The chapter presents the CBT-E module designed for patients with a clinically significant low body weight, including those with anorexia nervosa, atypical anorexia nervosa, bulimia nervosa, or other eating disorders with a high degree of weight suppression. This module takes priority when a significantly low weight is present, due to its decisive role in maintaining the eating disorder and the associated serious physical and psychological consequences. The chapter outlines a comprehensive, evidence-based framework for addressing weight restoration through specific CBT-E strategies and procedures. Key components include normalizing ambivalence, clarifying the psychological and physiological impacts of low weight, and guiding patients toward their individual “natural weight”, defined as a weight that does not contribute to the maintenance of the eating disorder and is free from impairment across physical, psychological, and social domains. A core strategy is assisted eating, typically implemented during the early weeks of treatment to help patients relearn regular eating patterns, manage meal-related anxiety, and gradually regain weight. Patients are supported in applying cognitive-behavioural strategies before, during, and after meals, including structured meal planning, using real-time self-monitoring tools, and practicing post-meal coping skills to prevent compensatory behaviours. The module also addresses common physical and emotional challenges that arise during refeeding, such as fullness, bloating, and changes in body perception. As patients progress, the focus shifts to unassisted eating, maintaining weight, and accepting the “new self”.

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Significant Low Weight and Undereating Module

  • Riccardo Dalle Grave

摘要

The chapter presents the CBT-E module designed for patients with a clinically significant low body weight, including those with anorexia nervosa, atypical anorexia nervosa, bulimia nervosa, or other eating disorders with a high degree of weight suppression. This module takes priority when a significantly low weight is present, due to its decisive role in maintaining the eating disorder and the associated serious physical and psychological consequences. The chapter outlines a comprehensive, evidence-based framework for addressing weight restoration through specific CBT-E strategies and procedures. Key components include normalizing ambivalence, clarifying the psychological and physiological impacts of low weight, and guiding patients toward their individual “natural weight”, defined as a weight that does not contribute to the maintenance of the eating disorder and is free from impairment across physical, psychological, and social domains. A core strategy is assisted eating, typically implemented during the early weeks of treatment to help patients relearn regular eating patterns, manage meal-related anxiety, and gradually regain weight. Patients are supported in applying cognitive-behavioural strategies before, during, and after meals, including structured meal planning, using real-time self-monitoring tools, and practicing post-meal coping skills to prevent compensatory behaviours. The module also addresses common physical and emotional challenges that arise during refeeding, such as fullness, bloating, and changes in body perception. As patients progress, the focus shifts to unassisted eating, maintaining weight, and accepting the “new self”.