Integrating Family-Based Treatment Components Into CBT-E for Adolescent Eating Disorders: A Narrative Review and Proposal for Family-Enhanced CBT-E (CBT-FE).

OBJECTIVE

Family-based treatment (FBT) and Enhanced Cognitive Behavior Therapy (CBT-E) are two leading evidence-based outpatient approaches for adolescent eating disorders, but their strengths and limitations may be partly complementary. This review critically examines both approaches and proposes a structured integration termed Family-Enhanced CBT-E (CBT-FE).

METHOD: The theoretical foundations, treatment structures, evidence base, and limitations of FBT and adolescent CBT-E were narratively reviewed, with particular attention to parental involvement, cognitive maintaining mechanisms, weight restoration, treatment engagement, and developmental considerations.

RESULTS

CBT-FE retains the four-phase structure, personalized formulation, and core intervention strategies of CBT-E as the treatment backbone while incorporating formulation-driven parent and family components adapted from FBT. These include a non-blaming stance, externalization, parental empowerment, structured meal support, and gradual transfer of responsibility for eating. Parental involvement is conceptualized as a flexible "dose" calibrated according to the adolescent's age, insight, weight status, clinical needs, and family capacity, and progressively reduced as treatment advances.

DISCUSSION: CBT-FE does not alter the first-line status of family therapy: it is intended for adolescents in whom individual treatment is indicated or chosen and structures family involvement within that treatment from the start. It is a conceptual proposal intended to preserve adolescent agency and CBT-E's direct targeting of maintaining mechanisms while mobilizing family resources when clinically indicated. Its feasibility, acceptability, and effectiveness require prospective evaluation in open trials and randomized controlled studies.