Lessons learned developing and testing family‐based interoceptive exposure for adolescents with low‐weight eating disorders

Abstract

Background Anorexia nervosa (AN) usually develops in early adolescence and is characterized by high rates of morbidity and mortality. Family‐based therapy (FBT) is the leading evidence‐based treatment for adolescents with AN, but not all patients experience sufficient improvement. The purpose of this manuscript is to describe the development and subsequent experience with a Family‐Based Interoceptive Exposure (FBT‐IE) for adolescents with a broader form of low‐weight eating disorders. Methods The novel IE‐based behavioral intervention is a six‐session family‐based treatment module designed to directly target and modify disgust by altering the prefrontal regulation of the insula response to aversive stimuli by decreasing visceral sensitivity (e.g., bloating). Each session teaches a new skill regarding tolerating distress to visceral sensations associated with disgust and an in‐vivo “IE exercise,” in which the family is provided with a meal replacement shake of unknown content and caloric density. Results In this novel treatment, the patient learns to tolerate disgust in the context of a challenging food stimulus as a way to increase consumption of restricted foods outside of session. Conclusion We discuss successes and challenges executing this treatment with patients with low‐weight eating disorders and propose future directions for the intervention.

Early change in gastric‐specific anxiety sensitivity as a predictor of eating disorder treatment outcome

“…Interoceptive exposure has been shown to effectively reduce anxiety sensitivity when incorporated into anxiety treatment (Boswell et al., 2013), to reduce VSI scores when added to cognitive behavioral therapy for irritable bowel syndrome (Craske et al., 2011), and to reduce pain and pain interference in young children with functional abdominal pain (Zucker et al., 2017), a group that may be at high risk for developing an ED (Zucker & Bulik, 2020). Interoceptive exposure is well‐suited to treating the interoceptive deficits and fears of body sensations that are common in EDs (Boswell et al., 2015), and has demonstrated effectiveness in reducing interoceptive deficits and improving ED symptoms in adults and adolescents (Boswell et al., 2019; Hildebrandt et al., 2021; Plasencia et al., 2019).…”

Disgust and Self-Disgust in Eating Disorders: A Systematic Review and Meta-Analysis

“…Traditional or adjunctive [90] exposure techniques that target aversive learning processes may be helpful to overcome disgust outcomes in response to food or eating. For example, future aversive expected outcomes might elicit a disgust response [6,15].…”