Table 1.

The Core Elements of the Focused Form of Enhanced Cognitive Behavioral Treatment

Stage One

The aims are to engage the patient in treatment and change.

Jointly creating a formulation of the processes maintaining the eating disorder Establishing real-time monitoring of eating and other relevant thoughts and behavior Providing education about body weight regulation and fluctuations, the physical complications and ineffectiveness of self-induced vomiting and laxative misuse as a means of weight control and the adverse effects of dieting Introducing weekly weighing Introducing a pattern of regular eating Involving significant others to facilitate treatment if appropriate

Stage Two

This is a transitional stage.

Jointly reviewing progress Identifying barriers to change Modifying the formulation as needed Planning Stage Three.

Stage Three

The aim is to address the key mechanisms that are maintaining   the patient’s eating disorder.

Overevaluation of shape and weight - providing education about overevaluation and its consequences - reducing unhelpful body checking and avoidance - relabelling unhelpful thoughts or feelings such as “feeling fat” - developing previously marginalized domains of self-evaluation - exploring the origins of the overevaluation Dietary restraint - changing inflexible dietary rules into flexible guidelines - introducing previously avoided food Event triggered changes in eating - developing problem-solving skills to directly tackle such events - developing skills to accept and modulate intense moods

Stage Four

The aims are to ensure that progress made in treatment is   maintained and that the risk of relapse is minimised.

Providing education about realistic expectations Devising a short-term plan for the months following treatment Devising a long-term plan to minimise relapse in the future