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An Exploratory Study of Neural Response to Food Cues Following Cognitive-Behavioral Therapy for Avoidant/Restrictive
Kendra R Becker1,2,3, Haley Graver1,3, Avery L Van De Water3,4,5
1Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.
The International Journal of Eating Disorders
|March 10, 2026
Summary
Cognitive-behavioral therapy for avoidant/restrictive food intake disorder (ARFID) may work by reducing salience network hyperactivity. Specifically, right anterior cingulate cortex (ACC) activation decreased after treatment.
Area of Science:
- Neuroscience
- Psychiatry
- Pediatric Psychology
Background:
- Avoidant/restrictive food intake disorder (ARFID) is a condition characterized by limited food intake.
- Cognitive-behavioral therapy for ARFID (CBT-AR) shows promise, but its neural mechanisms are not well understood.
- Previous research indicates heightened salience network (SN) activity in response to food among individuals with ARFID.
Purpose of the Study:
- To investigate the neural mechanisms underlying CBT-AR.
- To test if pre-treatment SN activation predicts treatment response in youth with ARFID.
- To examine changes in SN activation from pre- to post-treatment in ARFID.
Main Methods:
- Functional magnetic resonance imaging (fMRI) was used to measure brain activity in youth with ARFID.
- Participants viewed food and non-food images in a fasted state before and after treatment.
- Twenty-four youth with ARFID underwent pre-treatment fMRI scans, with 14 completing post-treatment scans.
Main Results:
- Pre-treatment SN activation did not correlate with ARFID symptom reduction or remission.
- A significant decrease in right anterior cingulate cortex (ACC) hyperactivation was observed from pre- to post-treatment.
- This reduction in ACC activity was associated with a large effect size (d=1.1).
Conclusions:
- Changes in SN neural activity, particularly in the ACC, may be a mechanism through which CBT-AR benefits individuals with ARFID.
- These pilot findings suggest that CBT-AR may modulate brain regions involved in salience processing.
- Further research, including randomized controlled trials, is needed to confirm these results.
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