Fear of food as a treatment target: exposure and response prevention for anorexia nervosa in an open series

Abstract

Objective: Anorexia nervosa (AN) is a severe mental illness with high rates of relapse and rehospitalization. New treatment approaches are needed. We aimed to evaluate the potential utility of addressing eating-related fear in the treatment of AN using psychotherapy techniques known to be effective in the treatment of anxiety disorders and obsessive compulsive disorder, namely exposure therapy and response prevention.

Method: We developed a brief treatment intervention for AN (AN-EXRP) and evaluated its effects in an open series of nine individuals with AN towards the end of acute weight restoration. We focused on eating behavior as the primary outcome, as it is related both to anxiety and to longer term course.

Results: Change in anxiety with AN-EXRP was associated with greater caloric intake.

Discussion: These findings support the anxiety-centered model of AN and suggest the potential utility of further developing this treatment approach.

Figure 1. Intake and change in anxiety

Caloric intake in the post-AN-EXRP laboratory meal was significantly associated with change in anxiety. Decrease in (A) pre-meal Spielberger State Anxiety Inventory (STAIS), (B) mean Subjective Units of Distress SUDS) during the test meal, (C) Food Fear and Anxiety Hierarchy (FAH) were each significantly associated with increased intake in the post-treatment meal.