Calugi, S., & Dalle Grave, R. (2026).
Abstract
The aim of this article is to describe the key theoretical differences between CBT- AN-20 and enhanced cognitive behaviour therapy (CBT-E), to compare briefly the findings from CBT-AN-20 with those of the principal outpatient CBT-E studies in adults with anorexia nervosa, and to examine the conceptual and clinical implications of the two approaches. The treatments differ in their theoretical foundations and strategies. CBT-AN-20, based on an anxiety model, promotes rapid behavioural change, exposure to feared foods, weight gain, and early assessment of engagement, with early progress viewed as a means of promoting inhibitory learning. Conversely, CBT-E is a transdiagnostic, formulation-driven treatment targeting over-evaluation of shape, weight, and control, along with other maintaining mechanisms. It emphasises collaborative engagement and the patient’s active decision to change, with planned, collaborative, and predictable steps that keep patients active and in control during treatment. Cross-study comparisons indicated that the short-term intention-to-treat increase in BMI observed with CBT-AN-20 was broadly comparable with that reported in longer CBT-E studies. However, CBT-AN-20 has so far been evaluated only in one sample with mild underweight, whose mean baseline BMI was 17.59 kg/m². Treatment completion was generally lower than in CBT-E studies, weight regain was less extensive than that achieved in more severely underweight CBT-E cohorts, normalisation of eating-disorder psychopathology appeared less frequent than in some studies, and evidence regarding the maintenance of change remains limited. In conclusion, if replicated in larger, well-designed studies with longer follow-up periods, the available findings suggest that CBT-AN-20 may represent a promising brief intervention for selected adults with mild underweight who are willing and able to engage rapidly in increased eating, weight regain, open weighing and dietary monitoring. However, the current evidence does not establish its equivalence to CBT-E.
Calugi, S., & Dalle Grave, R. (2026). Is a 20-Session Treatment Sufficient for Adult Anorexia Nervosa? A Critical Comparison of CBT-AN-20 with CBT-E. IJEDO, 8, 58–63. https://doi.org/10.32044/ijedo.2026.10 Full Text