In recent years there has been widespread acceptance that cognitive behavior therapy (CBT) is the treatment of choice for bulimia nervosa. The cognitive behavioral treatment of bulimia nervosa (CBT-BN) was first described in 1981. Over the past decades the theory and treatment have evolved in response to a variety of challenges. The treatment has been adapted to make it suitable for all forms of eating disorder—thereby making it “transdiagnostic” in its scope— and treatment procedures have been refined to improve outcome. The new version of the treatment, termed enhanced CBT (CBT-E) also addresses psychopathological processes “external” to the eating disorder, which, in certain subgroups of patients, interact with the disorder itself. In this paper we discuss how the development of this broader theory and treatment arose from focusing on those patients who did not respond well to earlier versions of the treatment.
In recent years there has been widespread acceptance that cognitive behavior therapy (CBT) is the treatment of choice for bulimia nervosa (National Institute for Health and Clinical Excellence, 2004, Wilson et al., 2007 and Shapiro et al., 2007). The cognitive behavioral treatment of bulimia nervosa (CBT-BN) was first described in 1981 (Fairburn, 1981). Several years later, Fairburn (1985) described further procedural details along with a more complete exposition of the theory upon which the treatment was based (Fairburn, Cooper, & Cooper, 1986). This theory has since been extensively studied and the treatment derived from it, CBT-BN (Fairburn, Marcus, & Wilson, 1993), has been tested in a series of treatment trials (e.g., Agras et al., 2000, Agras et al., 2000 and Fairburn et al., 1993). A detailed treatment manual was published in 1993 (Fairburn, Jones, et al., 1993). In 1997 a supplement to the manual was published (Wilson, Fairburn, & Agras, 1997) and the theory was elaborated in the same year (Fairburn, 1997a).
CBT-BN has evolved over the past decade in response to a variety of challenges: Its procedures have been refined, particularly those addressing patients' overevaluation of shape and weight, and it has been adapted to make it suitable for all forms of eating disorder, thereby making it “transdiagnostic” in its scope (see Fairburn, 2008 and Fairburn et al., 2003). The new version of the treatment, termed enhanced CBT (CBT-E), also addresses psychopathological processes “external” to the eating disorder, which, in certain subgroups of patients, interact with the disorder itself. In this paper we discuss how the development of this broader theory and treatment arose from focusing on those patients who did not respond well to earlier versions of the treatment.
