CBT-E can be delivered in two forms: (i) a “focused” form, which exclusively addresses the eating disorder psychopathology; or (ii) a “broad” form, which also addresses one or more of the following “external” maintaining mechanisms: clinical perfectionism, core low self-esteem, marked interpersonal difficulties.
The focused form is indicated for most patients, and should be viewed as the default version. With most patients it is more effective than the broad version and it is easier to implement. The broad form should be reserved for patients who (i) have a pronounced form of one of the “external” maintaining mechanisms to core eating disorder psychopathology and (ii) where this mechanism appears to be contributing to the maintainance of the eating disorder. The decision to use the broad form is taken during a review session in Stage Two, as by then the therapist knows the patient reasonably well and barriers to change will be becoming clear.