Overcoming fear of eating: A case study of a novel use of exposure and response prevention.

Abstract

Even after successful weight restoration, many patients with anorexia nervosa (AN) continue to exhibit maladaptive eating including repetitive behaviors (i.e., food rituals) used to decrease anxiety about food, and to describe fears related to food content its effect on shape and weight. While there are important differences between eating disorders and anxiety disorders, the shared clinical phenomena suggest potentially useful overlap in treatment strategies. This case study will describe treatment of a woman with AN using Exposure and Response Prevention for Anorexia Nervosa (AN-EXRP) as an adjunct to concurrent inpatient treatment. This is a novel use of a treatment approach with established efficacy in the treatment of anxiety disorders. AN-EXRP specifically targets eating-related anxiety with the intent to improve the restrictive eating patterns that persist after acute weight restoration. The case study described includes descriptions of (1) the treatment rationale and its phases of implementation, (2) illustrative sample dialogue between the patient and therapist, (3) pre- and post-treatment data on outcome measures of interest (e.g., food intake at a laboratory meal, self-report anxiety ratings, self-report eating-related rituals and preoccupations), and (4) therapist considerations (e.g., maintaining alliance, adhering to treatment frame).

Transdiagnostic fears and avoidance behaviors in self-reported eating disorders

“…Anxiety focused treatments such as exposure therapy aim at the disconfirmation of threat expectancies [63] and an essential pre-requisite to the choice of the right exposure target is a profound understanding of the fear-provoking cues and aversive outcomes a patient expects. So far, amongst the eating disorders, exposure therapy to feared foods, for instance, is most commonly applied in anorexia nervosa [12,13,28,[64][65][66][67][68][69]. If the other eating disorder diagnoses suffer from similar (eating related) fears as patients with anorexia nervosa, it is to be assumed that exposure therapy, which shows promising results in the treatment of anorectic fears, may be a valuable therapy for fear and avoidance in all eating disorders.…”

Transdiagnostic fears and avoidance behaviors across eating disorders

“…Only in the case of anorexia nervosa, a targeted treatment of speci c fears, such as the fear of food and eating, sometimes takes place. A few pilot studies investigated the effects of exposure therapy on fear reduction in anorexia nervosa, with promising results (Cardi et al, 2019;Glasofer et al, 2016;Steinglass et al, 2007;2011;. Exposure therapy according to the inhibitory learning model aims at the discon rmation of expectancies (Craske et al, 2014).…”

“…The subscale is calculated by summing the item scores and multiplying them by 2. Anxiety severity is categorized into normal (0-7), mild (8-9), moderate (10)(11)(12)(13)(14), severe (15)(16)(17)(18)(19) and extremely severe (20+). Internal consistency in the present study is Cronbach's α = 0.89.…”

“…DASS anxiety group comparisons. AN-R vs. HC (p < .001; = -.53), AN-BP vs. HC (p < .001; r = -.70), BN vs. HC (p < .001; r = -.55), BED vs. HC (p = .615; r = - 19…”

Exploring the perceived usefulness of practical food groups in day treatment for individuals with eating disorders

“…For this reason, many clinicians can find delivering experiential interventions challenging. Many feel they are not appropriately trained (Waller, ) and therapists often face difficulties in avoiding the instinct for reassurance, directing individuals’ thoughts to fear provoking situations, and having to contain clients’ levels of anxiety (Glasofer, Albano, Simpson & Steinglass, ; Waller, ). However, occupational therapists may be particularly well positioned to manage this challenge.…”