BOOK REVIEWS: Cognitive Behavior Therapy and Eating Disorders
Reprinted from Eating Disorders Review
January/February 2009 Volume 20, Number 3
©2009 Gürze Books
Any new book by Christopher Fairburn demands attention, and for good reason. Professor Fairburn is one of the world's most productive, generative, and creative clinical scientists working in the field of eating disorders. For several decades he and his collaborators at Oxford University, Stanford, and elsewhere around the world have diligently and persistently advanced the conceptual and experimental literature concerning cognitive-behavioral therapies (CBT) for eating disorders in theory, clinical research, knowledge dissemination and clinical guidance in anorexia nervosa, bulimia nervosa, binge eating disorders and eating disorders not otherwise specified (EDNOS). Their many studies have ranged from epidemiology to clinical treatment. Dr. Fairburn and his colleagues have freely shared their perspectives, instruments, and findings, and interested readers will find a great deal of information regarding their projects at an exceptionally informative website focusing on the efforts of CREDO (The Centre for Research on Eating Disorders at Oxford-www.psychiatry.ox.ac.uk/research/researchunits/credo/).
This new volume provides an excellent background discussion and treatment manual for the Oxford group's newest iteration of expanded theories and practices about a transdiagnostic perspective on eating disorders, encompassing patients with mixed clinical features of anorexia nervosa, bulimia nervosa, binge eating disorder, and other varieties of EDNOS. Chapters clearly present the "core protocol," a quasi step-by-step and session-by-session set of directions for novice and experienced clinicians alike.
This "Enhanced Cognitive Behavior Therapy for Eating Disorders," or CBT-E, contrasts with the more familiar and narrowly focused CBT that only targets eating disorder symptoms. In addition to an initial focus on eating disorders treatment CBT-E more broadly attends to impaired mood, clinically impairing perfectionism, low self-esteem and interpersonal deficits, depending on the clinician's appraisal of the patient's clinical problems. Empirical support for CBT-E has recently been published. In a randomized, controlled study, the broader version of CBT was shown to be better accepted and more effective for patients with more complex psychopathology, whereas the more narrowly focused CBT was better accepted by patients with less complex psychopathology (Fairburn CG et al. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: A two-site trial with 60-week follow-up. Am J Psychiatry 2009; 166: 311). The present volume details the rationale, methods and instruments used in this study and, accordingly, deserves to be studied by clinicians treating eating disorders patients who present with various mood and personality comorbidities, i.e., the most common types of patients we see. Bonus appendices include the most up-to-date versions of the Eating Disorders Examination (EDE 16.0D), Eating Disorders Examination Questionnaire (EDE-Q6.0) and the Clinical Impairment Assessment Questionnaire (CIA 3.0).
This book should be useful to all therapists and students working with eating disorders patients. In many treatment settings the book might profitably serve as the basis of an ongoing professional development educational seminar, supplemented by discussions of application related to the participants' case materials.