Cognitive behavioral therapy versus compassion focused therapy for adult patients with eating disorders with and without childhood trauma: A randomized controlled trial in an intensive treatment setting

Vrabel, K. R., Waller, G., Goss, K., Wampold, B., Kopland, M., & Hoffart, A. (2024). Cognitive behavioral therapy versus compassion focused therapy for adult patients with eating disorders with and without childhood trauma: A randomized controlled trial in an intensive treatment setting. Behaviour Research and Therapy, 174, 104480. https://doi.org/10.1016/j.brat.2024.104480

Summary by: Gizem Sönmez

Can Compassion Focused Therapy Help Heal Eating Disorders?

A new study shows that treating eating disorders with compassion focused therapy might be just as powerful as using traditional cognitive behavioral therapy. And this method was even better for people who’ve experienced childhood trauma.

Many people struggle with eating disorders, such as anorexia or bulimia. These are serious mental health conditions that affect how people eat, think about food, and view their bodies.

The most common therapy used is called Cognitive Behavioral Therapy (CBT). It helps people change negative thoughts and behaviors. CBT works well for many, but not for everyone, especially those who’ve had trauma in childhood, such as abuse or neglect. These people often feel shame, are very self-critical, and have trouble accepting kindness from others or even from themselves. So researchers started with this question: “Can therapy that focuses on compassion work better for people with trauma?”

Compassion Focused Therapy (CFT) is particularly suitable for individuals who struggle with intense feelings of shame and self-criticism, and who find it challenging to experience or express kindness and warmth toward themselves or others. This approach supports them in developing a greater sense of safety and emotional warmth in both their self-relationship and their interactions with others.

 What Did the Researchers Do?

They studied 130 adults with eating disorders who had not improved with past treatments. Half of them had a history of childhood trauma.

Participants were randomly assigned to two types of therapy:

1. CBT – Focuses on changing thoughts and behaviors linked to the eating disorder.
2. Compassion-Focused Therapy for Eating Disorders (CFT-E) – A newer therapy that helps people develop self-compassion, manage shame, and feel safe with emotions.

Both therapies were given in an intensive 13-week inpatient program in Norway. People had individual and group therapy, meals, and support. Researchers followed up for one year after treatment.

 What Did They Find?

• Both therapies were effective.
  Eating disorder symptoms dropped significantly during treatment in both groups.
• But there was a key difference:
  People with childhood trauma who got CFT-E were more likely to keep improving one year later.
• CBT worked better for improving some social skills.
  But CFT-E was better at reducing PTSD symptoms linked to ch,idhood trauma.

 Why Compassion Matters?

This study highlights the importance of self-kindness and compassion, especially for individuals who have experienced significant emotional pain due to childhood trauma. Compassion-Focused Therapy for Eating Disorders (CFT-E) supports individuals in several important ways:

• It helps them understand their feelings of shame.
• It teaches them how to treat themselves with care and gentleness.
• It supports them in reducing harsh self-criticism.
• It encourages the development of healthier strategies for managing difficult emotions.

Overall, CFT-E promotes emotional healing by fostering a more compassionate relationship with oneself.

 What Makes This Study Strong?

• It’s the first randomized controlled trial comparing CBT and CFT-E for eating disorders.
• The researchers used a real-world setting with very distressed patients.
• The therapy lasted long enough (13 weeks) to see real effects.

Conclusion

This study happened at one clinic in Norway, so results might not apply everywhere. There was no control group, so we can’t say how much change came just from being in treatment. More research is needed, especially in younger people and with different types of eating disorders

Yet, it’s a promising study. Compassion-focused therapy might be helpful for someone who has an eating disorder, especially with a history of trauma. CBT is still effective, but for people struggling with shame and self-hatred, learning to be kinder to themselves might make a lasting difference.