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Schema-informed CBT for anorexia nervosa: a case series for patients with chronic unmet need
Published online by Cambridge University Press: 18 August 2025
Abstract
Anorexia nervosa (AN) is often regarded as ‘difficult to treat’. This may in part be due to co-occurring diagnoses and traits that are less directly targeted either at the point of formulation or in treatment. Schema therapy may be suitable for individuals with AN who have not benefited from first-line interventions. It offers a schema formulation and change techniques that target broader characterological ways of being. However, schema therapy is typically 18 months duration or longer, and therefore not well-suited to services with resource constraints. We present a schema-informed cognitive behavioural therapy (CBT) approach for AN, based on a formulation that encapsulates the experience of chronic unmet emotional need and which uses cognitive and behavioural techniques to target schema and schema mode change over a relatively brief treatment. We argue that the experiential techniques of schema therapy can augment the change process for those with AN, by gradually turning up the ‘emotional heat’ and increasing tolerance for emotion. After outlining this proposed model, we present findings from a case series of n=11 patients with AN or atypical AN. All patients had received first-line eating disorder treatment(s) previously and n=8/11 had prior experience of day or in-patient treatment. Results supported the acceptability and feasibility of schema-informed CBT for AN: no patients discontinued treatment early, mean number of sessions was 31 (SD 10.28), and patient satisfaction was high. Improvements were seen in AN psychopathology, depression/anxiety, schemas and schema modes, mostly with medium effect sizes. We propose areas for future research and consideration.
Key learning aims
(1) To understand the rationale for a schema-informed CBT approach for anorexia nervosa.
(2) To understand the key components of schema-informed CBT for anorexia nervosa, including treatment objectives, stages of treatment and core methods.
(3) To evaluate the empirical evidence for schema-informed CBT with anorexia nervosa.
(4) To critically reflect on future opportunities for research and clinical practice with schema-informed CBT and eating disorders.
Information
- Type
- Empirically Grounded Clinical Guidance Paper
- Information
- Copyright
- © The Author(s), 2025. Published by Cambridge University Press on behalf of British Association for Behavioural and Cognitive Psychotherapies
References
Further reading
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Moorey, S., Byrne, S., & Ruths, F. (2020). Brief work: schema informed CBT. In Creative Methods in Schema Therapy (pp. 301–315). Routledge.10.4324/9781351171847-19CrossRefGoogle Scholar
Pugh, M. (2015). A narrative review of schemas and schema therapy outcomes in the eating disorders. Clinical Psychology Review, 39, 30–41.10.1016/j.cpr.2015.04.003CrossRefGoogle ScholarPubMed
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