Development of a brief cognitive‐behavioral treatment for avoidant/restrictive food intake disorder in the context of disorders of gut–brain interaction: Initial feasibility, acceptability, and clinical outcomes

Abstract

Background: Avoidant/restrictive food intake disorder (ARFID) symptoms are common (up to 40%) among adults with disorders of gut-brain interaction (DGBI), but treatments for this population (DGBI + ARFID) have yet to be evaluated.We aimed to identify initial feasibility, acceptability, and clinical effects of an exposure-based cognitive-behavioral treatment (CBT) for adults with DGBI + ARFID. Methods: Patients (N = 14) received CBT as part of routine care in an outpatient gastroenterology clinic. A two-part investigation of the CBT included a retrospective evaluation of patients who were offered a flexible (8-10) session length and an observational prospective study of patients who were offered eight sessions. Feasibility benchmarks were ≥75% completion of sessions, quantitative measures (for treatment completers), and qualitative interviews. Acceptability was assessed with a benchmark of ≥70% patients reporting a posttreatment satisfaction scores ≥3 on 1-4 scale and with posttreatment qualitative interviews. Mixed model analysis explored signals of improvement in clinical outcomes.Results: All feasibility and acceptability benchmarks were achieved (and qualitative feedback revealed high satisfaction with the treatment and outcomes). There were improvements in clinical outcomes across treatment (all p's < .0001) with large effects for ARFID fear (À52%; Hedge's g = 1.5; 95% CI = 0.6, 2.5) and gastrointestinal-specific anxiety (À42%; Hedge's g = 1.0; 95% CI = 0.5, 16). Among those who needed to gain weight (n = 10), 94%-103% of expected weight gain goals were achieved.Discussion: Initial development and testing of a brief 8-session CBT protocol for DGBI + ARFID showed high feasibility, acceptability, and promising clinical improvements. Findings will inform an NIH Stage 1B randomized control trial.

Preliminary data that psychological treatment and baseline anxiety are associated with a decrease in postprandial fullness and early satiation for individuals with bulimia nervosa and related other specified feeding or eating disorder

“…This may reflect differences in nutritional state between AN and BN. Findings extend work suggesting that the prevalence of DGBI and gastrointestinal symptoms generally decrease during inpatient treatment for BN (Chami et al, 1995; Salvioli et al, 2013) and data demonstrating reductions in fullness and satiation among individuals with avoidant/restrictive food intake disorder and DGBI during cognitive behavioral therapy (Burton Murray et al, 2022).…”

Translation of the nine item avoidant/restrictive food intake disorder screen (NIAS) questionnaire in French (NIAS‐Fr)

“…Up to 40% of DGBI patients meet criteria for symptoms of ARFID, 9 particularly those with a history of restrictive diets 10 . While ARFID‐like symptoms are common among DGBI patients, we found only eight papers that meet keywords for both ARFID and DGBI on PubMed to date 9,11–17 . In addition, since ARFID has been first described by the DSM‐5 in 2013, the current literature on this eating disorder among adult population is very limited.…”

“…10 While ARFID-like symptoms are common among DGBI patients, we found only eight papers that meet keywords for both ARFID and DGBI on PubMed to date. 9,[11][12][13][14][15][16][17] In addition, since ARFID has been first described by the DSM-5 in 2013, the current literature on this eating disorder among adult population is very limited. Studies are heterogeneous with regard to their methodology.…”

Relationships among symptoms of gastroparesis to those of avoidant/restrictive food intake disorder in patients with gastroparesis

“…20 In fact, one small study showed among adults with disorders of gut-brain interaction with ARFID (n = 7 of whom had functional dyspepsia) that a behavioral treatment aimed at increasing food intake was associated with large reductions in PAGI-SYM fullness/satiety scores. 21 Considering the similarities in symptoms of ARFID and Gp and the distinctly different management strategies for each disorder, it is important to continue to investigate the relationship and causal- This study has potential limitations. As noted above, we used NIAS score cutoffs validated in a prior study; however, this validation study was done in an ARFID clinical sample, not a sample of adults with Gp who were diagnosed with ARFID.…”