CBT-ARE ARFID and Eating Disorders Treatment Manual

CBT-ARE combines education, skills and interventions for ARFID and Eating Disorders, namely Anorexia. ARFID frequently presents with Anorexia, and the ARFID sections can be use alone as well. CBT-E is designed for eating disorders, but, at least at the time of the creation of this manual, the only group modules were in Italian. We developed our own referencing that version. This is designed for inpatient groups while retaining content more appropriate for the partial and residential levels of care. Additionally, this can be used in the individual therapy setting.

ARFID section covers the causes including limited safe food repertiore, fear of consequences of eating (like nausea and vomiting), and low hunger cues. We develop a fear ladder to identify foods that are just outside of our comfort zone, and start with simple food items or invidiual ingredients, then build up to more challenging foods and complex recipes. A goal is social functioning, targeting foods that allow the individual to partake in their full social life, as well as access to the nutrition needed for health. This gives people a sense of agency and motivation - many people respond quickly to this treatment. 

CBT-E aims to build a conceptualization of the eating pattern that is highly individualized and then to target parts of that pattern with various interventions. We start by trying to understand the individual's restrictive diet. We  build skills to use a monitoring card to track our progress in meals and adherence to current eating goals. There is a section on how we define ideal body weight, followed by a low-weight / restrictive eating module. Other compensatory behaviors are addressed as well including excessive exercise and eliminative behaviors (purging). The binge eating module is primarily helpful for outside the hospital setting and has utility for people who struggle with over eating as well. A body image module also tends to be helpful for later stages of treatment after the acute hospital. Next sections cover cognitions, emotions and events as related to eating. Slip ups vs relapse tends to be very important including helping people recognize an eat-disorder state of mind, and then preparation for stepping down in treatment (such as returning home). Other modules tend to be for low-levels of care including self-esteem, interpersonal difficulties, intolerance of emotions, and significant other involvement in care and maintenance.