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  • Oral presentation
  • Open Access

Switching to transdiagnostic treatment of worry and rumination following poor early response to CBT-E

  • 1,
  • 1Email author,
  • 1 and
  • 1
Journal of Eating Disorders20142 (Suppl 1) :O9

  • Published:


  • Anxiety Disorder
  • Major Depression
  • Eating Disorder
  • Early Response
  • Good Compliance

We describe the treatment of a patient with BN (plus comorbid major depression and generalised anxiety disorder) who completed stage one and stage two of CBT-E at a specialist eating disorders outpatient clinic. Despite good compliance with all components of the treatment, the patient did not achieve an early rapid reduction in binge-eating and purging by the stage two progress review and was considered to be at-risk of suboptimal treatment outcome. Her repetitive negative thinking (worry and rumination) was identified as significantly interfering with progress, and the primary trigger for episodes of binge-eating and vomiting. In light of this, it was decided to evaluate the usefulness of abandoning CBT-E and switching to metacognitive therapy (MCT) for repetitive negative thinking (RNT). RNT is defined as cognitive perseveration on negative themes. MCT has been shown to demonstrate excellent outcomes in patients with anxiety and depressive disorders at the same clinic. Switching to a transdiagnostic meta-cognitive was associated with achieving optimal outcomes at the end of treatment. It is recommended that clinicians routinely assess the degree to which patients have achieved an early response to CBT-E and systematically evaluate the effectiveness of switching or pursuing CBT-E in this patient group.

This abstract was presented in the Treatment in Community and Inpatient Settings stream of the 2014 ANZAED Conference.

Authors’ Affiliations

Centre for Clinical Interventions, Perth, Australia


© Raykos et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.