Category: Eating Disorders

Symposium

Examining the Effectiveness of Exposure and Response Prevention in the Treatment of Eating Disorders in Youth

Friday, November 17
1:45 PM - 3:15 PM
Location: Aqua 310, Level 3, Aqua Level

Keywords: Eating Disorders | Exposure | Body Image
Presentation Type: Symposium

Introduction: Although family-based treatment is the most evidence-based treatment for eating disorders (EDs) in youth, many patients do not benefit, and other families have difficulty committing to weekly family therapy (Dalle Grave et al., 2013). Thus, there is a need to examine individual treatment interventions for youth with EDs. Exposure and response prevention (ERP) is the treatment of choice for youth with obsessive compulsive disorder (OCD) and has been suggested as a suitable treatment for EDs based on the significant symptom overlap and shared neural mechanisms between EDs and OCD (Steinglass et al., 2012). The objective of the present investigation was to examine the effectiveness of ERP in the treatment of youth with EDs.           


Methods: Youth patients (N = 117) with a primary ED diagnosis were treated in a partial hospitalization program emphasizing ERP. Patients worked with a clinician to create an exposure hierarchy targeting common fear-evoking stimuli in the context of EDs, including feared eating scenarios (e.g., school cafeteria), body image triggers (e.g., wearing swimsuit), and foods associated with weight gain (e.g., pizza). Patients completed three hours of ERP activities daily under the guidance of program clinicians. At pre and posttreatment, all patients completed several measures assessing a variety of cognitive and behavioral ED features, including dietary restraint, concerns about weight and shape, preoccupation with eating-related thoughts, ritualistic eating behaviors, and body image distress.  


Results: Repeated measures analyses demonstrated that youth patients experienced statistically significant reductions across all ED features assessed from pre to posttreatment (all p’s < .05). Effect sizes were the largest for reductions in dietary restraint (d = .89), ritualistic eating behaviors (d = .77), and compulsive body checking (d = .73) and avoidance (d = .56). Global ED severity at pretreatment did not predict response on any of the outcome variables. 


Discussion: Though traditionally used in the treatment of OCD, ERP appears to be a promising individual intervention for EDs in youth. Patients receiving an ERP-focused treatment experienced robust improvements across a diverse array of ED symptom domains. Future endeavors to examine the effectiveness of ERP for youth EDs in diverse settings will be discussed.

Eric A. Storch

Professor, College Of Medicine Pediatrics
University of South Florida; Rogers Behavioral Health – Tampa; Johns Hopkins All Children’s Hospital

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