Clinician and practice characteristics influencing delivery and outcomes of the early part of outpatient cognitive behavioural therapy for anorexia nervosa
Abstract
Abstract Cognitive-behavioural therapy (CBT) can be effective for anorexia nervosa. However, there is evidence that the delivery of treatments for the eating disorders is inconsistent. This study examined evidence that clinician characteristics and practice can influence the effective implementation of CBT. The participants were 100 qualified clinicians who routinely offered outpatient CBT to adults with anorexia nervosa. They completed a survey of their demographic characteristics, level of anxiety, clinical practice in CBT for anorexia nervosa, and beliefs about the relationship between weight gain and therapeutic alliance in the early part of such treatment. Greater reported levels of weight gain were associated with the use of manuals, early focus on weight gain as a target, structured eating, and a belief that weight gain precedes a good working alliance. Clinician anxiety and early focus on the therapeutic alliance rather than structured eating were associated with poorer outcomes. These conclusions need to be tested within clinical and research settings. However, they suggest that clinicians should be encouraged to use manual-based approaches when treating anorexia nervosa using CBT, as focusing on techniques might result in the best possible outcome in this early part of treatment.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Such clinicians tend to focus on the role of the therapeutic alliance as an agent of change, and to prioritise its role over that of the therapeutic techniques that are supported by the evidence, even when doing so is associated with poorer outcomes.
“Such clinicians tend to focus on the role of the therapeutic alliance as an agent of change, and to prioritise its role over that of the therapeutic techniques that are supported by the evidence, even when doing so is associated with poorer outcomes”
From Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track (2016) · cites this paper as Brown et al., 2014
In treating anorexia nervosa, more anxious CBT therapists report that their patients gain less weight.
“in treating anorexia nervosa, more anxious CBT therapists report that their patients gain less weight”
From Therapist drift redux: Why well-meaning clinicians fail to deliver evidence-based therapy, and how to get back on track (2016) · cites this paper as Brown, Mountford & Waller, 2014
Cites
Cognitive Therapy for Depression
(2012) · PsycEXTRA Dataset · doi:10.1037/e675542012-001 · Cited by 9,678 · see citing works
The brief symptom inventory: an introductory report.
Derogatis, L. R., & Melisaratos, N. (1983) · Psychological Medicine · doi:10.1017/s0033291700048017 · Cited by 6,650 · see citing works
Cognitive Therapy of Depression
HOLLON, S. D., & BECK, A. T. (1979) · Cognitive-Behavioral Interventions · doi:10.1016/b978-0-12-404480-7.50012-5 · Cited by 4,685 · see citing works
(2008) · Cited by 1,397 · see citing works
Handbook of treatment for eating disorders
(1997) · Choice Reviews Online · doi:10.5860/choice.35-2151 · Cited by 1,074 · see citing works
Cognitive Behavior Therapy and Eating Disorders
Mitchell, J. E. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.09bk05121 · Cited by 886 · see citing works
A survey of psychologists’ attitudes towards and utilization of exposure therapy for PTSD
Becker, C. B., Zayfert, C., & Anderson, E. (2004) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(03)00138-4 · Cited by 759 · see citing works
Sudden gains and critical sessions in cognitive-behavioral therapy for depression.
Tang, T. Z., & DeRubeis, R. J. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.67.6.894 · Cited by 684 · see citing works
The use and reporting of cluster analysis in health psychology: A review
Clatworthy, J., Buick, D., Hankins, M., Weinman, J., & Horne, R. (2005) · British Journal of Health Psychology · doi:10.1348/135910705x25697 · Cited by 598 · see citing works
Bulimia nervosa treatment: a systematic review of randomized controlled trials.
Shapiro, J., Berkman, N., Brownley, K., Sedway, J., Lohr, K., & Bulik, C. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20372 · Cited by 593 · see citing works
Anorexia nervosa treatment: A systematic review of randomized controlled trials
Bulik, C. M., Berkman, N. D., Brownley, K. A., Sedway, J. A., & Lohr, K. N. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20367 · Cited by 427 · see citing works
Evidence-based treatment and therapist drift
Waller, G. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.10.018 · Cited by 359 · cited 2× · see citing works
“2007), and this failure is related to clinician characteristics and patterns of practice (Waller, 2009; Waller et al. 2012).”
BackgroundSelf-citationSudden gains and critical sessions in cognitive-behavioral therapy for depression
Tang, T. Z., & DeRubeis, R. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.67.6.894 · Cited by 284 · see citing works
Enhanced cognitive behaviour therapy for adults with anorexia nervosa: A UK–Italy study
Fairburn, C. G., Cooper, Z., Doll, H., O'Connor, M. E., Palmer, R. L., & Grave, R. D. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.09.010 · Cited by 271 · see citing works
Cognitive Behavioral Therapy for Eating Disorders
Waller, G., Cordery, H., Corstorphine, E., Hinrichsen, H., Lawson, R., Mountford, V. A., & Russell, K. N. (2007) · Cambridge University Press eBooks · doi:10.1017/cbo9781139644204 · Cited by 244 · see citing works
Self-citationThe effectiveness of enhanced cognitive behavioural therapy for eating disorders: An open trial
Byrne, S. M., Fursland, A., Allen, K. L., & Watson, H. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.01.006 · Cited by 225 · see citing works
Cognitive Behavioral Therapy for Anorexia Nervosa
(2012) · PsycEXTRA Dataset · doi:10.1037/e675412012-001 · Cited by 217 · see citing works
Carter, J. C., Mercer-Lynn, K. B., Norwood, S. J., Bewell, C., Crosby, R. D., Woodside, D. B., & Olmsted, M. P. (2012) · Psychiatry Research · doi:10.1016/j.psychres.2012.04.037 · Cited by 200 · see citing works
Cognitive Behavioral Therapy for Bulimia Nervosa
(2012) · PsycEXTRA Dataset · doi:10.1037/e675432012-001 · Cited by 162 · see citing works
Waller, G., Stringer, H., & Meyer, C. (2012) · Journal of Consulting and Clinical Psychology · doi:10.1037/a0026559 · Cited by 152 · see citing works
Self-citation“Contents may vary”: a pilot study of treatment histories of OCD patients
Stobie, B., Taylor, T., Quigley, A., Ewing, S., & Salkovskis, P. M. (2007) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246580700358x · Cited by 109 · see citing works
Tobin, D. L., Banker, J. D., Weisberg, L., & Bowers, W. (2007) · International Journal of Eating Disorders · doi:10.1002/eat.20426 · Cited by 90 · see citing works
What potential role is there for medication treatment in anorexia nervosa?
