Integrating Family‐Based Treatment Components Into CBT ‐E for Adolescent Eating Disorders: A Narrative Review and Proposal for Family‐Enhanced CBT ‐E ( CBT ‐ FE )

Objective Family‐based treatment (FBT) and Enhanced Cognitive Behavior Therapy (CBT‐E) are two leading evidence‐based outpatient approaches for adolescent eating disorders, but their strengths and limitations may be partly complementary. This review critically examines both approaches and proposes a structured integration termed Family‐Enhanced CBT‐E (CBT‐FE). Method The theoretical foundations, treatment structures, evidence base, and limitations of FBT and adolescent CBT‐E were narratively reviewed, with particular attention to parental involvement, cognitive maintaining mechanisms, weight restoration, treatment engagement, and developmental considerations. Results CBT‐FE retains the four‐phase structure, personalized formulation, and core intervention strategies of CBT‐E as the treatment backbone while incorporating formulation‐driven parent and family components adapted from FBT. These include a non‐blaming stance, externalization, parental empowerment, structured meal support, and gradual transfer of responsibility for eating. Parental involvement is conceptualized as a flexible “dose” calibrated according to the adolescent's age, insight, weight status, clinical needs, and family capacity, and progressively reduced as treatment advances. Discussion CBT‐FE does not alter the first‐line status of family therapy: it is intended for adolescents in whom individual treatment is indicated or chosen and structures family involvement within that treatment from the start. It is a conceptual proposal intended to preserve adolescent agency and CBT‐E's direct targeting of maintaining mechanisms while mobilizing family resources when clinically indicated. Its feasibility, acceptability, and effectiveness require prospective evaluation in open trials and randomized controlled studies.