Confronting fear using exposure and response prevention for anorexia nervosa: A randomized controlled pilot study

Area of Science:

• Clinical Psychology
• Psychiatry
• Eating Disorders Research

Background:

• Anorexia nervosa (AN) is a severe psychiatric disorder characterized by significant relapse rates.
• Maladaptive eating behaviors and eating-related anxiety are core features of AN, complicating weight restoration and relapse prevention.
• Exposure and Response Prevention for AN (AN-EXRP) is a novel therapeutic approach designed to directly address these specific behavioral and emotional challenges.

Purpose of the Study:

• To evaluate the efficacy of AN-EXRP as an adjunctive treatment during the weight restoration phase in patients with AN.
• To determine if AN-EXRP can improve eating behaviors, specifically caloric intake, at a critical juncture for shifting treatment focus to relapse prevention.
• To compare the effects of AN-EXRP with Cognitive Remediation Therapy (CRT) on eating behavior.

Main Methods:

• A randomized controlled trial was conducted with 32 hospitalized patients diagnosed with AN.
• Participants had achieved a BMI > 18.5 kg/m² and received 12 sessions of either AN-EXRP or CRT.
• Eating behavior was objectively assessed by measuring caloric intake during a standardized test meal before and after the intervention period.

Main Results:

• Participants receiving AN-EXRP showed an increase in average test meal caloric intake from 352 kcal to 401 kcal post-treatment.
• In contrast, participants receiving CRT experienced a decrease in average caloric intake from 501 kcal to 424 kcal.
• The improvement in caloric intake in the AN-EXRP group was significantly associated with a reduction in eating-related anxiety (Spearman's ρ = 0.40, p = 0.03).

Conclusions:

• AN-EXRP demonstrated superior outcomes in improving caloric intake during a laboratory meal compared to CRT in patients with AN undergoing weight restoration.
• The findings suggest that AN-EXRP is a promising adjunctive strategy for enhancing eating behavior and potentially reducing anxiety associated with eating.
• Further research is warranted to investigate the long-term efficacy and clinical significance of integrating AN-EXRP into comprehensive treatment programs for AN.