Cognitive Behavioral Therapy with Eating Disordered Youth

Current guidelines recognize family-based treatment (FBT) as the leading therapy for children and adolescents with eating disorders (EDs), with cognitive-behavioral therapy (CBT) recommended as a second-line option. Both approaches offer distinct advantages, and integrating components of CBT and FBT may optimize outcomes. This chapter describes how to combine CBT interventions with calibrated family support to promote and maintain adaptive eating behaviors in youth with EDs. CBT for children and adolescents with EDs employs interventions similar to adult treatment, aiming to modify eating-, weight-, and body shape-related beliefs and behaviors through developing a clinical formulation, psychoeducation, motivation enhancement, open weighing, meal planning, self-monitoring, cognitive restructuring, exposure therapy, and relapse prevention. New to this edition, this chapter also presents innovative modifications to some of these CBT interventions to target beliefs and emotions about the consequences of weight gain. These interventions are augmented with flexible family involvement, adjusting the frequency and format of family sessions based on the patient’s age, symptom severity, and clinical needs. 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.