Expanding exposure‐based interventions for eating disorders

Abstract

Initial trials evaluating exposure-based interventions for eating disorders (EDs) in the 1980s demonstrated mixed results. Since that time, innovations in exposure therapy for anxiety disorders have yielded insights that can be used to refine and expand the approach to effectively target ED behaviors. This article provides a brief summary of relevant advances in exposure therapy for anxiety and outlines how these advances may be adapted and evaluated for use with ED samples. More specifically, we propose shifting to an inhibitory learning framework, considering treatment targets other than fear, and increasing variability in exposure techniques represent three important areas for future study. Overall, this article aims to provide professionals in the field with a framework for how to incorporate cutting-edge advances in exposure therapy into rigorous intervention research for EDs.

Core psychopathology in anorexia nervosa and bulimia nervosa: A network analysis

“…The current findings point to the importance of considering shape and weight overvaluation as a primary ED treatment target, which is a key component of many cognitive–behavioral ED treatments (e.g., Fairburn, ; National Institute for Health and Care Excellence, ). Mitigating shape and weight overvaluation may be accomplished through a combination of techniques, such as cognitive reframing (e.g., identifying evidence supporting and negating beliefs about one's body), behavioral experiments (e.g., comparing one's body shape or weight to every fifth person who appears to be a similar age and gender), and exposures to situations that violate expectancies (e.g., open weighing where patients can observe objective trends; Fairburn, ; Reilly, Anderson, Gorrell, Schaumberg, & Anderson, ). Examining whether shape and weight overvaluation interventions decrease network connectivity and lead to reduced ED symptoms is an important endeavor for the ED field and a key test of the network theory of psychopathology (Borsboom & Cramer, ).…”

“…indicators of shape and weight concerns are differentially associated with ED and comorbid symptoms (Lydecker, White, & Grilo, 2017 ;Fairburn, 2008;Reilly, Anderson, Gorrell, Schaumberg, & Anderson, 2017). Examining whether shape and weight overvaluation interventions decrease network connectivity and lead to reduced ED symptoms is an important endeavor for the ED field and a key test of the network theory of psychopathology (Borsboom & Cramer, 2013).…”

The lived experience of working with people with eating disorders: A meta‐ethnography

“…Eating disorders (EDs) have a reputation for being challenging to treat (Startup, Mountford, Lavender, & Schmidt, ) in the context of high levels of risk, relapse, and resistance (Jansen, ; Reilly, Anderson, Gorrell, Schaumberg, & Anderson, ; Zaitsoff, Pullmer, Cyr, & Aime, ). Anorexia nervosa (AN) and bulimia nervosa (BN) are associated with many medical complications, some of which can be fatal (Westmoreland, Krantz, & Mehler, ), which means that healthcare professionals (HCPs) working with this client group are required to manage high levels of physical and psychiatric risk concurrently (Le, Barendregt, Hay, & Mihalopoulos, ).…”

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

“…Under the inhibitory framework, structuring exposure exercises to maximize the discrepancy between the patient's expected outcome and the actual outcome, the variability in the level of fear, and the number of cues targeted and contexts in which learning is practiced, will best facilitate corrective learning and decrease chances of retrieval of the original association (Craske et al, 2014). In a similar vein, Reilly, Anderson, Gorrell, Schaumberg, and Anderson (2017), suggested expanding exposure-based interventions for eating disorders (EDs) specifically. The importance of expectancy violation during exposure was already demonstrated in adolescent and adult overeating disorders (Schyns, Roefs, Mulkens, & Jansen, 2016;Schyns, Roefs, Smulders, & Jansen, 2018).…”