RICCARDO DALLE GRAVE, M. D.

Background

Engaging adolescents in treatment for eating disorders presents a significant challenge due to the egosyntonic nature of these conditions and the ambivalence toward change.

Main text

The adolescent version of Enhanced Cognitive Behavior Therapy (CBT-E) prioritizes active patient involvement to foster engagement and long-term commitment to recovery. This treatment employs a structured yet flexible approach to enhance patient engagement. Key strategies include adopting a supportive and collaborative stance, explaining the distinction between the disease model and the psychological CBT-E model, actively involving patients in the decision to change, agreeing on specific homework assignments between sessions, and engaging parents as supportive “helpers.” This engagement-focused approach encourages adolescents to take ownership of their recovery. By personalizing interventions and fostering adolescents’ active role in understanding the psychological maintaining processes of their eating disorder, deciding to address them, and navigating the process of change, CBT-E empowers them to move toward recovery with increasing independence. Parental involvement is carefully structured to provide support without undermining the adolescent’s sense of agency.

Conclusions

Future research should further evaluate engagement-focused adaptations of CBT-E and their impact on long-term treatment outcomes.

Adolescents with eating disorders often do not see their condition as a problem, which makes it harder for them to engage in treatment. Some approaches treat the illness as something separate from the young person, placing the focus on the disorder rather than the individual. Enhanced Cognitive Behaviour Therapy (CBT-E) takes a different view. It works from a psychological model, which means the eating disorder is seen as part of the young person’s thoughts and behaviours, but also something they can change. CBT-E helps teenagers take back control by involving them directly in their recovery. The therapy is supportive and collaborative, explaining how eating disorders are maintained and encouraging active decisions about change. Adolescents and therapists set clear goals and small tasks to practice between sessions. Parents are included as supportive “helpers,” but the main focus remains on building the teenager’s independence and long-term commitment to recovery.