Brief, early, and effective: evaluating CBT-T outcomes and change trajectories in a no-minimum threshold to access an eating disorder service.

Abstract

Objective: Cognitive Behavioural Therapy-Ten (CBT-T) offers a briefer manualised approach to treatment of non-underweight eating disorders (EDs) compared with traditional therapy models, and has the potential to help services deliver timely access to care. This study evaluated CBT-T outcomes in a naturalistic setting, with a focus on session-by-session change patterns.

Method: A total of 151 young adults received CBT-T in a no-threshold-to-access community ED service. Symptom trajectories were assessed using the ED-15 global scale and subscales (eating concern, weight/shape concern). Using intent-to-treat principle, linear mixed-effect models evaluated treatment effectiveness, and chi-squared and receiver operating characteristic (ROC) analyses explored associations between early symptom change and end-of-treatment remission.

Results: Treatment led to significant reductions in ED symptoms and psychosocial impairment, with large effect sizes. Reliable improvement in Weight/Shape Concern - but not Eating Concern - on ED-15 at session 4 significantly predicted ED symptom scores below the clinical cut-off at the last session.

Conclusions: CBT-T is effective in reducing ED symptoms in young adults with non-underweight EDs. While engagement and progress prior to session 4 have been used to guide treatment planning, as stated in the treatment manual, only the change in weight/shape concern at session 4 appeared to be strongly predictive of outcome in this sample, whereas change in eating concern did not. Early changes in weight and shape concerns at initial sessions may be informative in predicting treatment outcome. The findings can support the future development of CBT-T and other brief ED interventions.