Professor Waller and his team of highly specialist clinical psychologists and a specialist dietician have produced this excellent comprehensive guide of cognitive behavioural therapy (CBT) for treating a wide range of eating disorders, from relatively straightforward eating disorders to those with more complex presentations. Eating disorders are complex psychological disorders and often co-occur with other mental health problems and can be difficult to treat. Many clinicians lack confidence in working with this group of patients and are often left wondering what a course of CBT involves beyond the manualized disorder- specific treatment protocols that are currently available. Look no further; this cutting edge therapist guide is essential reading for all those working with eating disorders and will help from the point of referral to discharge. The guide stresses the importance of developing an individualized CBT case formulation approach that is essential in informing treatment. The authors highlight the link between theory and the flexible application of evidence-based skills to individuals with eating disorders. Case studies and sample dialogues are used to demonstrate the application of CBT skills and principles. In addition there are useful patient handouts.
The book is divided into seven sections and has 29 chapters. Section 1 is the introduction and had three chapters; first the philosophical stance underpinning CBT is presented that includes the importance of evidence in clinician-led treatment and the value of a case formulation from a ‘transdiagnostic’ perspective. In the second chapter an overview of general stages and the format of CBT is provided, and in chapter 3 issues relating to risk, risk assessment and monitoring risk throughout treatment are addressed.
Section 2 focuses on the core clinical skills required for effective CBT with eating disorders starting with the assessment. The therapist is guided to assess a range of eating disorder domains such as specific eating-disorder behaviours and cognitions in addition to more general information that inform the development of a provisional formulation. Both developmental and maintenance factors of the eating disorder are considered in the assessment as well as developing hypotheses about therapy interfering behaviours. Techniques for enhancing motivation to change are described and a useful trouble-shooting guide full of ideas for when the patient is not ready or fearful of changing. Next a practical guide to significant nutritional problems is presented which is particularly useful for health professionals with limited knowledge of dietetics and eating disorders. Questions such as what a basic meal plan should look like and how to manage weight gain in underweight patients are answered. The guide progresses onto the essential steps required in constructing a case formulation from diagnostic-specific eating disorders to those with more complex clinical presentations. Case formulation also involves conceptualizing the therapeutic alliance within the cognitive model and identifying ruptures to the therapeutic alliance. Strategies for dealing with these issues are discussed in detail and how to maintain clinical effectiveness; the importance of team working and regular supervision is also discussed. Information on psycho-education and dispelling myths about eating disorder beliefs is presented and finally the use of diaries and the role of weighing is discussed.
In Section 3 core cognitive therapy skills that can be applied to eating disorders are described such as Socratic questioning to guide discovery, cognitive restructuring, the use of behavioural experiments and CBT skills that address negative core beliefs.
Section 4 addresses CBT strategies that tackle specific eating-disorder symptoms relating to the core psychopathology of eating disorders, the over-evaluation of eating, weight and shape concerns. Body image issues are formulated and treatment approaches are presented.
In Section 5 the guide discusses when standard CBT is not enough for treating an eating disorder and considers the assessment, formulation and treatment of co-morbid Axis I and II disorders. For the treatment of co-morbid personality disorder the authors draw upon some of the principles and methods of dialectical behaviour therapy and schema-focused CBT.
Section 6 is dedicated to CBT with children and adolescents with eating disorders and their families and considers the factors important in working with this age group in addition to specific CBT strategies for this group.
Section 7 discusses ending CBT and the process of recovery. Strategies for relapse management and ending treatment are presented.
I have found myself dipping into this book and using some of the CBT techniques in my own clinical practice and would highly recommend this book to all health professionals working with eating-disordered patients, including clinical psychologists, psychological therapists, CBT therapists, occupational therapists, psychiatrists, nurses, counsellors and dieticians.
