Brief CBT for non-underweight eating disorders: An evidence-based approach

Prof. Glenn Waller

Monday, 19 September 2022


Eating disorders have very high personal, social and health costs, and the numbers of patients referred currently exceeds the capacity of specialist services to treat them all. In particular, individuals who have a non-anorexic presentation (e.g., binge eating disorder; bulimia nervosa) make up about 80% of adults with eating disorders. However, such patients are likely to end up on very long waiting lists or might be referred to IAPT, primary care and secondary care services, where training and skills in working with eating disorders are very limited, and where brief, effective therapies are needed.

This workshop will detail a new development in CBT for eating disorders (CBT-ED) that is designed to address this need for brief, effective therapy for non-underweight adults and adolescents. Ten sessions CBT for eating disorders (CBT-T) was introduced as a manualised treatment in 2019, and now features in the pathway of a large number of specialist eating disorder services, as well as primary care and IAPT services. It is based on evidence about what works in CBT-ED and recent developments in CBT (especially inhibitory learning). Approximately a dozen studies have demonstrated its effectiveness, which is at a level comparable with that of Fairburn’s (2008) enhanced CBT, even though it is half the length of that longer therapy.

The event will be equivalent to 2.3/4hrs of CPD.


This session will address the metacompetences and competences needed to deliver CBT-T to a range of eating-disordered patients, and to do so in a way that flexes to the individual patient’s presentation. The key skills to be covered include:
• Being clear about the targets of therapy, and why they matter (e.g., prevention of relapse)
• The role of behavioural change, particularly early in therapy
• Monitoring progress and outcomes
• Managing the therapeutic relationship effectively
• Understanding the role of food for both nutritional and exposure purposes
• Using inhibitory learning approaches to overcome anxiety around food
• Using behavioural experiments to modify cognitions regarding feared foods
• Working with emotional triggers to eating-disordered behaviours
• Addressing the factors that underpin body image distortion
• Concluding therapy appropriately, and using follow-ups to maintain development

These skills will be discussed and demonstrated as the session progresses.

Learning Objectives

Following this workshop, you will be able to:
1. Understand the need for CBT-T and the evidence that it is effective.
2. Link the pathology of the individual to the treatment methods that are needed in that case.
3. Address the extreme anxiety related to eating and weight gain
4. Modify negative body image by addressing the factors that maintain it

Training Modalities

Didactic content; Case discussion (including material from attendees); video role plays; questions and answers.

Key References

• Waller, G., Turner, H.M., Tatham, M., Mountford, V. & Wade, T. (2019). Brief Cognitive Behavioural Therapy for Non-Underweight Patients: CBT-T for Eating Disorders. Routledge. [Main reference: treatment manual]
• Waller, G., Tatham, M., Turner, H., Mountford, V. A., Bennetts, A., Bramwell, K., ... & Ingram, L. (2018). A 10‐session cognitive‐behavioral therapy (CBT‐T) for eating disorders: Outcomes from a case series of non-underweight adult patients. International Journal of Eating Disorders, 51, 262-269
• Tatham, M., Hewitt, C., & Waller, G. (2020). Outcomes of brief and enhanced cognitive-behavioural therapy for adults with non-underweight eating disorders: A non-randomized comparison. European Eating Disorders Review, 28, 701-708.
• Tatham, M., Turner, H., Mountford, V. A., Tritt, A., Dyas, R., & Waller G. (2015). Development, psychometric properties and preliminary clinical validation of a brief, session-by-session measure of eating disorder cognitions and behaviors: The ED-15. International Journal of Eating Disorders, 48, 1005-1115.

About the presenter

Glenn Waller is Professor of Clinical Psychology at the University of Sheffield, UK. His clinical and academic specialism is evidence-based CBT for eating disorders. He has published over 325 peer-reviewed papers, 20 book chapters and four books in the field, and regularly presents workshops at national and international meetings. He was Chair of the BABCP Scientific Committee. He is past president of the international Academy for Eating Disorders, and is on the editorial board of Behaviour Research and Therapy. He was a member of the NICE Eating Disorders Guideline Development Group, responsible for the 2017 update to the eating disorders guideline. He is Course Director of the University of Sheffield’s CBT-ED training course, funded by Health Education England to train clinicians in the delivery of evidence-based CBT for eating disorders across half of England.

Who should attend

This event is likely to be suitable for a wide range of professionals, working with adult and younger people with eating disorders. This treatment is likely to be particularly valuable in settings where briefer therapies are the norm (e.g., IAPT, Primary Care), and where eating disorder cases might be referred as a result of not meeting criteria for eating disorder services (e.g., patient who are referred to primary and secondary care services because they are not underweight enough to be treated in those specialist services).