Examining Within-Session and Between-Session Change in Exposure-Meal-Related Distress During Intensive Outpatient...

There has been increasing theoretical interest in adapting exposure therapy for eating disorders (EDs), and preliminary data tentatively support the utility of meal-based exposures for targeting eating-related distress. Drawing upon existing work examining habituation processes and theories of inhibitory learning in anxiety disorders, we evaluated patterns of between- and within-session change in subjective units of distress (SUDS) during meal exposures in a mixed diagnostic sample of individuals enrolled in an intensive outpatient program for EDs. Participants (N = 178) who were enrolled in an intensive outpatient program completed SUDS at regular intervals during exposure meals over the course of treatment, M(SD)_{TreatmentDuration} = 13.67(10.27) weeks. Results from multilevel models suggested significant between-session decreases in SUDS; no significant changes in within-session SUDS occurred over the course of treatment. Models examining associations between average self-reported eating disorder symptoms and global functioning and SUDS trajectories indicated that individuals with higher global functioning reported slightly lower within-session decreases in SUDS compared with those with lower global functioning. Overall, results provide an initial descriptive examination of habituation processes associated with the use of meal-based exposures for EDs and contribute to a growing body of evidence suggesting benefits of adapting exposure-based intervention approaches for EDs.