself. Clients are offered encouragement, emotional support, empathy and validation. Supportive psychotherapy involves practical problem solving, fostering hope, building resilience and agency to empower change.
SSCM is particularly beneficial for individuals who are ambivalent about recovery, those who have tried various therapeutic approaches with limited success, or those seeking a more adaptable treatment strategy.
SSCM has many qualities which are appealing to individuals suffering with eating disorders. SSCM is an individualised and flexible approach rather than having strict adherence to a specific theory. It provides a safe and supportive therapeutic space. This includes regular appointments, a strong therapist-client relationship, and a focus on listening to the whole person. It utilises a non-confrontational, non-judgmental approach that highlights the client's strengths and potential for recovery.
Cognitive Behavioural Therapy (CBT) for ARFID
Cognitive Behavioural Therapy (CBT) has been adapted as treatment for ARFID and has shown to be effective. There are four phases to treatment.
Phase 1 involves learning more about what maintains symptoms. This can include psychoeducation and keeping monitoring records. If underweight, preferred foods are used to improve the adequacy of the diet and address deficiencies.
Phase 2 involves early changes to eating to increase volume and variety and setting goals towards change.
Exposure to new or feared foods are worked on in phase three. Exposure is important as the avoidance of foods maintains anxiety. The least difficult step is started with. As confidence rises, this allows for challenges to progress. Different strategies can be utilised to incorporate feared foods such as ‘fading in’, ‘food chaining’, using condiments or deconstructing meals. Strategies are developed to help manage distress around eating and maximise success.
Relapse prevention focuses on developing skills to keep progressing and practicing skills independently.
Cognitive Behavioural Therapy - Enhanced for Eating Disorders (CBT-E)
CBT-E is a manualised form of cognitive behavioural therapy designed for the treatment of eating disorders. CBT-E focuses on the factors which contribute to the maintenance of an eating disorder.
It targets the core features of the eating disorder. These include over-evaluation of shape and weight, coping skills and emotional regulation, dietary restraint and compensatory behaviours. It also addresses underlying psychological issues, such as perfectionism, low self-esteem, and interpersonal difficulties.
CBT-E typically follows a structured format over 20-40 sessions and includes;
Cognitive Restructuring: Challenging and changing distorted beliefs about food, weight, and body image.
Behavioural Interventions: Modifying disordered eating behaviours, such as restrictive eating or bingeing, encouraging more regular, balanced eating patterns, and challenging food rules.
Self-monitoring: Encouraging clients to track food intake, emotions, and behaviours to increase awareness and promote change.
Relapse Prevention: Developing strategies to maintain progress and prevent future setbacks.