Fear of food as a treatment target: Exposure and response prevention for anorexia nervosa in an open series
Open accessAbstract
Objective: Anorexia nervosa (AN) is a severe mental illness with high rates of relapse and rehospitalization. New treatment approaches are needed. We aimed to evaluate the potential utility of addressing eating‐related fear in the treatment of AN using psychotherapy techniques known to be effective in the treatment of anxiety disorders and obsessive compulsive disorder, namely exposure therapy and response prevention. Method: We developed a brief treatment intervention for AN (AN‐EXRP) and evaluated its effects in an open series of nine individuals with AN towards the end of acute weight restoration. We focused on eating behavior as the primary outcome, as it is related both to anxiety and to longer term course. Results: Change in anxiety with AN‐EXRP was associated with greater caloric intake. Discussion: These findings support the anxiety‐centered model of AN and suggest the potential utility of further developing this treatment approach. © 2011 by Wiley Periodicals, Inc. (Int J Eat Disord 2012)
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The current findings add to prior research by showing the potential and success of exposure therapy in the treatment of anorectic fears.
“On the other hand, the current findings add to prior research by showing the potential and success of exposure therapy in the treatment of anorectic fears (e.g. [26, 37, 39, 41–43, 64, 66].”
From Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa (2024) · cites this paper as [42]
The Discussion reports that changes in anxiety during exposure and response prevention were associated with later food intake, supporting the approach’s potential. It also says intake did not significantly change, anxiety reductions were not statistically significant, and exposure could not be identified as the agent of change. This open series therefore does not establish treatment success. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe increase in calorie intake in the present study was larger than in other studies.
“and the increase in calorie intake in the present study was larger than in other studies [41, 42].”
From Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa (2024) · cites this paper as [42]
The Results (Caloric Intake) report a small increase in laboratory-meal intake, from 429 to 434 kcal, while the Discussion says there was no significant change in intake. This provides a comparison value for one cited study, but our copy cannot establish whether the citing paper’s increase was larger. (LLM, conf=0.82)
Experimental — accuracy not yet measuredExposure therapy can also be relevant in the treatment of fears seen in anorexia nervosa.
“Its effectiveness is primarily known from the treatment of anxiety disorders, but an emerging line of research shows that it can also be relevant in the treatment of fears seen in anorexia nervosa (e.g. [16, 25, 35–43].”
From Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa (2024) · cites this paper as [42]
The finding that anxiety is highest before the breakfast begins, followed by a drop in fear, supports previous suggestions to specifically focus on pre-meal anxiety when treating eating related fears.
“Finding that anxiety is highest before the breakfast begins, which is followed by a drop in fear, for instance, supports previous suggestions to specifically focus on pre-meal anxiety when treating eating related fears [37, 39, 42].”
From Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa (2024) · cites this paper as [42]
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Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Diagnostic and Statistical Manual of Mental Disorders.
Widiger, T. A. (2000) · Oxford University Press eBooks · doi:10.1037/10518-009 · Cited by 19,767 · see citing works
The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication
Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007) · Biological Psychiatry · doi:10.1016/j.biopsych.2006.03.040 · Cited by 4,973 · see citing works
The outcome of anorexia nervosa in the 20th century
Steinhausen, H.-C. (2002) · American Journal of Psychiatry · doi:10.1176/appi.ajp.159.8.1284 · Cited by 1,761 · see citing works
(2008) · Cited by 1,397 · see citing works
Comorbidity of Anxiety Disorders With Anorexia and Bulimia Nervosa
Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., Masters, K., & the Price Foundation Collaborative Group (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.12.2215 · Cited by 1,162 · see citing works
Cognitive Behavior Therapy and Eating Disorders
Mitchell, J. E. (2009) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.09bk05121 · Cited by 886 · see citing works
Abnormal Psychology: An Integrative Approach
Barlow, D. H., & Durand, V. M. (1994) · Medical Entomology and Zoology · Cited by 615 · see citing works
Eysenck, H. J. (1968) · Psychosomatic Medicine · doi:10.1097/00006842-196801000-00025 · Cited by 572 · see citing works
Frank, J. D. (1967) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-196708000-00013 · Cited by 552 · see citing works
Comorbidity of Psychiatric Diagnoses in Anorexia Nervosa
Halmi, K. A. (1991) · Archives of General Psychiatry · doi:10.1001/archpsyc.1991.01810320036006 · Cited by 509 · see citing works
Ten-year follow-up of anorexia nervosa: clinical course and outcome
Eckert, E. D., Halmi, K. A., Marchi, P., Grove, W. M., & Crosby, R. D. (1995) · Psychological Medicine · doi:10.1017/s0033291700028166 · Cited by 394 · see citing works
Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa
Pike, K. M., Walsh, B. T., Vitousek, K., Wilson, G. T., & Bauer, J. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.11.2046 · Cited by 373 · see citing works
Eating disorders and antecedent anxiety disorders: a controlled study
Bulik, C. M., Sullivan, P. F., Fear, J. L., & Joyce, P. R. (1997) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1997.tb09913.x · Cited by 353 · see citing works
Does Fluoxetine Augment the Inpatient Treatment of Anorexia Nervosa?
