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Inside Exposure: Tracking Fear and Threat Expectancy Dynamics Within and Between Exposure Sessions for Anorexia
Hanna Melles1, Michelle Spix1, Stefanie Duijvis1
1Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, MD, the Netherlands.
The International Journal of Eating Disorders
|March 25, 2026
Summary
Exposure therapy effectively reduces fear and threat expectancies in anorexia nervosa treatment. This approach helps break avoidance cycles, promoting patient recovery by challenging individual fears.
Area of Science:
- Clinical Psychology
- Psychotherapy Research
- Eating Disorders
Background:
- Anxiety and avoidance are central to anorexia nervosa.
- Exposure therapy, based on inhibitory learning, targets these by violating threat expectancies.
Purpose of the Study:
- Investigate fear and threat expectancy dynamics during exposure therapy for anorexia nervosa.
- Examine within- and between-session changes and the impact of exposure focus (eating vs. body).
Main Methods:
- Analyzed 2895 data points from 417 individualized exposure sessions.
- Utilized linear mixed models to assess changes in threat expectancies and fear levels.
Main Results:
- Significant reductions in threat expectancies and fear occurred within sessions and across multiple sessions.
- Body-related exposures initially evoked stronger fears but yielded similar outcomes to eating-related exposures.
Conclusions:
- Threat expectancy change is a probable mechanism driving therapeutic progress in anorexia nervosa.
- Exposure therapy is a valuable tool for overcoming avoidance and fostering recovery in anorexia nervosa.
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