Anxious Therapists “Drift” from CBT Principles for Eating Disorders

Cognitive Behavioral Therapy (CBT) is an empirically supported treatment strategy for people struggling with eating problems, such as bulimia nervosa and anorexia nervosa. However, research suggests that many clinicians do not adhere to, but rather drift from, the core principles of CBT for eating issues. “Why do many clinicians fail to apply empirically supported treatments?” asked Glenn Waller of the Eating Disorders Section of the Institute of Psychiatry at King’s College in London. “They often state that the research does not apply to their patient group.” But evidence shows that CBT is very effective for eating problems. Waller believes that many clinicians do not follow the guidelines set forth in treatment manuals for eating disorders and that this omission leads to compromised results. He also theorizes that the clinician’s own anxiety about upsetting their client adds to the likelihood of drift. He said, “Therefore, it can be hypothesized that anxious clinicians are less likely to require patients to adhere to core behavioral elements of CBT (e.g., changing eating patterns).”

Waller led a study involving 80 clinicians who used CBT for treating eating issues in an attempt to determine how many of them drifted from traditional practices and why. Each participant reported their adherence to core CBT principles and also completed the Brief Symptom Inventory for anxiety. Waller found that 50% of the clinicians reported drifting significantly away from the foundation of CBT. “The methods that were most commonly reported included well-supported techniques (i.e., weighing, structured eating) but also included pre-therapy motivational work,” said Waller. “In short, when describing their use of CBT for the eating disorders, not many clinicians report actually using the techniques that underpin and define that therapy.” He also found that even though many clinicians claimed to use traditional CBT methods, they did not. This was especially evident in the highly anxious clinicians. Waller believes that these findings have implications for clients and therapists. He added, “Thus, clinicians and patients should not assume that the use of the label CBT is clearly related to what clinicians do in practice.”

Waller, G., Stringer, H., & Meyer, C. (2011, December 5). What Cognitive Behavioral Techniques Do Therapists Report Using When Delivering Cognitive Behavioral Therapy for the Eating Disorders?. Journal of Consulting and Clinical Psychology. Advance online publication. doi: 10.1037/a0026559

© Copyright 2011 by By John Smith, therapist in Bellingham, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • adair


    December 12th, 2011 at 4:46 PM

    How can I be sure to choose a provider who is going to stick with a proven course of therapy? I don’t need one going off on some kind of tangent that is not going to help me with my issues with food. I have enough problems as it is.

  • Colllin


    December 13th, 2011 at 6:03 PM

    My question for the trained professionals who deal with these types of issues and clients on a daily basis is why stray from the tried and true, from the things that have been proven to help in the past? If there is no better way to help them then why not just stick with what you know is going to be of benefit to them?

  • Stacy


    December 14th, 2011 at 10:44 PM

    An interesting piece of news.Because CBT is picking up so much nowadays you might hear your therapist throw around the term too.But having read this,I am cautioned.What can the clients do to ensure that their therapist is actually following the core elements?Even if one were to be in the know of things,its not like we can just open up and say “Hey,you’re doing it wrong” to our therapist,yeah?

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