Attia, E., Haiman, C., Walsh, B. T., & Flater, S. R. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.4.548 · Cited by 323 · see citing works
Self-citationLiberman, R. P. (1982) · Schizophrenia Bulletin · doi:10.1093/schbul/8.1.62 · Cited by 300 · see citing works
Cognitive-behavioral treatment of bulimia nervosa: A controlled evaluation
Wilson, G. T., Rossiter, E. M., Kleifield, E. I., & Lindholm, L. (1986) · Behaviour Research and Therapy · doi:10.1016/0005-7967(86)90187-7 · Cited by 202 · see citing works
Exposure plus response-prevention treatment of bulimia nervosa.
Leitenberg, H., Rosen, J. C., Gross, J., Nudelman, S., & Vara, L. S. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.4.535 · Cited by 189 · see citing works
Patton, G. (1988) · Psychological Medicine · doi:10.1017/s0033291700009879 · Cited by 186 · see citing works
Treatment of patients with eating disorders,third edition. American Psychiatric Association.
(2006) · PubMed · Cited by 185 · see citing works
Should amenorrhea be a diagnostic criterion for anorexia nervosa?
Attia, E., & Roberto, C. A. (2009) · International Journal of Eating Disorders · doi:10.1002/eat.20720 · Cited by 180 · see citing works
Self-citationLong-Term Mortality in Anorexia Nervosa
Crisp, A. H., Callender, J. S., Halek, C., & Hsu, L. K. G. (1992) · The British Journal of Psychiatry · doi:10.1192/bjp.161.1.104 · Cited by 179 · see citing works
Assessment of social phobia: Reliability of an impromptu speech task
Beidel, D. C., Turner, S. M., Jacob, R. G., & Cooley, M. R. (1989) · Journal of Anxiety Disorders · doi:10.1016/0887-6185(89)90009-1 · Cited by 175 · see citing works
Post-treatment effects of exposure therapy and clomipramine in obsessive–compulsive disorder
Simpson, H. B., Liebowitz, M. R., Foa, E. B., Kozak, M. J., Schmidt, A. B., Rowan, V., Petkova, E., Kjernisted, K., Huppert, J. D., Franklin, M. E., et al. (2004) · Depression and Anxiety · doi:10.1002/da.20003 · Cited by 161 · see citing works
Self-citationBulik, C. M., Sullivan, P. F., Carter, F. A., McIntosh, V. V. W., & Joyce, P. R. (1998) · Psychological Medicine · doi:10.1017/s0033291798006618 · Cited by 158 · see citing works
Pre-meal anxiety and food intake in anorexia nervosa
Steinglass, J. E., Sysko, R., Mayer, L., Berner, L. A., Schebendach, J., Wang, Y., Chen, H., Albano, A. M., Simpson, H. B., & Walsh, B. T. (2010) · Appetite · doi:10.1016/j.appet.2010.05.090 · Cited by 153 · see citing works
Self-citationBehavioral Management for Anorexia Nervosa
Attia, E., & Walsh, B. T. (2009) · New England Journal of Medicine · doi:10.1056/nejmct0805569 · Cited by 149 · see citing works
Self-citationSteinglass, J. E., Sysko, R., Glasofer, D., Albano, A. M., Simpson, H. B., & Walsh, B. T. (2011) · International Journal of Eating Disorders · doi:10.1002/eat.20784 · Cited by 145 · see citing works
Self-citationThe Yale-Brown-Cornell eating disorder scale: A new scale to assess eating disorder symptomatology
Sunday, S. R., Halmi, K. A., & Einhorn, A. M. (1995) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199511)18:3 · Cited by 138 · see citing works
Dietary energy density and diet variety as predictors of outcome in anorexia nervosa
Schebendach, J., Mayer, L., Devlin, M. J., Attia, E., Contento, I. R., Wolf, R. L., & Walsh, B. T. (2008) · American Journal of Clinical Nutrition · doi:10.1093/ajcn/87.4.810 · Cited by 129 · see citing works
Self-citationInfluence of overanxious disorder of childhood on the expression of anorexia nervosa
