Delivering Brief Cognitive Behavioral Therapy (CBT-T) for Eating Disorders: Examining Real-World Outcomes of a Large-Scale Training Program

Abstract

Objective: Cognitive Behavioral Therapy-Ten (CBT-T) is a 10-session manualized eating disorder (ED) treatment protocol for nonunderweight EDs. CBT-T was developed to increase access to treatment and reduce wait times, as it can be delivered in half the time as existing CBT approaches for EDs. To improve access to treatment, the Nova Scotia Eating Disorder Provincial Service trained 36 clinicians through a 10-month CBT-T training program and offered CBT-T provincially. This study examines changes in ED psychopathology, binge eating, compensatory behaviors, anxiety, and depression in a transdiagnostic cohort of adult patients treated with CBT-T. Further, an exploratory analysis of predictors of treatment outcome was conducted. Methods: A retrospective chart review was conducted on adults who began CBT-T between July 2022 and March 2024. Participants completed routine outcome measures per the CBT-T manual. Mixed-effects models examined symptom changes over time, along with predictors of treatment outcome, dropout, and extension. Results: A total of 267 patients started CBT-T. Significant reductions in ED psychopathology, binge eating, and compensatory behaviors, anxiety, and depression were observed throughout treatment. Effect sizes were large to very large at the end of treatment for primary and secondary outcomes. Early change in ED psychopathology predicted better outcomes, whereas diagnoses of anorexia nervosa and atypical anorexia nervosa were associated with higher dropout rates. Discussion: Findings support that CBT-T may be an effective, scalable treatment associated with significant symptom reductions corresponding to large effect sizes. Future research should explore adaptations to improve retention, especially for those with anorexia nervosa and atypical anorexia nervosa.