Therapies & approaches
CBT-E (Enhanced cognitive behavioural therapy)
What it’s for
Designed for all types of eating disorders – anorexia, bulimia, binge eating, or other mixed patterns.
How it works
- CBT-E looks at how your thoughts, feelings, and behaviours around food, weight, and shape keep the eating disorder going.
- We will identify unhelpful rules (like “I can only eat after exercising” or “I must stay under a certain weight”) and learn practical ways to challenge and change them.
- It focuses on building regular eating, reducing guilt, and improving self-confidence and body image.
CBT-E helps you break the cycle of strict eating rules and negative thoughts, replacing them with healthier habits and more balanced thinking.
What sessions are like
- Usually 20–40 weekly sessions.
- It’s structured and active, with clear goals and small tasks between sessions.
- You’ll work together to make changes early on, which helps you see progress and build motivation.
How many sessions will I need?
Eating disorder work usually requires a minimum of 20 sessions which ideally are weekly at least at first and this may extend to up to 40 sessions which may be fortnightly. But there aren’t any rigid requirements or limits and we will discuss and review progress as we go along.
MANTRA (Maudsley model of anorexia
nervosa treatment for adults)
What it’s for
Mainly used for people with anorexia nervosa, especially if you’ve been unwell for a while or find change difficult.
How it works
- MANTRA focuses on you as a person, not just your eating or symptoms.
- Together we will explore the reasons your eating disorder developed and what maintains it now. These factors are unique to you, but usually fall under thinking style, emotions, relationships, and identity.
- The sessions help you understand how your anorexia “fits” into your life and what might make recovery feel scary or hard.
- You’ll gradually work on building motivation, improving self-care, and finding new ways to cope.
What sessions are like
- Usually 20–40 sessions over 9–18 months.
- We might use a workbook and do MANTRA exercises such as letter writing.
- It’s collaborative and at your pace – especially helpful if you’re not sure about change.
In short
MANTRA helps you understand why your eating disorder exists and gently supports you to find your own motivation and tools for change.
Acceptance and commitment therapy (ACT)
What it’s for
ACT is used to help people who feel stuck in unhelpful patterns because they are trying to avoid, control, or get rid of difficult thoughts, emotions, urges, or body sensations. In eating disorders, ACT is particularly helpful when:
- Food, weight, or body image thoughts dominate daily life.
- Eating disorder behaviours are used to avoid distress (e.g. anxiety, shame, disgust).
- Clients feel exhausted by fighting their thoughts or emotions.
- Life has become narrowed around eating disorder rules rather than values
ACT is used across all types of eating disorder, chronic dieting and body image distress
How it works
ACT aims to build psychological flexibility - the ability to stay present, open, and engaged in life even when difficult internal experiences are present.
Rather than changing the content of thoughts (e.g. “I am fat”), ACT focuses on changing the relationship with those thoughts. In eating disorders, behaviours are understood as attempts to avoid or control internal experiences. ACT helps clients respond differently so distress no longer dictates behaviour.
What sessions are like
- Typically 12–20 sessions which may extend to 40 sessions for complex or long-standing eating disorders.
- ACT is often combined with CBT-based or other support.
- Between-session practice such as values-based actions and brief mindfulness or defusion exercises will be encouraged.
In short
- Stop fighting thoughts, feelings, and body sensations.
- Reduce the control eating disorder/unhelpful thoughts have over behaviour.
- Increase flexibility around food and eating.
- Move toward recovery guided by values rather than fear
- Build a meaningful life alongside recovery
Compassion focused therapy (CFT)
What it’s for
Compassion-Focused Therapy (CFT) was developed by psychologist Paul Gilbert to help people who struggle with high shame, self-criticism, and self-hatred. These are common in many mental health difficulties, but they’re especially central in eating disorders.
CFT is often used for anorexia nervosa, bulimia nervosa, Binge eating disorder, other/mixed eating disorders (OSFED), chronic dieting and body image distress; and co-occurring issues like depression, anxiety, trauma, or perfectionism.
CFT is particularly effective if you
- Have a loud, cruel inner critic.
- Feel intense shame around eating or your body.
- Have tried CBT but felt blamed or overwhelmed.
- Struggle with trauma, attachment wounds, or emotional neglect.
- Feel recovery threatens your sense of safety or identity.
How it works
CFT works by helping you shift the emotional system that drives your eating disorder/associated issue. Instead of trying to eliminate behaviors through control or criticism, CFT:
- Reduces threat and shame (which fuel restriction, bingeing, and purging)
- Builds a compassionate motivational system that supports recovery
- Changes the reason you eat, rest, and care for your body - from fear to care
What sessions are like
- Typically 12-20 sessions which can extend to up to 40 sessions for complex eating disorders, trauma, or long-standing illness.
- CFT can be a stand-alone therapy or work alongside CBT-E or other therapy.
- You will be encouraged to do between-session practice of simple, repeatable exercises (it’s not lots of homework). The focus is on process rather than performance.
In short
Compassion-Focused Therapy aims to:
- Reduce shame and self-attack.
- Increase emotional safety and distress tolerance.
- Support eating and recovery through care rather than fear.
- Build a sustainable, compassionate motivation for change.
You are not alone
Thousands of people in the UK recover from eating disorders every year. It’s okay to be unsure, you just need to start the conversation. Even one small step can begin to change things. “I’m not sure what’s going on, but I think I might need some help.” That’s all you have to say.
Remember: You deserve support, understanding, and a full life not ruled by food, self-criticism or shame. You’re not alone, and recovery really is possible.