Table 3.
Therapist-Rated Barriers to Implementing CBT
| Barrier | M (SD) | Barrier | M (SD) |
|---|---|---|---|
| ED symptoms | Patient characteristics | ||
| Unwillingness to follow a meal plan | 77.27 (25.55) | Refusal to complete homework | 72.01 (26.96) |
| Severity of ED symptoms (sx) | 73.82 (26.03) | Personality disorders | 68.43 (25.87) |
| Medical instability/risk | 73.42 (27.84) | Substance use | 62.09 (30.43) |
| Chronicity | 71.92 (25.42) | Low distress tolerance | 60.80 (28.51) |
| Perseveration | 58.53 (27.77) | Resistance to directedness of treatment | 60.09 (29.53) |
| Subtypes and/or diagnosis | 49.58 (28.30) | Comorbid symptoms | 59.25 (26.40) |
| Social systems | Obsessive-compulsive disorder | 57.86 (25.82) | |
| Family reinforces weight stigma | 73.18 (25.43) | Life stressors | 56.81 (25.83) |
| Symptoms are reinforced/supported | 64.11 (26.80) | Depression | 55.42 (27.56) |
| Family does not support treatment | 58.68 (33.02) | Lack of financial resources | 54.47 (33.12) |
| Social isolation of patient | 55.87 (30.39) | Posttraumatic stress disorder | 54.10 (27.42) |
| Family history of EDs | 49.20 (30.93) | Anxiety | 51.93 (28.35) |
| Loss of family member/partner/job | 39.44 (26.08) | Functional impairment | 51.23 (29.97) |
| Patient motivation | Alexithymia (emotion identification) | 50.10 (30.18) | |
| Premature termination | 56.34 (33.69) | Perfectionist/obsessive style | 49.13 (28.17) |
| Minimal motivation at outset | 53.10 (29.53) | Intellectual/cognitive ability | 45.89 (31.66) |
| Motivation ↓: no focus on weight loss | 48.20 (29.89) | Low self-esteem/self-efficacy | 43.33 (29.06) |
| Motivation ↓: sx improvement | 43.69 (28.09) | Dependency/unassertiveness | 37.80 (27.82) |
| Motivation ↓ : learns reasons for ED | 25.14 (24.85) | Physical problems | 31.94 (26.29) |
| Treatment expectations | Beliefs about the nature of EDs | ||
| Weight gain/fluctuation unacceptable | 71.01 (28.83) | Internalized diet culture | 71.05 (25.49) |
| Only willing to give up part of ED | 68.04 (26.74) | Internalized weight stigma | 67.97 (25.58) |
| Behavior change (BxΔ) not required | 62.63 (31.57) | Regular eating = catastrophic weight gain | 67.08 (30.13) |
| Wants ↓ ED thoughts before ΔED bx | 55.63 (32.25) | ED gives sense of achievement/control | 63.23 (30.05) |
| BxΔ not possible until thoughts/urges/affect↓ | 54.89 (33.35) | ED is part of identity/unchangeable | 57.46 (30.62) |
| Therapist will do all the work | 53.73 (29.68) | Fears related to weight gain are realistic | 56.82 (29.94) |
| Co-occurring sx are more important | 52.23 (30.53) | ED makes their life better | 55.54 (31.63) |
| Will be free of all ED symptoms | 48.75 (29.14) | Self-monitoring = ↑ weight/shape concern | 47.14 (33.23) |
| Pessimism due to past therapy | 48.22 (27.87) | ED is due to external factors | 35.79 (26.29) |
| Desire to focus only on past events | 48.20 (31.37) | EDs are a choice | 31.49 (29.67) |
| Treatment will be brief and easy | 43.37 (27.87) | ED are caused by sociocultural stressors | 30.30 (27.92) |
| Symptom reduction not enough | 42.16 (27.99) | EDs are biologically based | 24.40 (25.99) |
Note. CBT = cognitive-behavioral therapy; M = mean; SD = standard deviation; ED = eating disorder; sx = symptom; bx = behavior; ↓ = decrease; ↑ = increase; Δ = change. Barriers rated on a Likert-type scale: 0 = not at all, 100 = is a major problem.