CBT for anorexia nervosa

What CBT for anorexia involves

NICE (information for the public) describes CBT for adults with anorexia as:

• weekly sessions for up to 40 weeks (9 to 10 months), with 2 sessions a week for the first 2 or 3 weeks
• coping with feelings, understanding nutrition and the effects of starvation, making healthy food choices
• 'homework' practice, monitoring progress and relapse prevention.

Cognitive work challenges beliefs such as 'I am only worth something if I am thin'; behavioural work includes regular eating and gradually introducing feared foods.

Alternatives and context

NICE also lists MANTRA (Maudsley Anorexia Nervosa Treatment for Adults, 20 sessions) and SSCM (specialist supportive clinical management, 20 or more weekly sessions) for adults, and the NHS says under-18s are usually offered family therapy, with CBT as a possible addition. People can switch therapy if one does not suit them.

Evaluation

• Targets the maintaining beliefs about weight and shape that drugs do not change, and teaches relapse prevention.
• Recommended by NICE, so it has an evidence base, while medication is only an adjunct.
• Long and demanding: up to 40 weeks; people who are very underweight may struggle to engage because starvation affects thinking.
• Motivation: people with anorexia may value their low weight (Reichel et al., 2014, found reduced startle to emaciated bodies, suggesting they appeal to patients), so they may resist change.
• Compare with drugs: fewer physical risks, but slower and costlier in therapist time.

Worked example

Explain how Reichel et al.'s (2014) findings might affect CBT for anorexia.

1. Reichel et al. found people with anorexia showed a reduced startle reflex to emaciated body images, suggesting an automatic appetitive (positive) reaction.
2. So starvation may feel rewarding, not only driven by fear of weight gain.
3. CBT could therefore focus more on the rewards of starvation and building motivation for change, not only on reducing 'weight phobia', as the authors suggested.

Answer: Therapy may need to address the appeal of thinness as well as fear of weight gain.

Check yourself

1. NICE describes CBT for adults with anorexia as lasting up to how many weeks?
   Show answer

   40 weeks. Up to 40 weeks.

2. If a client has 2 sessions a week for the first 3 weeks and then 1 a week up to week 40, how many sessions is that in total?
   Show answer

   43 sessions. 2 x 3 = 6, plus 37 weekly sessions = 43.

3. What does CBT for anorexia mainly target?
   • Dopamine levels
   • Beliefs about weight and shape and the eating behaviours that maintain the disorder
   • Repressed childhood memories
   • Family expressed emotion only
   Show answer

   Beliefs about weight and shape and the eating behaviours that maintain the disorder. Thoughts and behaviours that keep anorexia going.

4. Which treatment does the NHS say is usually offered to under-18s with anorexia?
   • Olanzapine only
   • Electroconvulsive therapy
   • Family therapy
   • No treatment
   Show answer

   Family therapy. Family therapy, sometimes with CBT.

5. Which is another psychological treatment NICE lists for adults with anorexia?
   • MANTRA
   • Systematic desensitisation
   • Depot injection
   • Token economy
   Show answer

   MANTRA. Maudsley Anorexia Nervosa Treatment for Adults.

6. Explain one weakness of CBT for anorexia nervosa.
   Show answer

   People with anorexia may value their low weight and lack motivation to change, and starvation affects thinking, so they may not engage fully with a long course of CBT.. Low motivation, starvation effects and length reduce engagement.

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Sources

• Pearson Edexcel International Advanced Subsidiary/Advanced Level in Psychology specification (issue January 2026)
• Pearson IAL Psychology component guide: WPS04 (Issue 2, November 2024)
• NICE NG69 information for the public: anorexia nervosa, treatment for adults
• NHS: Anorexia nervosa, overview
• Pearson IAL Psychology summary of studies: WPS04

Last updated 8 November 2026. Spotted a mistake? Tell us.