Impact case study database

In the UK alone, there are an estimated two million people with eating disorders. The prevalence of eating disorders varies between countries, but estimates place the total prevalence, across the different forms, as around 4% of those over 16 years of age. Most cases of eating disorders are self-perpetuating in the absence of effective treatment.

Taken together, the findings from clinical trials provided a substantial body of work demonstrating the effectiveness of CBT-E can treat all forms of eating disorder and that it is as effective, or more effective, than the main alternative treatments. For example, one of the systematic reviews of the effects of CBT-E, conducted independently of the Oxford team, concluded that there is robust evidence to support its effectiveness, ending their abstract with the statement that “ There is robust evidence that CBT-E is an effective treatment for patients with an eating disorder” [A].

In terms of specific benefit to patients, the Oxford studies showed that around a half to two-thirds of patients who received CBT-E recovered from the eating disorder. Almost half of the patients who received CBT-E reported no binge eating, self-induced vomiting or laxative misuse at the end of treatment [3]. These studies also demonstrated that the benefits of CBT-E are well maintained one year later, despite the patients in these studies having had an eating disorder for eight years on average [2,3]. Importantly, a significantly greater proportion of patients receiving CBT-E recovered by the end of the treatment (66%) compared to those receiving an alternative leading psychological treatment, Interpersonal Psychotherapy (33%) [3]. The findings also indicated that improvements following CBT-E extended meaningfully beyond the eating disorder, including important reductions in depressive features, that were maintained beyond 1 year [3].

The clinical and research findings on CBT-E led the Chief Medical Officer in her 2014 annual report to recommend its wide use:

“*I recommend that Clinical Commissioning Groups ensure prompt access to evidence-based enhanced cognitive behaviour therapy (CBT-E) and family-based therapy for eating disorders. This should be available in all areas, as in the NICE guidance, and not restricted to specific age groups.*” [B, page 12].

In 2015, NHS England published access and waiting time standards for the treatment of younger patients with an eating disorder. It too specified that there should be prompt access to CBT-E as well as to a specific form of family therapy [C, pages 24 and 45].

In 2017 the National Institute for Health and Care Excellence (NICE) published new clinical guidelines on the treatment of eating disorders [D], strongly endorsing CBT-E. The guidelines state that CBT-E (referred to as CBT-ED) is the leading specialist treatment for bulimia nervosa [D, p.20] and binge eating disorder [D, p.19] and one of three leading specialist treatments for anorexia nervosa [D, p.11-12] in adults. For younger patients, CBT-E was one of the two leading recommended treatments for all three eating disorders [D p.15, 20 and 22] (the other treatment being a specific form of family therapy).

3,500 therapists worldwide, across 40 countries, have received the free web-based CBT-E training programme that CREDO have shown to be effective [E, F], including 1,200 therapists within the NHS. The last annual survey of users’ experience of this training has shown that 98% would recommend it to others and over 90% have found it to be very helpful [G]. Testimonials from clinicians include:

“We have found your online training to be extremely valuable for our clinicians. It is very reassuring to know that my clinicians have received world class training in CBT-E and I have observed first-hand the value of this during our clinic meetings and supervision sessions.” (Clinical Director, Western Australia, 2020) [Hi]

“I continue to use the treatment myself with patients and also supervise others in use of the CBT-E model. I often consult the online training resources for myself and use them additionally as a supervision tool. The scalability of this mode of delivery has meant that therapists who are relatively novice in eating disorders can have flexible access to modern training techniques to supplement the delivery of their treatment.”

(Clinical Psychologist, describing work in a private service) [Hii]

The additional face-to-face workshops held by CREDO have supplemented the web-based programme, training a further 750 therapists (who have not taken part in the web-based training), including 300 NHS therapists. CREDO also provided two advanced workshops for 300 therapists already trained in CBT-E from a diverse range of countries.

In total, around 1,500 NHS professionals have received training in CBT-E from the CREDO research group using both forms of training since 2013 Following consultation with trainees, it is estimated that the average therapist who has participated in this training will have treated at least 20 cases using CBT-E. This suggests that at least 30,000 patients have received CBT-E. In addition to the research studies supporting the effectiveness of CBT-E there are numerous positive reports from clinicians using CBT-E in the real-world. For example, an outpatient service described that:

“As a team, we implemented CBT-E across the outpatient service in around 2014 [as] we felt close adherence to the CBT-E model would help more of our patients get better. ... I believe that the service we provided to the patients was of exceptional quality and this was supported in large part by the work of the CREDO team and their materials.”

(Clinical Psychologist, for work in an NHS eating disorders service) [Hii]

and an inpatient unit that introduced CBT-E in 2016 reported that:

“... we have experienced a transformation of the clinical service, not only in the practice, but also the philosophy of collaboratively working with patients.. We have been able to discharge 5 to 6 patients completely from services to the care of a [GP] with full remission of eating disorder symptoms and restoration of weight. In the previous 26 years of practice I have not been able to discharge patients in a similar manner.”

(Consultant Adolescent Psychiatrist, NHS inpatient unit) [Hiii]

In response to high levels of demand for information about CBT-E during the REF period, in 2020 CREDO, together with Italian colleagues, launched a dedicated website [I]. This website provides up to date information on CBT-E for members of the public (whether they are patients or family members) and health professionals. A recent analysis of its use over a ten-month period showed that over 30,000 users from 144 countries accessed this website [J].