Patterns of symptom change in behaviors and cognitions during 10-session cognitive behavioral therapy (CBT-T) for non-underweight eating disorders

Objective

Little is known about the timing of behavioral versus cognitive change in 10-session cognitive-behavioral therapy for non-underweight eating disorders (CBT-T). We aimed to: (a) evaluate the magnitude of behavioral and cognitive symptom reduction across treatment; and (b) investigate the relation between early behavioral change and subsequent cognitive change. We hypothesized: (a) large and significant reductions in behavioral and cognitive symptoms from pre- to mid-treatment and from pre- to post-treatment; and (b) that early behavioral change would predict subsequent cognitive change over the course of treatment.

Method

Patients (N = 63) were offered CBT-T and completed the Eating Disorder-15 on a weekly basis. We used intent-to-treat analyses. For Aim 1, we conducted a series of fixed-effect multilevel models for each outcome variable, accounting for repeated measures (pre-, mid-, and post-treatment) within individuals. For Aim 2, we conducted a linear regression using early behavioral change as the predictor and subsequent cognitive change as the outcome.

Results

We observed large and significant reductions in most behavioral and all cognitive symptoms pre- to mid-treatment and pre- to post-treatment. Early changes in behavioral symptoms did not significantly predict subsequent cognitive changes.

Discussion

Behavioral improvements occurred rapidly and were sustained throughout treatment, whereas cognitive changes followed a more gradual trajectory. The absence of a significant predictive relationship between early behavioral change and subsequent cognitive change suggests that these domains may improve independently. Future research should investigate the mechanisms linking behavioral and cognitive changes.