What Is Enhanced CBT (CBT-E)?
Enhanced Cognitive Behavior Therapy (CBT-E) is a structured individual therapy for eating disorders. It is a well-researched treatment for adults and works directly with the thoughts, behaviors, and patterns around eating, shape, and weight that keep an eating disorder going.
CBT-E is part of the Eating Disorders Program at PPG, directed by Dr. Heather Rosen. Sessions are available in person at our Chappaqua and Hartsdale offices and online.
Who CBT-E Is For
We offer CBT-E to young adults and adults, ages 18 and older. Many of the people we see are managing recovery alongside college, a first job, or a move away from home. For children and teens under 18, we most often use Family-Based Treatment, in which parents take an active role in recovery.
CBT-E is an outpatient treatment. When a person's medical or psychiatric needs call for a higher level of care, we help coordinate that care and can continue treatment when they step back down.
Eating Disorders We Treat with CBT-E
For ARFID, we use a related approach called CBT-AR. Learn more about ARFID
Bulimia Nervosa
CBT-E addresses binge-purge cycles and the rules and routines around eating that sustain them. Learn more about bulimia
Binge Eating Disorder
Treatment builds regular eating and other ways of responding to the moments that lead to bingeing. Learn more about binge eating disorder
OSFED
CBT-E was designed to treat eating disorders that do not fit a single diagnosis. Learn more about OSFED
Anorexia Nervosa
CBT-E can be used for anorexia nervosa in adults, with adjustments and a longer course. Learn more about anorexia
The four stages of CBT-E
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1
Getting Started
Sessions are twice weekly for the first four weeks. You and your therapist build the working relationship, map the patterns that keep the eating disorder going, and begin regular eating, which is the foundation for the rest of treatment.
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2
Reviewing Progress
About five weeks in, you and your therapist step back to review progress, look at what is getting in the way, and plan the main work of treatment.
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3
Addressing What Keeps It Going
This is the longest stage. Treatment focuses on how shape and weight are judged, dietary rules, changes in eating tied to events or moods, and any broader patterns that apply.
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4
Ending Well
The final sessions build a plan for staying well after treatment ends and for handling setbacks.
What CBT-E Works On
CBT-E is flexible. Each person's plan focuses on the patterns that apply to them.
Regular Eating
Building a steady pattern of meals and snacks is the foundation of treatment. Regular eating can reduce the urges to restrict, binge, or purge.
Shape and Weight Concerns
Many people judge their self-worth mainly by shape, weight, and control over eating. Therapy works to widen what a person values about themselves.
Dietary Rules
Strict food rules and efforts to restrict can keep an eating disorder going. Treatment looks at these rules and gradually changes them.
Eating and Triggers
For some people, eating changes in response to events or moods. Therapy builds other ways of responding to those moments.
Body Checking and Avoidance
Checking, comparing, or avoiding the body can keep body concerns strong. Treatment addresses both.
Perfectionism, Self-Worth, and Relationships
When these also play a part, CBT-E can address them alongside eating. This is the "enhanced" part of the approach.
The CBT-E Approach to Care
CBT-E is active and collaborative. Sessions follow a clear structure, and you and your therapist review your eating records together and plan practice between sessions. Treatment usually takes about 20 weeks, with around 20 sessions. People who are underweight may need a longer course.
Eating disorders can affect physical health, so ongoing medical monitoring by a physician is part of care. With your consent, your therapist coordinates with your doctor, a dietitian, and any other providers involved.
What to Expect
A Free Consultation
We talk briefly about what you are looking for and match you with a clinician whose training and style fit your needs.
An Assessment
Your clinician gathers history about eating, health, and daily functioning, and discusses whether medical monitoring or a higher level of care is needed.
A Treatment Plan
Treatment follows the stages of CBT-E and is tailored to your needs. We coordinate with your existing providers and help you add others, such as a dietitian or physician, if needed.
Care That Connects Across Specialties
CBT-E is often one part of a broader plan. Our clinicians work across specialties, and with your consent your therapist can coordinate with colleagues across the practice.
- Eating Disorders Program: Evaluation, care coordination, and step-down support.
- Anxiety & Panic: Therapy for anxiety and panic that occur alongside an eating disorder.
- Depression & Burnout: Support for low mood, exhaustion, and loss of interest.
- Trauma & EMDR: Trauma-focused care, including EMDR.
- Neuro-Affirming Care: Therapy that takes neurodivergent ways of thinking and eating into account.
- Couples Therapy: Sessions for partners when an eating disorder affects the relationship.
