CBT-E for eating disorders: Q&A with Chris Fairburn

In May this year, NICE recommended that a specialised form of CBT (called ‘enhanced cognitive behaviour therapy’ or CBT-E) is used to treat all forms of eating disorder seen in adults. 

Chris Fairburn
Professor Chris Fairburn: developed CBT-E for eating disorders with his team at Oxford.

We asked Professor Chris Fairburn, one of our Principal Research Fellows, to tell us how he and his team at Oxford developed CBT-E, and what’s new about it. 

What does CBT-E involve?

CBT-E is a personalised treatment which can be used with any form of eating disorder. It's designed to address the processes that are maintaining the individual patient's eating disorder. 

It generally involves about 20 one-to-one treatment sessions over about 20 weeks, with twice-weekly sessions at first. Treatment takes longer with patients who are underweight, such as those with anorexia nervosa.

What do the NICE recommendations mean?

In May 2017, NICE published new clinical guidelines on the treatment of eating disorders. These recommended CBT-E for the treatment of all eating disorders seen in adults. This includes anorexia nervosa, bulimia nervosa and binge eating disorder.

CBT-E was also recommended as a treatment for younger patients as an alternative to family-based forms of treatment.

What are the next steps?

A major barrier to implementing CBT-E is how to train therapists nationally and internationally. With the support of a Wellcome Strategic Award, we’ve developed an online training programme which has proved remarkably effective and popular. 

So far, more than 2,000 therapists worldwide have undergone online training in CBT-E.

What are you now focusing on now?

The focus of our work has shifted to the digitalisation of CBT-E. Our goal is to convert it into an autonomous online intervention that can be directly accessed by the general public. This would allow people to get help far earlier than at present.

Where do you mainly work and who’s on your team?

My research group occupies a Wellcome-funded building that’s part of Oxford’s Department of Psychiatry.

My team has changed in nature and size over the years, depending on the type of research we’ve been conducting. For a long time we ran a research clinic for patients from central Oxfordshire. Then, we were staffed mainly by clinical psychologists. Now that we’re digitalising the treatment, we need fewer therapists and more expertise in digital interventions and digital marketing.

Why did you decide to focus on eating disorders and how did you develop the treatment?

I became interested in psychological treatments and their evaluation as a medical student in Oxford in the 1970s. Oxford’s Department of Psychiatry was one of the first centres in the world to specialise in this area.

I went on to train in psychiatry in Edinburgh. It was then that the first cases of bulimia nervosa began to be seen in clinics. I started to ‘collect’ them and, initially through a process of trial and error, I developed a specific form of cognitive behaviour therapy designed to interrupt the processes maintaining the eating disorder. Its effects were striking, especially as the disorder was viewed as intractable.

In 1980 I returned to Oxford and started to formally evaluate this treatment, a line of work that has continued to this day with long-term support from Wellcome. In 2004 it became the first psychological treatment ever to be strongly endorsed by NICE.

Around the turn of the century, my Oxford colleagues and I modified the treatment in two ways. First, we attempted to make it more potent. Second, we adapted it so that it was suitable for any form of eating disorder rather than just bulimia nervosa. The resulting treatment was CBT-E. 

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