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Both focused and enhanced cognitive behavioural therapy improve eating disorder symptom severity

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Is a complex cognitive behavioural therapy (CBT) package addressing mood intolerance, clinical perfectionism, low self-esteem and interpersonal difficulties more effective than CBT focused on eating disorder symptoms alone?


154 adults attending eating disorder clinics (95.5% female; mean age 26.1 years; 38.3% had bulimia nervosa). Participants had to have a body mass index >17.5 and those who had received similar previous CBT or with a psychiatric disorder were excluded. Clinically warranted antidepressants were allowed during the trial.


Two eating disorder clinics in the UK (Oxfordshire and Leicester), recruitment was March 2002–July 2005.


Enhanced CBT, focused CBT or waiting list control. Enhanced CBT covered mood intolerance, clinical perfectionism, low self-esteem, interpersonal difficulties as well as aspects of eating disorders, while focused CBT covered only specific eating disorder features such as shape and weight, binging and purging. Both CBT groups received a 90 min initial session, then 20 sessions of 50 min duration and a review session 20 weeks after treatment. The waiting list control group were assessed after 8 weeks and then received one of the two CBT treatments.


Two primary outcomes, both measured using the …

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  • Source of funding Wellcome Trust.


  • Competing interests GW is the lead author of a treatment manual on CBT for patients with eating disorders which takes a broadly comparable approach to treatment to the one employed here.