Category: Eating Disorders

Symposium

Graduated Food Exposure Reduces Eating-Related Fear and Avoidance Among Adult Inpatients With Severe Eating Disorders

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

Keywords: Eating Disorders | Exposure
Presentation Type: Symposium

Introduction: Inpatient treatment of individuals with severe eating disorders (EDs) primarily emphasizes alleviation of acute medical complications but often does not address the core underlying cognitive-behavioral features of EDs. However, there is a growing body of evidence that brief cognitive-behavioral interventions targeting transdiagnostic ED features (e.g., selective food avoidance) are effective in reducing the severity of these features in inpatient settings (e.g., Dalle Grave, Calugi, El Ghoch, Conti, & Fairburn, 2014). The aim of the present study was to assess the effectiveness of exposure therapy targeting fears and avoidance of eating in adults receiving inpatient care for severe EDs.           


Methods: Participants included 97 adults (M age = 28.7 years, SD = 7.9; M length of stay = 17.3 days, SD = 11.6; M body mass index = 18.6, SD = 1.8; 83.5% female; 86.6% Caucasian) receiving inpatient treatment for EDs at a large behavioral health hospital. Principal ED diagnoses included: anorexia nervosa (n = 49; 50.5%), bulimia nervosa (n = 23; 23.7%), avoidant/restrictive food intake disorder (n = 8; 8.2%), binge eating disorder (n = 6; 6.2%), and other specified/unspecified feeding or eating disorder (n = 11; 11.3%). All patients were guided in developing a food exposure hierarchy in which feared foods were gradually introduced into their diets throughout the course of treatment. At admission and discharge, patients completed measures of global ED symptom severity (Eating Disorder Examination-Questionnaire 6.0; Fairburn & Beglin, 2008) as well as fear and avoidance of eating (Fear of Food Measure; Levinson & Byrne, 2015).   


Results: From admission to discharge, patients showed significant reductions in anxiety about eating, t(96) = 3.93, d = .69, food avoidance behaviors, t(96) = 5.52, d = 1.23, and feared concerns related to eating t(96) = 2.95, d = .52 (all p’s < .01). Additionally, patients experienced significant reduction in global ED severity from admission to discharge, t(96) = 3.17, p < .01, d = .62. There was also a marginally significant increase in patients’ body mass index t(96) = 1.88, p = .09, d = .24. Reductions in fear of eating and food avoidance was not associated with ED diagnosis or global ED severity.


Discussion: The present findings add to a growing body of evidence for the effectiveness of exposure-based therapy for eating disorders. In a clinical sample with severe ED concerns, an exposure-based intervention targeting eating-related fear and avoidance yielded significant symptom relief in a relatively short period of time.

Nicholas R. Farrell

Clinical Supervisor
Rogers Memorial Hospital

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