Riccardo Dalle Grave, MD & Simona Calugi
Department of Eating and Weight Disorders, Villa Garda Hospital, Garda (VR), Italy
Abstract
Background: Enhanced Cognitive Behaviour Therapy (CBT-E) is a transdiagnostic treatment that targets the psychopathology of eating disorders. Although CBT-E has demonstrated efficacy across multiple populations and settings, recent meta-analyses have reported mixed results, partly due to variations in study quality, therapist competence, and treatment fidelity.
Objective: This paper critically reviews current research on CBT-E and proposes methodological recommendations to enhance the rigor and validity of future studies.
Main Discussion: Evidence indicates that CBT-E achieves its best outcomes when delivered with high fidelity by trained and supervised clinicians. However, several studies suffer from methodological weaknesses, including inadequate adherence to the CBT-E protocol, small sample sizes, and inappropriate comparison conditions. Some trials also combined CBT-E with interventions from other theoretical models without clear justification. To strengthen internal validity, future research should ensure accredited therapist training, structured supervision, and systematic fidelity assessment. Further priorities include adopting standardized recovery criteria, employing active comparators, and developing flexible, personalized applications of CBT-E that reflect real-world clinical contexts.
Conclusions: By improving methodological consistency and preserving theoretical integrity, future research can enhance both the effectiveness and generalizability of CBT-E as a leading evidence-based treatment for eating disorders.
Keywords
CBT-E
Eating Disorders
Treatment Fidelity
Methodological Rigor
Internal Validity
Recovery Criteria