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A formulation based on Fairburn's enhanced cognitive-behavioural model — mapping over-evaluation of eating, shape, and weight alongside maintaining mechanisms.
This formulation maps the core psychopathology of eating disorders: over-evaluation of eating, shape, weight, and their control as the basis of self-worth. This drives dietary restraint, which leads to binge eating (in some presentations), compensatory behaviours, and a cycle of low self-esteem. Additional maintaining mechanisms — perfectionism, mood intolerance, or interpersonal difficulties — may also be relevant. Complete with your therapist.
Introduce during the formulation phase of CBT-E, typically in sessions 1-4. Use collaboratively to map the client's personalised maintenance mechanisms including over-evaluation of shape/weight, dietary restraint, and any additional maintaining factors.
Frame as a shared map of what keeps the eating difficulty going, not a diagnostic label. Explain that understanding these patterns together will guide which areas to address first in treatment.
For clients with low BMI, prioritise weight restoration psychoeducation alongside formulation. For adolescents, consider involving parents in the formulation process. Simplify language for clients with limited psychological mindedness.
Avoid detailed formulation work if the client is medically unstable or at dangerously low weight — prioritise medical stabilisation first. Be cautious with clients who intellectualise as a way of avoiding emotional engagement with their difficulties.
Use Fairburn's transdiagnostic model as your template. Ensure you identify which of the four additional maintaining mechanisms apply (clinical perfectionism, core low self-esteem, interpersonal difficulties, mood intolerance) as these determine whether broad or focused CBT-E is indicated.
Suitable for clients working with eating disorder, formulation, cbt-e, fairburn, bulimia, anorexia, binge eating, maintenance cycle. This tool can be used as a standalone worksheet or as part of a structured homework plan.
Create a free account to access 10 worksheets per month.
Track body checking and body avoidance behaviours, their triggers, and function.
Identify rigid dietary rules and design experiments to test what happens when you break them.
Explore how difficulty tolerating emotions drives eating disorder behaviours — and develop alternative ways to manage intense feelings.
Track weekly weight to observe natural fluctuation and reduce the power of daily weighing.