Table 1 The core elements of the focused CBT-E version for adolescents with eating disorders

Assessment and preparation

The aims are to assess the nature of the young person's eating problem and engage them in the decision to begin Step One of CBT-E

This phase involves two appointments within one week and involves

• Assess the nature and severity of eating disorder

• Describe the nature and organization of CBT-E

• Describe the nature and organization of CBT-E

• Evaluate the pros and cons to start the Step One

Step one – Starting well and deciding to change

The aims are to engage the patient in treatment and change, including addressing weight regain. The appointments are twice weekly for 4 weeks and involve the following:

• Jointly creating the personal formulation of the processes maintaining the eating disorder

• Establishing real-time self-monitoring

• Educating about body weight regulation and fluctuations, the adverse effects of dieting

• Introducing and establishing weekly in-session weighing

• Introducing and adhering to a pattern of regular eating

• Thinking about addressing weight regain (if indicated)

• Involving parents to facilitate treatment

Step two – Addressing the change

The aim is to address weight regain and the key mechanisms that are maintaining the patient's eating disorder. The appointments are once a week for patients who are not underweight and twice a week until the rate of weight regain stabilizes in underweight patients, at which time they are held once a week. This step involves the following CBT-E modules:

• Underweight and undereating

• Overvaluation of shape and weight

• Dietary restraint

• Events and mood-related changes in eating

• Setbacks and mindsets

Review sessions

These are held 1 week after Step One and then every 4 weeks for:

• Collaboratively reviewing treatment compliance and progress and identifying barriers to change

• Deciding to continue with the focused form of CBT-E rather than the broad form^a

Step 3 – Ending well

The aims are to ensure that progress made during treatment is maintained and the risk of relapse minimizes. There are three appointments, 2 weeks apart, covering the following:

• Addressing concerns about ending treatment

• Devising a short-term plan for addressing residual eating disorder psychopathology

• Phasing out treatment procedures, in particular self-monitoring and in-session weighing

• Devising a long-term plan for avoiding relapse

Post-treatment review session

Reviewing the long-term maintenance plan around 4, 12, and 20 weeks after treatment has finished