After nearly two decades of reviewing books for the Eating Disorders Review and reading many excellent books on cognitive behavior therapy (CBT), when I pick up a “new” book on CBT I’m at the point where my anticipation is jaded and I expect that I’m going to run into the “same-old, same-old.” Therefore, I was delighted to open this outstanding, highly nuanced and clinically sophisticated new book by Glenn Waller and his colleagues, writing from several of London’s Mental Health National Health Service Trusts, St. George’s, The Institute of Psychiatry at Kings College, London, and their affiliated programs. These facilities have a long history of conducting elegant clinical studies and research devoted to understanding and treating eating disorders, and this book is a worthy contemporary culmination of the cognitive therapy aspects of that work.

A gift to clinicians

Waller, an eminent consulting clinical psychologist and professor, has headed numerous research studies on cognitions, schemas, attitudes, and related psychological phenomena involving a large variety of eating disorders patients and normal subjects. In this book, he and his productive colleagues provide a gift to clinicians. Here’s a comprehensive and detailed textbook and treatment manual based on a wide-based appreciation of cognitive psychology and beyond.

Starting from the transdiagnostic model of Fairburn and incorporating all that has been learned about cognitive errors and distortions in eating disorders and core beliefs and schema in associated conditions, the authors offer thorough discussions of what clinicians should be thinking about and attending to before first seeing the patient, as well as thoughtful considerations of assessment, case formulation, and motivation that will stimulate and educate psychotherapists from any school of practice. The list of competencies for doing CBT is practical and complete. The “must” topics to incorporate in the psycho-education of patients and families regarding eating disorders are covered in detail.

In addition to instructing readers about what precise steps need to be taken and what needs to be done, practical summaries abound of how to actually go about accomplishing these goals in step-by-step fashion. For example, the authors include “how to construct a case formulation, get good at formulating, survive as an effective clinician, engage in Socractic questioning, the “downward arrow technique” in CBT, design effective behavioral experiments, etc. The figures showing how to visually map out individual case formulations, explicating and linking core schemas to secondary defensive attitudes and behaviors, are excellent illustrations, and offer a technique that clinicians may want to start using regularly.

Beyond conventional topics

As well as covering the conventional topics and approaches required for eating disorders CBT, the book goes beyond to address a range of issues related to “when the standard approach to CBT is not enough.” These include a variety of specific comorbid axis I issues (e.g., depression and low self-esteem, obsessive compulsive disorder, social anxiety and social phobias, post-traumatic stress disorder, and impulsive behaviors and multi-impulsivity), and also axis II considerations that lead to practical manual-based treatments dealing with emotions (e.g., CEBT-ED, cognitive-emotional-behavioral therapy for eating disorders) as well as more deeply embedded self-defeating core beliefs (e.g., SFCBT, schema-focused CBT) for the eating disorders.

The figures that map out the complex relationships among pathogenic attitudes and schemes linking eating disorder and comorbid features in these chapters are especially elucidating, and the discussions here are among the most clinically informed you’ll find anywhere. A special section is devoted to working with children and adolescents and their families, and an excellent concluding section discusses “endings,” such as what to do when CBT is ineffective, as well as events during terminations that do and don’t go by the book.

Appendices include assessment forms, patient handouts, resource lists and diary sheets used by the program and these will be helpful to novices and veterans alike.

To sum up, from my perspective, Waller et al. have raised the bar on textbooks for CBT in eating disorders. You’ll want to own and study a copy of this fine work.

– J.Y.