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Peer-reviewedCC BY 4.0The International Journal of Eating Disorders

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

  • Heather C. Duggan1
  • Hannah M. Turner2
  • Charlotte L. Rose3
  • Jennifer J. Thomas4,5
  • Kamryn T. Eddy4,5
  • Kathryn G. Pasquariello4
  • Kendra R. Becker4,5
  • Debra L. Franko4,6
  • Glenn Waller7
7 affiliations
  1. 1University of Sheffield, School of Psychology Sheffield UK
  2. 2Hampshire and Isle of Wight Health NHS Foundation Trust Southampton UK
  3. 3Avon and Wiltshire Mental Health Partnership NHS Trust Bristol UK
  4. 4Eating Disorders Clinical and Research Program, Massachusetts General Hospital Boston Massachusetts USA
  5. 5Department of Psychiatry Harvard Medical School Boston Massachusetts USA
  6. 6Northeastern University Boston Massachusetts USA
  7. 7Department of Psychology University of Warwick Coventry UK
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Abstract

Objective: 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.

Method: 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.

Results: 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.

Discussion: 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.

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Cite

BibTeXRIS
BibTeX
@article{duggan2026therapists,
  title = {{How Do Therapists Experience 20‐Session Cognitive‐Behavioral Therapy for Anorexia Nervosa (CBT‐AN‐20)? A Qualitative Study}},
  author = {Heather C. Duggan and Hannah M. Turner and Charlotte L. Rose and Jennifer J. Thomas and Kamryn T. Eddy and Kathryn G. Pasquariello and Kendra R. Becker and Debra L. Franko and Glenn Waller},
  journal = {The International Journal of Eating Disorders},
  year = {2026},
  month = jul,
  doi = {10.1002/eat.70174},
  url = {https://doi.org/10.1002/eat.70174},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - How Do Therapists Experience 20‐Session Cognitive‐Behavioral Therapy for Anorexia Nervosa (CBT‐AN‐20)? A Qualitative Study
AU  - Heather C. Duggan
AU  - Hannah M. Turner
AU  - Charlotte L. Rose
AU  - Jennifer J. Thomas
AU  - Kamryn T. Eddy
AU  - Kathryn G. Pasquariello
AU  - Kendra R. Becker
AU  - Debra L. Franko
AU  - Glenn Waller
PY  - 2026
DA  - 2026/07/28
JO  - The International Journal of Eating Disorders
DO  - 10.1002/eat.70174
UR  - https://doi.org/10.1002/eat.70174
AB  - Objective: 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.  Method: 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.  Results: 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.  Discussion: 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.
SN  - 0276-3478
SN  - 1098-108X
ER  -