Category: Eating Disorders

Symposium

Exposure Therapy and Response Prevention for Adults With Anorexia Nervosa: Developing Treatments More Than "Just Eating"

Saturday, November 18
8:30 AM - 10:00 AM
Location: Cobalt 501, Level 5, Cobalt Level

Keywords: ERP (Exposure and Response Prevention) | Eating Disorders | Eating
Presentation Type: Symposium

Background: Maladaptive eating behavior that prevents patients with anorexia nervosa (AN) from meeting their nutritional needs is a central component of relapse. Although there are important differences between eating disorders and anxiety disorders, the shared clinical phenomena suggest potentially useful overlap in treatment strategies. Exposure and Response Prevention for AN (AN-EXRP) addresses maladaptive eating behavior by targeting eating-related fear and anxiety. We evaluated AN-EXRP as an adjunctive strategy to improve eating behavior within the structure of an inpatient treatment program. Case study material highlights phases of implementation of exposures, sample dialogue illustrating the difference between AN-EXRP and “just eating,” and other therapist considerations. Methods: Thirty-two hospitalized patients with AN who had achieved weight restoration to a body mass index > 18.5 kg/m2 were randomized to receive 12 sessions of either AN-EXRP or a comparison treatment, Cognitive Remediation Therapy (CRT). Outcome was assessed by a change in caloric intake in a standardized, laboratory lunch meal. Psychological assessment included self-reported eating related rituals and preoccupations and mealtime anxiety. Mealtime behavior was videotaped and analyzed for presence of anxiety related behaviors in a subset of patients (n = 26) and healthy controls (n = 10). Individual outcome data will be provided for the selected case study. Results: AN-EXRP supported higher caloric intake at the laboratory meal relative to CRT. The data on changes in anxiety were mixed. Analysis of mealtime behavior confirmed that individuals with AN can be distinguished from healthy controls by maladaptive eating behaviors, and that for patients, a subset of these behaviors were related to overall intake and anxiety. Conclusions: AN-EXRP was associated with better caloric intake in a laboratory meal over time than CRT. Future work is needed to investigate the value of techniques focusing on behavior, and eating behavior specifically, in making clinically meaningful change.

Deborah R. Glasofer

Assistant Professor
Columbia University Medical Center

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Exposure Therapy and Response Prevention for Adults With Anorexia Nervosa: Developing Treatments More Than "Just Eating"



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