The Three Steps of CBT for BED

CBT for BED is organized into three steps. Step One lasts 4 weeks, involves two sessions per week, and has the goals of increasing the patient’s understanding of the cognitive behavioural mechanisms that maintain BED, reducing weight concerns and the frequency of binge-eating episodes, and adopting an active lifestyle. A Review Session is planned at the end of Step One to review progress made over the first 4 weeks, as well as to identify any obstacles and plan the next treatment step. Step Two lasts about 20 weeks and involves one session weekly for the first 2 months and then one session every 2 weeks. However, in patients who achieve complete remission of their eating-disorder psychopathology early, and do not need or wish to address weight loss, the duration of Step Two can be reduced to three to four biweekly sessions. In this step, the procedures begun in Step One continue to be applied, and the treatment is personalized with specific modules to address the eating-disorder psychopathology operating in the individual patient and, if indicated, achieve and accept reasonable and healthy weight loss. Step Three lasts 48 weeks and involves one session every 4 weeks. However, in patients in whom weight loss was not addressed during Step Two, the duration of Step Three can be reduced to two to three sessions. The goals of this step are to prevent binge eating from recurring and to ensure a healthy weight is maintained.