Raney, T. J., Thornton, L. M., Berrettini, W., Brandt, H., Crawford, S., Fichter, M. M., Halmi, K. A., Johnson, C., Kaplan, A. S., LaVia, M., et al. (2008) · International Journal of Eating Disorders · doi:10.1002/eat.20508 · Cited by 97 · see citing works
An integrative quantitative model of factors influencing the course of anorexia nervosa over time
Yackobovitch‐Gavan, M., Golan, M., Valevski, A., Kreitler, S., Bachar, E., Lieblich, A., Mitrani, E., Weizman, A., & Stein, D. J. (2008) · International Journal of Eating Disorders · doi:10.1002/eat.20624 · Cited by 88 · see citing works
What potential role is there for medication treatment in anorexia nervosa?
Crow, S. J., Mitchell, J. E., Roerig, J. L., & Steffen, K. J. (2008) · International Journal of Eating Disorders · doi:10.1002/eat.20576 · Cited by 84 · see citing works
Cognitive-behavioral group psychotherapy of bulimia nervosa: Importance of logistical variables
Mitchell, J. E., Pyle, R. L., Eckert, E. D., Zollman, M., Crosby, R. D., Zimmerman, R., Pomeroy, C., & Seim, H. C. (1993) · International Journal of Eating Disorders · doi:10.1002/1098-108x(199311)14:3 · Cited by 82 · see citing works
Mortality in anorexia nervosa in Denmark during the period 1970‐1987
Møller‐Madsen, S., Nystrup, J., & Nielsen, S. L. (1996) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1996.tb09890.x · Cited by 69 · see citing works
Adolescent anorexia nervosa treated by desensitization
Hallsten, E. A. (1965) · Behaviour Research and Therapy · doi:10.1016/0005-7967(65)90011-2 · Cited by 66 · see citing works
STEINGLASS, J., SYSKO, R., SCHEBENDACH, J., BROFT, A., STROBER, M., & WALSH, B. T. (2007) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000281484.89075.a8 · Cited by 56 · cited 1× · see citing works
“In a preliminary study of the use of exposure (without response prevention) we found that repeated exposure to feared eating situation can increase intake in the laboratory setting (36).”
BackgroundSelf-citationCognitive-Behavioral Therapy for Social Phobia in Adolescents: Therapist Guide
Albano, A. M., & DiBartolo, P. M. (2007) · Oxford University Press eBooks · doi:10.1093/med:psych/9780195307764.001.0001 · Cited by 36 · see citing works
Self-citationCognitive-Behavioral Therapy for Social Phobia in Adolescents: Stand Up, Speak Out Therapist Guide
Albano, A. M., & DiBartolo, P. M. (2007) · Medical Entomology and Zoology · Cited by 27 · see citing works
Self-citation‘Personality’ and Anorexia Nervosa – the Phobic Avoidance Stance
Crisp, A. H., & Bhat, A. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000287626 · Cited by 24 · see citing works
The use of exposure with response prevention in a male anorexic
Boutelle, K. N. (1998) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/s0005-7916(97)00041-4 · Cited by 18 · see citing works
Goldfarb, L. A., Fuhr, R., Tsujimoto, R. N., & Fischman, S. E. (1987) · Psychological Reports · doi:10.2466/pr0.1987.60.2.511 · Cited by 18 · see citing works
Fluoxetine After Weight Restoration in Anorexia Nervosa: A Randomized Controlled Trial
Walsh, B. T., Kaplan, A. S., Attia, E., Olmsted, M., Parides, M., Carter, J. C., Pike, K. M., Devlin, M. J., Woodside, B., Roberto, C. A., et al. (2006) · JAMA · doi:10.1001/jama.295.22.2605 · Cited by 13 · see citing works
Self-citationHandbook of behavioral assessment
Rowland, L. (1988) · Behaviour Research and Therapy · doi:10.1016/0005-7967(88)90024-1 · Cited by 4 · see citing works
Mussell (1997) · doi:10.1002/(sici)1098-108x(1997)21:4
Flagged first, then by citations
Research works printed but not linked: 2
- [28]Kozak MJ Foa EB Mastery of Obsessive-Compulsive Disorder 1997 Oxford University Press New York
