Enhanced Cognitive Behaviour Therapy (CBT-E) at The Wave

The WavED team is trained in the delivery of Enhanced Cognitive Behaviour Therapy (CBT-E), having completed training with the originator at The Centre for Research into Eating Disorders, Oxford. U.K. The team, led by Fiona Yassin, specialises in the treatment of eating disorders in teenagers and young adults.

Our young people often arrive with us having been hospitalised in acute settings around the world. Our Eating Disorder Programs have a 100% completion rate and have been particularly successful with teenagers and young adults who have found engaging in treatment, weight restoration or sustained recovery challenging.

The WavED team has incorporated the clinical guidelines for both complex and early treatment eating disorders into the programs at The Wave, utilising best practice guidelines. Young people will complete between 20–40 CBT-E sessions during their treatment episode.

Our programs are combined with those addressing borderline personality disorder, mood disturbances, fractured educational background and complex trauma.

How CBT-E Has Been Adapted for Teenagers and Young Adults

The early intervention and treatment of eating disorders in young people are essential to ensure there are no long-lasting physical or psychological issues, as these disorders can have a radical impact on their physical and psychological development.

During adolescence, there is a high risk of medical complications in those with an eating disorder. Therefore it is necessary for frequent medical assessments and the acceptance that hospital admission may be necessary. Parent involvement and support is vitally important during this time.

CBT-E treatment focuses on two specific attributes – physical health and parental inclusion – and there are many reasons why it works so well for teenagers and young adults with eating disorders. For example:

  • One of the features of CBT-E treatment is how it supports a flexible and personalised approach. It is malleable to the needs of young people and their cognitive development, with the therapist creating an individualised treatment version of CBT-E based on the specific eating disorder and situation.
  • For young people, CBT-E is clear and simple to understand, making it easier for them to accept treatment. It is also a collaborative process, in which the young person is fully involved in the decision-making process.
  • There are various strategies used to keep young people engaged during CBT-E treatment, in addition to involving them in the decision process, that help them to make healthy and positive changes in their lives.
  • Finally, CBT-E practices autonomy and control, which helps teenagers and young adults stay healthy even after the treatment has finished.

What Are the Four Stages of CBT-E?

The goal during CBT-E treatment is to get the young person to make the decision to embark on weight regain, rather than having the decision made for them. Towards the end of the treatment, the focus is switched to successfully maintaining the weight gained during treatment.

At the start of treatment, there are generally two preliminary assessments, in which the therapist will assess the situation and start to prepare the personalised treatment plan.

The treatment of young people who are not extremely underweight begins with an initial assessment of the condition, typically followed by 20 individual treatment sessions over a period of 20 weeks.

When a young person is significantly underweight, the number of sessions is increased to around 40 over a 40 week period. During this time, the CBT-E treatment is combined with a weight-regain program, at the same time as addressing the eating disorder psychopathology. This is introduced after the first few weeks of the young person and their therapist discussing the eating disorder and the changes needed for recovery.

Treatment is then broken down into four main stages:

  • Stage One: Starting well and deciding to change.
    During stage one, a mutual understanding between the therapist and young person is established, regarding the eating problem. Focus is put on helping the young person to adapt and balance their eating patterns, as well as providing personalised education, and addressing concerns about their weight.
  • Stage Two: Taking stock of the situation.
    During stage two, a review is carried out and a schedule made for the main part of the treatment program.
  • Stage Three: Body image and shape.
    During stage three, the focus is placed on the processes that are causing the young person’s eating problem, such as dietary restraints, events, and moods – along with setbacks and mindsets. Towards the end of stage three and moving into stage four, the focus shifts onto the future.
  • Stage Four: Ending well.

During the final stage, the therapist works with the young person to agree on ways to deal with setbacks and strategies to maintain the changes and improvements made during the program.
A review session takes place a few months after CBT-E treatment has finished, where progress can be reviewed, and any problems that have remained or reoccurred can be addressed.

Is CBT-E Effective?

To date, there have been four studies on the effectiveness of CBT-E for young people. The studies were carried out on patients between the ages of 11–19 years. In all cases, the young people were receptive to the treatment, and a high percentage of those who completed the treatment regained full weight and showed minimal signs of eating disorder psychopathology.

CBT-E offers a number of advantages for teenagers and young adults suffering from an eating disorder, compared to other treatments, especially that it is a collaborative treatment, which makes it more acceptable to young people who may be opposed to treatment.

Grow, heal, and lay the groundwork for a successful, happy life

About The Wave

At The Wave, we help teenagers and young adults, between the ages of 15 and 30, overcome eating disorders, behavioural problems, addiction, and other mental health problems. We use a combination of physical activities and therapy sessions to help our young people to grow, heal, and lay the groundwork for a successful, happy life.

Mahisha Naidu leads our Creative Arts Therapy activities, having trained in Dance and Movement Psychotherapy at Goldsmiths, London. Mahisha has led The Wave Clinical Team for two years. She is passionate about her treatment of eating disorders and leads our food and body groups three times a week. Her role has seen her develop a specialist interest in working with adolescent girls, particularly focused on borderline personality disorder, self-harm and developing emotional regulation.

Mahisha is currently studying Internal Family Structures (IFS), which is an innovative therapy, particularly suited to our work at The Wave, where it has been used effectively with our young people and their families. Mahisha is a member of APPCH.

To learn more about Art Therapy at The Wave, please contact us.

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