A new cognitive behavior therapy for adolescents with avoidant/restrictive food intake disorder in a day treatment setting: A clinical case series

Abstract

Objective Avoidant/restrictive food intake disorder (ARFID) is a new diagnosis in the DSM‐5 Feeding and Eating Disorders section, for which very limited treatment research has been carried out, yet. A new, 4‐week exposure based cognitive behavioral therapy (CBT) day treatment, which integrated the inhibitory learning principles, was developed for adolescents with ARFID, and tested in the current study. Method A nonconcurrent multiple baseline design was used in a clinical case series of eleven 10‐ to 18‐year‐old patients. After baseline, the 4‐week CBT followed. Measurements of DSM‐5 ARFID diagnosis, food neophobia and related measures such as body weight and length, were taken at baseline (t1), at the end of the 4‐week intensive day treatment (t2) and 3 months after treatment (follow‐up, t3). A food selectivity test, a 1‐week food diary, and behavioral measures on food intake were also taken at baseline and at 3‐month follow‐up. Furthermore, continuous measurements of believability of dysfunctional cognitions, anxiety, and food acceptance were taken throughout the 4‐weeks day treatment. Results At follow‐up, 10 out of 11 patients were in remission and had a healthy body weight and an average, age‐adequate nutritional intake. For most patients, food neophobia scores decreased to a nonclinical range. The belief in dysfunctional cognitions and anxiety levels decreased during treatment. Discussion This new exposure‐based CBT for adolescents with ARFID seems promising. These results may be very useful for clinical practice and stimulate further development of effective CBT interventions in the area of ARFID.

Cognitive‐behavioral therapy for avoidant/restrictive food intake disorder: Feasibility, acceptability, and proof‐of‐concept for children and adolescents

“…Only three small randomized controlled trials have been published, and all have focused on young children ages 13 months to 12 years (Lock et al, 2019a; Sharp et al, 2016; Sharp et al, 2017). Published research on the treatment of older children and adolescents is limited to retrospective chart reviews (Bryson, Scipioni, Essayli, Mahoney, & Ornstein, 2018; Makhzoumi et al, 2019), case studies (Thomas, Brigham, Sally, Hazen, & Eddy, 2017), and case series (Dumont, Jansen, Kroes, de Haan, & Mulkens, 2019; Rienecke, Drayton, Richmond, & Mammel, 2020). A growing number of reports have highlighted the potential application of cognitive‐behavioral (Görmez, Kılıç, & Kırpınar, 2018; Steen & Wade, 2018; Zucker et al, 2019), family‐based (Eckhardt, Martell, Lowe, Le Grange, & Ehrenreich‐May, 2019; Lock et al, 2019; Rienecke et al, 2020; Spettigue, Norris, Santos, & Obeid, 2018), and parent‐management (Dahlsgaard & Bodie, 2019) approaches.…”

Avoidant Restrictive Food Intake Disorder—More Than Just Picky Eating: A Case Discussion and Literature Review

“…Options for psychotherapy include patient-specific options, such as applied behavior analysis (ABA), cognitive behavioral therapy (CBT), and exposure therapy, as well as family-based treatment (FBT) and therapy for the caregivers of someone with ARFID. [23][24][25][26][27][28][29] These therapies can be implemented on an inpatient or outpatient basis. Teleconsultation, which could be used by various members of the feeding clinic team, including nurse practitioners (NPs), dietitians, speech therapists, and psychologists, has also been suggested for those who may find it difficult to make frequent inperson visits.…”

“…24 CBT is especially beneficial in assisting patients to cope with their anxiety and has been found to be successful in patients with ARFID and would be conducted by a psychologist. 25 Exposure therapy includes having the patient try novel or nonpreferred foods over time and has been shown to be successful in various studies. [23][24][25][26][27][28][29] Family Therapy: In conjunction with individual therapy, FBT conducted by a psychologist has also been found to be beneficial.…”

Introduction to a special issue on child and adolescent feeding and eating disorders and avoidant/restrictive food intake disorder

“…For example, Lock et al () describe the application of family based treatment (FBT) to three children with ARFID, illustrating how FBT can be tailored to fit each patient's unique presentation (e.g., sensory sensitivity, fear of aversive consequences, lack of interest in eating, or food). In contrast, Dumont, Jansen, Kroes, Haan, and Mulkens () describe the use of exposure‐based cognitive–behavioral therapy in a partial hospital program for adolescents with ARFID, highlighting how the violation of expectations through exposure may be a key mechanism of change.…”