Crow, S. J., Mitchell, J. E., Roerig, J. L., & Steffen, K. J. (2008) · International Journal of Eating Disorders · doi:10.1002/eat.20576 · Cited by 84 · see citing works
Therapeutic alliance and weight gain during cognitive behavioural therapy for anorexia nervosa
Brown, A., Mountford, V., & Waller, G. (2013) · Behaviour Research and Therapy · doi:10.1016/j.brat.2013.01.008 · Cited by 48 · see citing works
Self-citationTreatment manuals: Use in the treatment of bulimia nervosa
Wallace, L. M., & von Ranson, K. M. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.09.002 · Cited by 33 · see citing works
Wiborg, J. F., Knoop, H., Wensing, M., & Bleijenberg, G. (2012) · Behaviour Research and Therapy · doi:10.1016/j.brat.2012.03.002 · Cited by 31 · see citing works
What's in a name? Classifying ‘the dropout’ from treatment for anorexia nervosa
Sly, R. (2009) · European Eating Disorders Review · doi:10.1002/erv.964 · Cited by 30 · see citing works
Lockwood, R., Serpell, L., & Waller, G. (2010) · International Journal of Eating Disorders · doi:10.1002/eat.20885 · Cited by 25 · see citing works
Self-citationKyriacou, O., & Waller, G. (2012) · International Journal of Eating Disorders · doi:10.1002/eat.22014 · Cited by 14 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
Waller, G., & Turner, H. (2016) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.12.005 · Cited by 256 · see citing works
Self-citationClinicians' concerns about delivering cognitive-behavioural therapy for eating disorders
Turner, H., Tatham, M., Lant, M., Mountford, V. A., & Waller, G. (2014) · Behaviour Research and Therapy · doi:10.1016/j.brat.2014.04.003 · Cited by 48 · see citing works
Self-citationDuggan, H. C., Hardy, G. E., & Waller, G. (2025) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2025.2465745 · Cited by 20 · see citing works
Self-citationA systematic review on the role of therapist characteristics in the treatment of eating disorders
Albano, G., Teti, A., Scrò, A., Bonfanti, R. C., Fortunato, L., & Coco, G. L. (2024) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2024.750 · Cited by 9 · see citing works
Wade, T. D., Calvert, S., Thompson, E., Wild, C., Mitchison, D., & Hay, P. (2021) · International Journal of Eating Disorders · doi:10.1002/eat.23529 · Cited by 7 · see citing works
Fitzpatrick, M., Clarke, V., Ramsey‐Wade, C. E., & Moller, N. P. (2023) · Counselling and Psychotherapy Research · doi:10.1002/capr.12687 · Cited by 5 · see citing works
Hernandez, M. E. H., & Waller, G. (2021) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2020.1862292 · Cited by 5 · see citing works
Self-citationGatley, D., Millar‐Sarahs, V., Brown, A., Brooks, C. P., & Matcham, F. (2024) · International Journal of Eating Disorders · doi:10.1002/eat.24350 · Cited by 2 · see citing works
Self-citationBrooks, C. P., Rennick, A., Basra, R. S., Lavender, T., Startup, H. M., & Oldershaw, A. (2025) · Journal of Clinical Psychology · doi:10.1002/jclp.23769 · Cited by 1 · see citing works
Johnson, I., & Waller, G. (2021) · Journal of Behavioral and Cognitive Therapy · doi:10.1016/j.jbct.2021.03.002
Self-citationTherapeutic Alliance in the Treatment of Eating Disorders
Brown, A. (2017) · Springer eBooks · doi:10.1007/978-981-287-104-6_61
Self-citationTherapeutic Alliance in the Treatment of Eating Disorders
Brown, A. (2015) · Springer eBooks · doi:10.1007/978-981-287-087-2_61-1
Self-citation
- Authors
- Brown, A., Mountford, V., & Waller, G.
- Affiliations
- King's College London (GB)
- University of Sheffield (GB)
- Corresponding author
- Brown, Amy
- Venue
- The Cognitive Behaviour Therapist
- Publisher
- Cambridge University Press (CUP)
- Published
- 2014-07-10
- Volume
- 7
- ISSN
- 1754-470X (ISSN-L)
- OpenAlex
- W2101314572
- Cited by
- 12
- References
- 29
- Citations by year
- 2025: 2 · 2024: 2 · 2023: 1 · 2021: 3 · 2017: 1 · 2015: 2 · 2014: 1
- FWCI
- 1.57
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Cognitive Behaviour Therapist (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- anorexia nervosa, cognitive behavioral therapy, outpatient care, treatment delivery, clinician characteristics, clinician anxiety, therapeutic relationship, weight gain, treatment outcomes, eating disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
