Beyond the manual: The flexible use of cognitive behavioral therapy for bulimia nervosa Original Research Article

The treatment manual applying cognitive behavioral therapy principles for bulimia nervosa originally was used in early treatment outcome studies and was later expanded and enhanced by for broader clinical use. The manual is well researched as an effective treatment and currently is advocated as the first-line treatment for bulimia nervosa. However, despite the research data supporting its use, these manual-based techniques are still not widely practiced in the treatment of eating disorders outside of academic research settings. This article aims to elaborate on aspects of the manual that may have hindered some therapists in its use. We focus on clarifying aspects of the treatment process that may assist clinicians to flexibly apply the treatment manualʹs specific techniques by emphasizing stylistic approaches to help facilitate treatment adherence, diminish risks of treatment dropout, and address behaviors that interfere with treatment.