What is cognitive emotional behavioral therapy (CEBT)?
Cognitive emotional behavioral therapy (CEBT) is a hybrid form of therapy used to treat eating disorders that borrows methods and philosophies from both cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT). (1)
Cognitive emotional behavioral therapy works to help prepare patients for the more emotionally challenging aspects of therapy. It is frequently prescribed as a “pre-treatment” for patients. (1) At its core, CBT teaches patients about their emotions, using a range of techniques to help people gain more awareness of their feelings and learn to better manage them.
CEBT incorporates a number of strategies to help people restructure their behavioral patterns. Methods can include mindfulness meditations, experiential exercises, and other tactics to help instill motivation to change. (2)
The intention is to dig out the issue of disordered eating from the root, while planting the seeds that will blossom into new, healthier eating behaviors. The potential for such a powerful transition is why cognitive emotional behavioral therapy is often engaged for deep-seated, difficult, and potentially dangerous cases, like eating disorders.
How to treat eating disorders with cognitive emotional behavioral therapy (CEBT)
Cognitive emotional behavioral therapy is considered a pre-treatment for many people, but for those struggling with eating disorders, it’s often the primary course of therapy. That’s because the method includes a few modalities that are particularly well-suited to address the underlying conditions of many eating disorders.
How are eating disorders treated with CEBT?
CEBT operates under the general philosophy, “knowledge is power.” It strives to shed light on the emotional reactions people have around food and eating, proposing that these responses are the first signs of oncoming harmful behavior, and, if prepared, a person may be able to control them. The idea is that managing these emotional responses in a healthier way will lead to healthier thoughts (cognitive) and actions (behavior).
But before people can regulate their reactions, they have to understand them. With that in mind, CEBT works to teach people struggling with eating disorders what these emotions might look like, how they might feel, and where they might come from.
When used to treat eating disorders, cognitive emotional behavioral therapy typically breaks those lessons down into four stages: (3)
- Background: Patients’ own personal histories are taken into account first, and they’re also given a bigger picture perspective on how their eating disorder may be perceived or stigmatized in society.
- Self-awareness development: Patients will then explore their own histories for behavioral patterns related to their eating disorder.
- Emotional recognition: Once patients are familiar with their own patterns, the work begins to help them recognize the emotions driving them. Patients also examine the relationship between emotions and eating behavior, body image, and self-esteem.
- Initiating change: Once patients are aware of the emotional mechanisms behind their condition, they’re given strategies for how to better manage them.
This education is considered the foundational step toward sustainable change. The goal of CEBT is to give people struggling with eating disorders the tools to both recover from their condition and manage a lifelong recovery.
What to expect in cognitive emotional behavioral therapy (CEBT)?
Like cognitive behavioral therapy, CEBT typically follows a more structured format. Patients start out with a number of sessions over a period of time, and with a fixed set of goals. The sessions can be one-on-one or take place in a group setting.
Also, like CBT, cognitive emotional behavioral therapy typically asks patients to bring some work home with them. These “homework” assignments involve practicing many of the methods patients are taught to recognize and regulate emotions, including journaling, meal planning, and exposure to feared foods. (4)
Aspects of other forms of therapy may also be included, such as: (2)
- Dialectical behavior therapy (DBT), which focuses on creating positive change
- Acceptance and commitment therapy (ACT), which focuses on how to deal with unpleasant emotions and experiences without using defense mechanisms or unhealthy patterns
- Mindfulness and meditation, which is used to lower stress levels and increase awareness of both self and environment
Patients are taught how to practice these lessons through role playing exercises, participating in games or puzzles that might help reinforce new perspectives, or breathing exercises.
Evaluating cognitive emotional behavioral therapy (CEBT) as an effective eating disorder treatment
No form of therapy is perfect, but there are several benefits to CEBT and to back them up.
What are the benefits of cognitive emotional behavioral therapy (CEBT)?
Cognitive emotional behavioral therapy has been found to be one of the most potent tools for eating disorder recovery.
Having greater awareness of emotions and emotional reactions has been found to help with many difficulties, including anxiety and depression, which often come hand-in-hand with eating disorders. (5)
Emotional awareness has also been linked to greater adaptive emotional responses in patients. (3) This means patients are able to retain the CEBT strategies they’ve learned and apply them successfully in the future. This is especially important for people with eating disorders, who tend to be at a high risk for relapse. (7)
The different coping strategies taught through CEBT are also useful to navigate many other stressful life situations, not just eating disorder recovery. Overall, this can instill in patients a greater sense of self-confidence and self-assurance. (4)
Plus, many people benefit from the structured format of cognitive emotional behavioral therapy. There are clear expectations, which can make the process seem less overwhelming. Some evidence suggests CEBT can also help people achieve recovery faster than other forms of therapy. (7)
What are the limitations of cognitive emotional behavioral therapy (CEBT)?
