title: D-Cycloserine facilitation of exposure therapy improves weight regain in patients with anorexia nervosa: a pilot randomized controlled trial.
abstract: OBJECTIVE
  Exposure therapy in anorexia nervosa has preliminarily been shown to be effective for increasing food intake. D-Cycloserine is a glutamatergic N-methyl-d-aspartate receptor agonist that has been shown to facilitate the benefits of exposure therapy for anxiety disorders by enhancing the emotional learning in the exposures; therefore, we examined D-cycloserine-facilitation of exposure therapy to increase body mass index (BMI) in patients with anorexia nervosa.
  
  
  METHODS
  Participants (N = 36) with anorexia nervosa (diagnosed via DSM-IV) were recruited from a partial hospitalization eating disorder clinic between February 2013 and November 2013. Participants were randomly assigned to receive exposure therapy plus D-cycloserine (n = 20) or placebo (n = 16). Participants completed psychoeducation and 4 sessions of exposure therapy, with medication (D-cycloserine vs placebo) given prior to the first 3 exposure sessions. They also completed a 1-month follow-up.
  
  
  RESULTS
  As hypothesized, participants in the D-cycloserine group showed a significantly greater increase in BMI than those in the placebo group (Wilk Λ = 0.86, F3,32 = 2.20, P = .043, ηp(2) = 0.12). D-Cycloserine participants gained 3 pounds relative to 0.5 pounds in the placebo group. Both groups experienced significantly decreased anxiety over the course of therapy (Wilk Λ = 0.80, F3,32 = 3.32, P = .023, ηp(2) = 0.20).
  
  
  CONCLUSIONS
  This study preliminarily demonstrates that D-cycloserine facilitates exposure therapy for anorexia nervosa, leading to increased weight gain. A potential mechanism is that participants who receive D-cycloserine may generalize learning from within-session exposures to food intake during other similar meals, resulting in sustained increases in BMI. Further research is needed to confirm these findings and test the putative mechanism that generalized learning from exposure therapy can increase BMI and stabilize a healthy weight.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01996644.
authors.affiliation: Department of Psychology, Washington University in St Louis, St Louis, Missouri cherialevinson@wustl.edu.
authors.forename: Cheri A
authors.initials: CA
authors.lastname: Levinson
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Rodebaugh
authors.forename: Laura
authors.initials: L
authors.lastname: Fewell
authors.forename: Andrea E
authors.initials: AE
authors.lastname: Kass
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Riley
authors.forename: Lynn
authors.initials: L
authors.lastname: Stark
authors.forename: Kimberly
authors.initials: K
authors.lastname: McCallum
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Lenze
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000188:drug therapy / Q000628:therapy*; D015992:Body Mass Index; D003131:Combined Modality Therapy; D003523:Cycloserine / Q000627:therapeutic use*; D004311:Double-Blind Method; D018690:Excitatory Amino Acid Agonists / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007171:Implosive Therapy; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D015430:Weight Gain / Q000187:drug effects*; D055815:Young Adult
chemical_list: D018690:Excitatory Amino Acid Agonists; D003523:Cycloserine