Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa

Steinglass, Joanna E.; Sysko, Robyn; Glasofer, Deborah R.; Albano, Anne Marie; Simpson, Helen Blair; Walsh, B. Timothy

doi:10.1002/eat.20784

Cited by 125 publications

(145 citation statements)

References 58 publications

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“…Second, these findings suggest that theories positing the importance of emotion regulation 4 , as well as those emphasizing anxiety 14,15 , during acute stages of AN are likely both valid, but may be identifying two different processes that may be associated with symptom expression among underweight individuals with AN. The data indicate that in the acute stages of AN, problems appropriately managing emotions may be more highly associated with eating disorder symptoms and impairment for some individuals, while high, but stable levels of anxiety may be more highly associated with eating disorder behavior for others.…”

Section: Discussionmentioning

confidence: 94%

“…There is concurrently increasing interest in the role that anxiety plays in influencing AN symptomology 14,15 . It has been suggested that individuals who develop AN have elevated levels of anxiety resulting from a dysfunctional serotonin system, and that restrictive eating serves to reduce baseline levels of anxiety to a more manageable level 16 .…”

Section: Introductionmentioning

confidence: 99%

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Examining the associations between emotion regulation difficulties, anxiety, and eating disorder severity among inpatients with anorexia nervosa

Haynos¹,

Roberto²,

Attia³

2015

Comprehensive Psychiatry

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Objective There is growing interest in the role of emotion regulation in anorexia nervosa (AN). Although anxiety is also hypothesized to impact symptoms of AN, little is known about how emotion regulation, anxiety, and eating disorder symptoms interact in AN. In this study, we examined the associations between emotion regulation, anxiety, and eating disorder symptom severity in AN. Methods Questionnaires and interviews assessing emotion regulation difficulties, anxiety, eating disorder symptoms, and eating disorder-related clinical impairment were collected from group of underweight individuals with AN (n = 59) at admission to inpatient treatment. Hierarchical linear regressions were used to examine the associations of emotion regulation difficulties, anxiety, and the interaction of these constructs with eating disorder symptoms and eating disorder-related clinical impairment. Results Emotion regulation difficulties were significantly positively associated with eating disorder symptoms and related clinical impairment only when anxiety levels were low and anxiety was significantly positively associated with eating disorder symptoms and related clinical impairment only when emotion regulation problems were not elevated. Conclusions This study adds to a growing literature suggesting that emotion regulation deficits are associated with eating disorder symptoms in AN. Certain individuals with AN may especially benefit from a focus on developing emotion regulation skills in the acute stages of illness.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Examining the associations between emotion regulation difficulties, anxiety, and eating disorder severity among inpatients with anorexia nervosa

Haynos¹,

Roberto²,

Attia³

2015

Comprehensive Psychiatry

View full text Add to dashboard Cite

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“…In addition to these core diagnostic criteria and the specific behaviors that characterize the two AN subtypes (i.e., binge eating-purging subtype and restricting subtype), many individuals with AN exhibit related behaviors that have been described as compulsive and ritualistic in nature (e.g., Mazure, Halmi, Sunday, Romano, & Einhorn, 1994; Steinglass et al, 2011). One set of body-related ritualistic behaviors that has received attention in the literature is body checking behaviors.…”

mentioning

confidence: 99%

A naturalistic examination of body checking and dietary restriction in women with anorexia nervosa

Lavender

Wonderlich

Crosby

et al. 2013

Behaviour Research and Therapy

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Body checking has been conceptualized as a behavioral manifestation of the core overvaluation of eating, shape, and weight concerns underlying eating disorder psychopathology. Cognitive-behavioral theories suggest that body checking behaviors may function to maintain dietary restriction. The current study examined the association between body checking frequency and dietary restriction among women with anorexia nervosa (AN) in the natural environment. Women (N = 118) with full or partial AN completed baseline clinical interviews and a two-week ecological momentary assessment protocol, during which they reported on body checking behaviors (i.e., checking whether one’s thighs touch; checking joints/bones for fat) and dietary restriction (i.e., 8 waking hours without eating; consuming less than 1200 calories per day). Average daily body checking frequency was positively associated with baseline eating disorder symptoms and body mass index. Daily body checking frequency was associated with both forms of dietary restriction on the same day, as well as the following day. Results support the theorized association between body checking and overvaluation of shape and weight, and suggest that targeting such behaviors in treatment may have utility in reducing dietary restriction.

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“…They manifest repetitive behaviors (i.e., food rituals) used to decrease anxiety about food, which bear strong similarities to obsessive compulsive disorder (e.g., Hsu, Kaye, & Weltzin, 1993). While there are important differences between eating disorders (EDs) and anxiety disorders, the shared clinical phenomena suggest potentially useful overlap in treatment strategies (Steinglass et al, 2011). …”

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confidence: 99%

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

et al. 2016

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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).

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Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa

Cited by 125 publications

References 58 publications

Examining the associations between emotion regulation difficulties, anxiety, and eating disorder severity among inpatients with anorexia nervosa

Examining the associations between emotion regulation difficulties, anxiety, and eating disorder severity among inpatients with anorexia nervosa

A naturalistic examination of body checking and dietary restriction in women with anorexia nervosa

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

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