Still, every person is different and responds differently to different therapies.
While CEBT may be a great option for people who prefer a more structured and focused approach, the method might not be a great option for someone with a less reliable schedule, or who can’t or won’t commit to the full course of treatment. The “homework” assignments may also be tricky for people with unstable home environments.
Cognitive emotional behavioral therapy also embodies the old adage that says, you can bring a horse to water, but you can’t make them drink. While it’s possible to point out to patients the mechanics behind their emotional reactions and behavioral patterns, change will only happen if and when the patient is ready to embrace it.
This is why traditional “talk” therapy treatment approaches may not work for some people. As its name suggests, CEBT is very cognitive in focus, with emphasis placed on the mind, thinking, and talking. This is sometimes referred to as “top-down” therapy.
But there are many other types of therapies that focus on the body, the senses and feelings–or “bottom-up” processing–that can be effective when talk therapy “hits a wall.” These include art therapy, dance, movement, or yoga therapy, eye-movement desensitization and reprocessing (EMDR), somatic experiencing therapy.
Sometimes called alternative therapies, these modalities can help patients explore feelings and memories that may be buried or deeply entrenched beliefs that traditional talk therapy may not be able to access. These body-focused methods can be more effective in treating emotional, physical, and sexual trauma, which can play a significant role in the development of eating disorders. This type of care is sometimes referred to as “trauma-informed” care.
Efficacy of cognitive emotional behavioral therapy (CEBT) in healing eating disorders
Still, overall, Cognitive Emotional Behavioral Therapy has been found to be a solid and successful strategy for healing eating disorders.
The lion’s share of research on CEBT has been performed alongside examinations on Cognitive Behavioral Therapy, which is currently the leading treatment for people struggling with eating disorders. These studies have yielded results including a 42% success rate for patients receiving different forms of CBT after a 5-month course of treatment, compared to 6% who received psychoanalytic psychotherapy during that time. (8)
Another study showed that 66% of patients undergoing different types of CBT reached remission by the end of 20 weeks, compared to just 33% of a group undergoing interpersonal psychotherapy. (7)
One 2020 exam that focused exclusively on Cognitive Emotional Behavioral Therapy also found a high success rate for the method, as described by the patients themselves. More than 66% of participants—who were diagnosed with binge eating disorder—said they were somewhat or totally surprised by the efficacy of CEBT, with 63% reporting that the positive changes in their life would not have happened without the therapy. (3)
While there’s no doubt far more work to be done on who CEBT can help and how, the current outlook for the therapy is certainly encouraging.
Cognitive emotional behavior therapy at Within Health
Within Health doesn’t offer CEBT at this time, however, we do provider cognitive-behavioral therapy (CBT), and dialectical behavioral therapy (DBT), as well as many other treatment modalities. All of our care programs include a trauma-informed approach to eating disorder treatment, as well as compassionate care tailored to our client’s individual needs. If you would like to learn more about our virtual care programs for eating disorders, or wish to start treatment, call our team.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
- The British CBT & Counselling Service. Cognitive Emotional Behavioural Therapy (CEBT).
- European Eating Disorders Review. (2006, October). Cognitive–Emotional–Behavioural Therapy for the eating disorders: working with beliefs about emotions.
- Frontiers in Psychology. (2020, March). Emotion-Focused Cognitive Behavioral Therapy in Comorbid Obesity With Binge Eating Disorder: A Pilot Study of Feasibility and Long-Term Outcomes.
- The Psychiatric Clinics of North America. (2010, September). Cognitive Behavioral Therapy for Eating Disorders.
- Cognitive Therapy and Research. (2012, July). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses.
- BMC Psychiatry. (2016, September). Rate, timing and predictors of relapse in patients with anorexia nervosa following a relapse prevention program: a cohort study.
- Behaviour Research and Therapy. (2015, July). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders.
- The American Journal of Psychiatry. (2014, January). A Randomized Controlled Trial of Psychoanalytic Psychotherapy or Cognitive-Behavioral Therapy for Bulimia Nervosa.