Therapists Love This New 10-Session Eating Disorder Treatment (But Need Help with Two Key Skills)

First study of clinician experiences reveals mostly positive responses to brief CBT approach, with specific training needs identified

When Dr. Sarah, a young psychologist working in an NHS eating disorder clinic, first heard about a new 10-session therapy for bulimia and binge eating disorders, she was skeptical. How could such a brief treatment possibly help people with complex eating problems that typically took months or even years to address?

But after delivering Cognitive Behaviour Therapy Ten (CBT-T) to dozens of patients over the past two years, Sarah has become one of its biggest advocates. "It's a really lovely therapy," she explains. "I'm massively passionate about it."

Sarah's experience isn't unique. The first comprehensive study of therapist experiences with CBT-T reveals that clinicians are overwhelmingly positive about this innovative brief treatment, though they've identified specific areas where they need more support and training.

What Makes CBT-T Different

Traditional eating disorder therapy often involves 20 or more sessions, creating long waiting lists and leaving many people without timely access to care. CBT-T was specifically designed to address this problem by condensing effective treatment into just 10 sessions spread across five phases.

The treatment focuses on people with non-underweight eating disorders like bulimia nervosa, binge eating disorder, and other specified eating disorders. Unlike anorexia nervosa, these conditions don't require immediate medical stabilization, making them suitable for this briefer approach.

What makes CBT-T particularly innovative is that it can be delivered by supervised practitioners who don't yet have full professional qualifications, making treatment more accessible and cost-effective. This allows eating disorder services to see more patients more quickly, addressing the chronic problem of treatment delays.

What Therapists Actually Think

Researchers from the University of East Anglia interviewed 13 NHS eating disorder clinicians who had been delivering CBT-T for at least six months. The results, published in a recent study, paint a remarkably positive picture of therapist experiences.

"It's a really nice therapy to deliver and work with patients on," explained one participant. Another noted they had "liked delivering CBT-T the most out of all therapies."

Three main themes emerged from the interviews: predominantly positive experiences, changes over time as therapists gained experience, and specific challenges that need addressing.

The Surprisingly Strong Therapeutic Relationship

One of the most interesting findings was how well therapists were able to build strong relationships with their patients, despite the brief timeframe. This was particularly surprising given that CBT-T specifically instructs therapists not to spend time building rapport at the expense of making progress on eating disorder symptoms.

Traditional therapy wisdom suggests that building a strong therapeutic alliance requires time and specific relationship-building activities. But CBT-T operates on a different principle: that people develop trust in their therapist when they see early improvements in their symptoms.

"I feel like the therapeutic alliance has been really good. I think it tends to be strong," reported one therapist. Another noted, "If they can do the changes then the therapeutic alliance is going to be stronger."

This finding challenges conventional thinking about therapy relationships. Rather than needing extensive time to build trust, it appears that helping people see quick improvements actually strengthens the therapeutic bond more effectively.

The Value of Structure

Unlike many therapists who typically resist highly structured treatments, the CBT-T clinicians appreciated having a detailed manual to follow. This was particularly valuable for less experienced practitioners who might otherwise feel overwhelmed by the complexity of eating disorder treatment.

"It is containing...having that guidance and knowing what to do," explained one participant. Another noted, "You know you're delivering the right thing that you're meant to deliver each week."

This positive response to structure likely reflects the participant characteristics. Most were relatively young practitioners without extensive therapy experience, and research shows that less experienced clinicians tend to view treatment manuals more favorably than seasoned therapists who prefer flexibility.

Growing Confidence Over Time

As therapists gained experience with CBT-T, their confidence grew and their anxiety about delivering the treatment decreased. This is normal for any new therapy approach, but what was particularly notable was how therapists' belief in the treatment model strengthened as they witnessed its effectiveness.

"I became more and more confident with delivering it," shared one participant. Another explained, "I've seen the positive outcome that it has."

This experiential learning proved more powerful than initial training. Seeing patients improve quickly validated the approach and motivated therapists to continue developing their skills with the model.

The Challenges: Where Therapists Struggle

Despite the overall positive response, therapists identified several specific challenges that interfere with optimal treatment delivery.

Imagery Rescripting: The Technical Challenge

Nearly all participants mentioned struggling with imagery rescripting, a technique used in Phase 3 of treatment where patients revisit and rewrite traumatic memories related to their eating disorder. Therapists felt the manual didn't provide enough detail for them to deliver this intervention confidently.

"Imagery rescripting isn't detailed enough to feel comfortable delivering it as a clinician," explained one participant. Another requested, "I would like more training on imagery rescripting."

This technique requires specialized skills that many general CBT practitioners haven't fully developed, yet it's a crucial component of CBT-T for addressing underlying emotional triggers.

