Applying the disgust conditioning model of food avoidance: A case study of acceptance‐based interoceptive exposure

Abstract

Objective The current case report details the treatment of a 16‐year‐old adolescent with anorexia nervosa utilizing a novel adjunct, acceptance‐based interoceptive exposure, prior to family‐based treatment (FBT) for eating disorders. Method The exposure‐based module focused particularly on the tolerance of disgust. For six sessions, the clinician taught the client skills that could be used to tolerate distress to visceral sensations associated with disgust. These skills were to be used during in‐ and between‐session exposures. Each session included exposure to physical sensations that occurred while drinking a milkshake. Results Across six sessions, the client reported improvement in symptoms in addition to gaining weight. Additionally, she consumed more calories of a test meal following the intervention. Within broader FBT, the client reached an established weight goal, was able to return to physical activity, and reported an increased ability to manage distress. Discussion Given the client's improvement on the Eating Disorders Examination‐Questionnaire (EDE‐Q) within six sessions, we believe IE may be a useful adjunct to FBT. Interoceptive exposure may augment the efficacy of FBT for anorexia nervosa as it provides clients with skills to utilize during the refeeding phase of treatment.

Do children with recurrent abdominal pain grow up to become adolescents who control their weight by fasting? Results from a UK population‐based cohort

“…For example, we might want to consider routinely enquiring about childhood RAP in eating disorder assessments, not just those concerning Avoidant and Restrictive Food Intake Disorder (ARFID) (Zucker & Bulik, 2020) and routinely assessing disordered eating in patients with GI disorders (Zucker & Bulik, 2020). Also, our findings suggest that our cognitive‐behavioral interventions for patients with eating disorders might be enriched by incorporating an exposure component that targets patients' anxiety and fear associated with their visceral sensations, and helps them to accept and better tolerate their physiology (Plasencia et al, 2019; Zucker et al, 2019).…”

On bells, saliva, and abdominal pain or discomfort: Early aversive visceral conditioning and vulnerability for anorexia nervosa

“…Intriguingly, colleagues in agriculture may be important consultants, as they are frequently under pressure from environmentalists to develop healthy diets that reduce methane production in livestock (Alemu, Vyas, Manafiazar, Basarab, & Beauchemin, ). Finally, developing interventions that aid individuals in interoceptive re‐mapping may hold promise in helping patients develop more accurate cartography of their internal sensations, their meaning, and their threat (Craske et al, ; Plasencia, Sysko, Fink, & Hildebrandt, ; Zucker et al, ; Zucker et al, ). Finding ways to assist our patients to develop a less adversarial relationship with their own physiology is an important treatment target.…”

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

“…However, taking a fresh perspective on ARFID, which includes many different and varied rationales for food restriction, may open our minds to new ideas for intervention. For example, Zucker et al () present a novel developmentally appropriate interoceptive exposure treatment for a 4‐year‐old boy with ARFID, whereas Placensia, Sysko, Fink, and Hildebrandt () describe acceptance‐based interoceptive exposure for 16‐year‐old girl with AN. Although the cases and specific treatment techniques differ, both approaches appear to target the same underlying mechanism—non‐acceptance of uncomfortable internal sensations—by helping patients learn to tolerate and accept distressing visceral (e.g., fullness) and emotional (e.g., disgust) sensations in order to increase food intake.…”