Early intervention and augmentation therapy for eating disorders: a Delphi consensus study on transdiagnostic cognitive behavioural processes

Little is known about which transdiagnostic cognitive behavioural processes (precipitating or maintaining factors across different psychiatric disorders) are most critical to target to improve the outcomes of interventions for eating disorders (EDs). As a first step toward developing a better understanding of this issue, we conducted a modified Delphi study to reach consensus on processes for early intervention and augmenting evidence-based treatment. Across three rounds, four panels were included: people with lived experience (<i>n</i> = 38), significant others (<i>n</i> = 27), clinicians specialising in the treatment of EDs (<i>n</i> = 44), and ED researchers (<i>n</i> = 29). For early intervention, nine processes were endorsed: basing self-worth on one or two aspects of oneself; persistent and excessively high standards; poor distress tolerance skills; being self-critical; negative body image; difficulty coping with developmental life transitions; low self-compassion; low self-worth and self-acceptance; and negative social media use. For augmenting treatment, nine similar processes were endorsed, except life transitions and social media use, which were replaced by social isolation and unhelpful thinking habits. This information can inform a future research agenda for improving interventions for EDs. However, consensus only occurred for approximately one fifth of the 49 processes, with a disconnect between the lived experience and researcher panels that requires attention.