Emotion Work: The Vague Guidelines

The second major challenge was what therapists called "emotion work" – helping patients identify, understand, and manage difficult emotions that trigger eating disorder behaviors. While the manual mentions using skills from Dialectical Behavior Therapy (DBT), therapists felt this guidance was too vague.

"The manual is a bit vague... I stray and bring other stuff in," admitted one therapist. Another explained, "The manual says that you can use some DBT skills, but for somebody who has never really used CBT before it doesn't really explain what that might look like."

This vagueness led many therapists to improvise or draw from other approaches, potentially reducing treatment fidelity and effectiveness.

The Termination Dilemma

Perhaps the most emotionally challenging aspect for therapists was having to end treatment after 10 sessions, even when patients wanted to continue. CBT-T protocol requires stopping treatment if patients haven't made sufficient progress by session 4, a decision that many therapists found difficult to implement.

"It feels really hard to be sat in front of another human, not as a patient and as a therapist, but as a human being saying, 'you've not done enough to receive any more of our help,'" shared one participant.

This highlights the tension between evidence-based protocols and human compassion that many therapists experience, particularly when working with vulnerable populations.

When Therapists Break the Rules

Despite being trained in a structured protocol, many therapists admitted to making unauthorized modifications to CBT-T. These ranged from adding extra sessions to addressing issues outside the eating disorder scope.

"Definitely had to make adaptations," acknowledged one therapist. Another explained, "If you're going by the protocol you're not supposed to slow it down or make adaptations, but with a real person we often find that we have to."

This "therapist drift" is common across all psychological treatments, but it's particularly concerning with manualized therapies like CBT-T because it moves treatment away from the evidence base that proves its effectiveness.

Who Benefits Most

Therapists noted that CBT-T seemed to work better for some patients than others. They reported particularly good results with patients who had bulimia nervosa or binge eating disorder, and less success with more complex presentations.

"When I see people who have binge eating disorder or bulimia, for me they've done really well," shared one participant. However, another noted, "Sometimes with people who would be described as complex, I find I really struggle to address everything in 10 sessions."

This suggests that while CBT-T is highly effective for its target population, it may need modifications or alternatives for patients with significant comorbidities or complex trauma histories.

Implications for Training and Support

The research findings point to several specific ways that CBT-T training and ongoing support could be improved:

Enhanced Training on Imagery Rescripting: The manual and training programs need more detailed guidance on this technique, including role-play opportunities for therapists to practice in a safe environment.

Clearer Emotion Work Guidelines: Rather than vague references to DBT skills, the manual should provide specific, step-by-step instructions for helping patients manage difficult emotions.

Support for Treatment Termination: Therapists need guidance on how to handle the emotional challenges of ending treatment and clear criteria for when exceptions might be appropriate.

Fidelity Monitoring: Regular supervision and check-ins could help prevent therapist drift and ensure consistent delivery of the evidence-based protocol.

The overwhelmingly positive response from therapists bodes well for the continued implementation and development of CBT-T. When clinicians believe in a treatment and enjoy delivering it, they're more likely to implement it faithfully and advocate for its use.

However, the identified challenges need addressing to maximize treatment effectiveness. The researchers recommend that future versions of the CBT-T manual include more detailed guidance on imagery rescripting and emotion work, and that training programs incorporate more hands-on practice with these difficult techniques.

The study also suggests investigating why therapists make unauthorized modifications to the protocol. Understanding these reasons could lead to either better training to prevent drift or evidence-based modifications that improve treatment while maintaining effectiveness.

This research represents an important step in understanding how innovative brief treatments can be successfully implemented in real-world clinical settings. While much attention is typically paid to patient outcomes, clinician experiences are equally important for successful treatment adoption.

The largely positive response to CBT-T suggests that brief, structured treatments can be both effective and satisfying to deliver, challenging assumptions that longer treatments are always better. For healthcare systems struggling with long waiting lists and limited resources, this offers hope for more efficient service delivery.

For the thousands of people waiting for eating disorder treatment, these findings suggest that effective help may be available sooner than traditionally thought possible. The key is ensuring that therapists receive the training and support they need to deliver all components of the treatment with confidence.

As one study participant summed up the experience: "People always seem to say they feel more confident leaving the sessions, and I think that says a lot about how powerful CBT-T is." With the right support for therapists, that power can be maximized to help even more people recover from eating disorders.

The challenge now is translating these research findings into improved training programs and clinical support systems that address the specific needs therapists have identified. Only then can CBT-T reach its full potential as a game-changing treatment for eating disorders.

Hewitt, C., Coker, S., Burgess, A., & Waller, G. (2025). Clinicians' Experiences of Delivering Cognitive Behaviour Therapy Ten (CBT‐T): A Qualitative Investigation. European Eating Disorders Review.