Confronting fear using exposure and response prevention for anorexia nervosa: A randomized controlled pilot study.
OBJECTIVE
Anorexia nervosa (AN) is a severe illness with high rates of relapse. Exposure and Response Prevention for AN (AN-EXRP) is a new approach that specifically addresses maladaptive eating behavior by targeting eating-related fear and anxiety. The aim of this study was to evaluate AN-EXRP as an adjunctive strategy to improve eating behavior during weight restoration, at a pivotal moment when treatment goals shift toward relapse prevention.


METHODS
A randomized controlled trial was conducted to compare AN-EXRP with a comparison condition, Cognitive Remediation Therapy (CRT). Hospitalized patients with AN (n = 32) who had achieved weight restoration to a BMI > 18.5 kg/m(2) received 12 sessions of either AN-EXRP or CRT. Outcome was assessed by change in caloric intake in an objective assessment of eating behavior.


RESULTS
The average test meal caloric intake of participants who received AN-EXRP increased from 352 ± 263 kcal at baseline to 401 ± 215 kcal post-treatment, while that of participants who received CRT decreased from 501 ± 232 kcal at baseline to 424 ± 221 kcal post-treatment [t(28) = 2.5, p = .02]. Improvement in intake was significantly associated with improvement in eating-related anxiety (Spearman's ρ = 0.40, p = .03).


CONCLUSIONS
These data demonstrate that AN-EXRP, compared to a credible comparison intervention, is associated with better caloric intake in a laboratory meal over time in AN. Additional studies are required to determine whether incorporation of these techniques into a longer treatment program leads to enduring and clinically significant change.
Columbia University, 622 West 168th Street, New York, New York; New York State Psychiatric Institute, 1051 Riverside Drive, New York, New York.
Joanna E
JE
Steinglass
Anne Marie
AM
Albano
H Blair
HB
Simpson
Yuanjia
Y
Wang
Jingjing
J
Zou
Evelyn
E
Attia
B Timothy
BT
Walsh
D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy*; D001007:Anxiety / Q000150:complications; D001835:Body Weight; D015928:Cognitive Behavioral Therapy; D002149:Energy Intake; D005239:Fear; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D010865:Pilot Projects; D012107:Research Design
anorexia nervosa; anxiety; cognitive behavior therapy; controlled trial; eating disorders; exposure and response prevention; exposure therapy; psychotherapy; randomized trial; treatment