When someone with an eating disorder starts therapy, clinicians often believe they can tell who will respond well to treatment early on. But a new study reveals that these professional instincts may not be as accurate as therapists think.
The Challenge of Eating Disorders
Eating disorders that don't involve being underweight, such as binge eating disorder and bulimia nervosa, affect millions of people. These conditions come with serious consequences, including psychological distress, physical health problems, and increased healthcare costs. The standard treatment typically involves up to 20 sessions of specialized cognitive behavioral therapy, but long waitlists and limited resources have created a need for shorter, more efficient treatment options.
A Faster Approach
Researchers have developed a streamlined 10 session version of cognitive behavioral therapy specifically designed for people with eating disorders who aren't underweight. This shorter treatment includes techniques like food monitoring, weekly weigh ins, nutrition education, exposure therapy, and cognitive restructuring. The condensed format aims to provide faster access to care while still delivering effective results.
What Clinicians Think Matters
The research team interviewed therapists who deliver this 10 session treatment to understand what they believed predicted early improvement. The clinicians identified several factors they felt were crucial: patient motivation and readiness to change, the type of eating disorder diagnosis, how long patients waited for treatment, the strength of the therapeutic relationship, therapist confidence, and whether patients had depression or anxiety alongside their eating disorder.
Therapists were particularly emphatic about certain factors. They believed that a strong therapeutic bond between patient and therapist was essential for early progress. Many also thought the treatment worked better for some diagnoses than others, specifically expressing concerns that it might be less suitable for patients with restrictive eating patterns.
The Surprising Truth
Here's where things get interesting. When the researchers analyzed actual treatment data from 107 patients, they found something unexpected: none of the factors clinicians believed were important actually predicted early improvement in eating disorder symptoms.
The therapeutic alliance that clinicians emphasized so strongly? It showed no relationship with early change. Wait times for treatment? No significant connection. Baseline depression and anxiety levels? They didn't predict early improvement either. Even the type of eating disorder diagnosis, which therapists thought mattered, showed no association with how quickly patients improved.
This disconnect between clinical intuition and statistical reality reveals an important lesson. While therapists develop strong beliefs about what helps patients improve based on their experiences, these impressions can be misleading. Previous research has shown that clinicians are often not very accurate at predicting treatment outcomes, and statistical analysis tends to be more reliable than professional judgment.
Why the Mismatch?
There are several reasons why therapists' perceptions might differ from what the data shows. Clinicians may fall prey to common mental shortcuts, remembering dramatic cases more vividly or noticing patterns that aren't actually there. They also rarely receive systematic feedback about whether their predictions were correct, making it hard to calibrate their intuitions over time.
In some cases, what clinicians believe might influence how they deliver treatment. For instance, therapists who felt the 10 session approach was less suited for certain diagnoses reported adapting the treatment for those patients. These modifications might have evened out outcomes, masking any differences that would otherwise exist.
What Does Work
Despite the confusion about what predicts early change, the study did confirm something important: the 10 session therapy produces meaningful improvements quickly. Within just four sessions, nearly 18% of patients had improved enough to move below the clinical threshold for their eating disorder, and more than 21% showed clinically significant change.
This matters because early improvement is the strongest predictor of overall treatment success in eating disorders. When patients start seeing results quickly, they're more likely to continue improving throughout therapy.
These findings underscore the complexity of predicting treatment response. While motivation, readiness to change, and commitment all seem intuitively important, and some research supports these factors, they weren't routinely measured in this clinical setting, so their impact remains unclear.
The study also highlights several areas that need more investigation. The role of trauma history, which most people with eating disorders have experienced, deserves closer examination. Understanding whether certain types of eating disorders truly respond differently to this brief treatment requires more focused research.
Perhaps most importantly, the findings emphasize why reviewing progress at session four is critical. While the 10 session approach works well for many people, it's not universally effective. Checking in early allows therapists and patients to consider alternative treatment pathways if needed, rather than continuing with an approach that isn't helping.
This research provides valuable insights for both clinicians and patients navigating eating disorder treatment. It suggests that therapists should focus less on building the perfect therapeutic relationship and more on pushing for symptom change from the very beginning. It also indicates that preconceived notions about who will benefit from brief therapy may not be as valid as clinicians assume.
For people seeking treatment, these findings offer reassurance that brief therapy can produce meaningful results quickly, regardless of factors like how long you've been waiting or whether you have anxiety or depression alongside your eating disorder. However, ongoing research is still needed to fully understand what makes treatment work and for whom, ensuring that everyone with an eating disorder can access the most effective care for their specific situation.
Gatley, D., Millar‐Sarahs, V., Brown, A., Brooks, C. P., & Matcham, F. (2025). Understanding Early Treatment Response in Brief CBT for Nonunderweight Eating Disorders: A Mixed Methods Study. International Journal of Eating Disorders, 58(3), 518-530.
