How Do Therapists Experience 20-Session Cognitive-Behavioral Therapy for Anorexia Nervosa (CBT-AN-20)? A Qualitative...

We need to understand therapists' experiences of delivering manual-based psychotherapies to identify possible dissemination barriers and opportunities. This study explored therapists' experiences of delivering CBT-AN-20, a new 20-session cognitive-behavioral intervention for outpatients with anorexia nervosa.

Ten therapists who had delivered CBT-AN-20 to at least one patient participated in an online survey. We used descriptive statistics (Likert-scale questions; demographics) and thematic analysis (open-ended text) to analyze responses. Pre-registration: https://doi.org/10.17605/OSF.IO/R2U8P.

Therapists' mixed experiences of CBT-AN-20 were evident across quantitative and qualitative responses. Thematic analysis generated three main themes: Feelings about therapy over time; beliefs about for whom therapy might work; and perceptions of the characteristics of therapy. Despite some initial uncertainty, therapists reported both positive and negative experiences of delivering CBT-AN-20. They felt it worked well for some patients (highly motivated/less complex eating disorder presentations) but not for others (less motivated/more complex presentations). They experienced CBT-AN-20 as fast-paced and action-packed, yet with a clear, supportive structure. Therapists found encouraging rapid, early changes to patients' eating and weight difficult but worthwhile.

CBT-AN-20 is feasible and broadly acceptable for therapists to deliver. Therapists' mixed feelings were like those reported in qualitative studies of other psychotherapies for anorexia nervosa. While the manual addresses many identified challenges, training and supervision should focus on bolstering therapists' confidence in delivering CBT-AN-20 with fidelity. Future research should explore whether therapists' perceptions of CBT-AN-20 change with experience and if their expectations about whom CBT-AN-20 might work for are accurate.