Cognitive Behavioral Therapy with Eating Disordered Youth

Cognitive behavioral therapy (CBT) is currently recognized as the most effective treatment for adults with eating disorders (EDs); however, few studies have examined CBT’s efficacy for younger patients. In this chapter, we describe how to adapt CBT for children and adolescents with EDs. Similar to the approach used with adults, CBT for younger patients involves an array of interventions designed to modify beliefs and behaviors related to eating, weight, and shape. These include developing a clinical formulation, psychoeducation, enhancing motivation, open weighing, meal planning, self-monitoring, cognitive restructuring, exposure therapy, and relapse prevention. Individual CBT for children and adolescents with EDs should be augmented with family involvement, with the frequency and format of family sessions varying as a function of the patient’s age, symptom pattern and severity, and other considerations. Particularly during the early phase of treatment for underweight patients, family sessions focus on coaching the patient’s caregivers to support their child with normalized eating and weight restoration. As patients become more active participants in treatment and behavior change, family involvement is reduced gradually.