- [30]MetropolitanLifeInsurance New weight standards for men and women Statistical Bulletin 1959 40 1 4
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Khalsa, S. S., & Lapidus, R. C. (2016) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2016.00121 · Cited by 366 · see citing works
Wierenga, C. E., Ely, A., Bischoff-Grethe, A., Bailer, U. F., Simmons, A. N., & Kaye, W. H. (2014) · Frontiers in Behavioral Neuroscience · doi:10.3389/fnbeh.2014.00410 · Cited by 195 · see citing works
Steinglass, J. E., Albano, A. M., Simpson, H. B., Wang, Y., Zou, J., Attia, E., & Walsh, B. T. (2014) · International Journal of Eating Disorders · doi:10.1002/eat.22214 · Cited by 158 · see citing works
Self-citationPsychological treatments for eating disorders
Kass, A. E., Kolko, R. P., & Wilfley, D. E. (2013) · Current Opinion in Psychiatry · doi:10.1097/yco.0b013e328365a30e · Cited by 152 · see citing works
Exposure therapy for eating disorders: A systematic review
Butler, R. M., & Heimberg, R. G. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101851 · Cited by 143 · see citing works
Schaumberg, K., Reilly, E. E., Gorrell, S., Levinson, C. A., Farrell, N. R., Brown, T. A., Smith, K. M., Schaefer, L. M., Essayli, J. H., Haynos, A. F., et al. (2021) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101952 · Cited by 121 · see citing works
Exposure therapy in eating disorders revisited
Koskina, A., Campbell, I. C., & Schmidt, U. (2013) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2012.11.010 · Cited by 127 · see citing works
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Treasure, J., Cardi, V., Leppanen, J., & Turton, R. (2015) · Physiology & Behavior · doi:10.1016/j.physbeh.2015.06.007 · Cited by 91 · see citing works
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Levinson, C. A., & Williams, B. M. (2020) · International Journal of Eating Disorders · doi:10.1002/eat.23382 · Cited by 83 · see citing works
Intolerance of uncertainty in eating disorders: an update on the field
Kesby, A., Maguire, S., Brownlow, R., & Grisham, J. R. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.07.002 · Cited by 83 · see citing works
Hildebrandt, T., Grotzinger, A., Reddan, M., Greif, R., Levy, I., Goodman, W., & Schiller, D. (2015) · Behaviour Research and Therapy · doi:10.1016/j.brat.2015.06.008 · Cited by 82 · see citing works
Levinson, C. A., Vanzhula, I. A., & Christian, C. (2019) · Eating Behaviors · doi:10.1016/j.eatbeh.2019.101320 · Cited by 63 · see citing works
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“This could particularly identify the fear experienced immediately before food consumption as an important point in time and relevant treat-ment target for exposure therapy [37, 39, 42].”
BackgroundResultLevinson, C. A., Christian, C., & Vanzhula, I. A. (2020) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-019-00751-3 · Cited by 3 · see citing works
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- Authors
- Steinglass, J., Albano, A. M., Simpson, H. B., Carpenter, K., Schebendach, J., & Attia, E.
- Affiliations
- Columbia University Irving Medical Center (US)
- Corresponding author
- Steinglass, Joanna
- ORCID
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2011-05-03
- Volume
- 45
- Issue
- 4
- Pages
- 615-621
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- PMC
- PMC3151474
- OpenAlex
- W2103766757
- Cited by
- 119
- References
- 45
- Citations by year
- 2026: 5 · 2025: 8 · 2024: 8 · 2023: 9 · 2022: 6 · 2021: 8 · 2020: 11 · 2019: 10 · 2018: 4 · 2017: 6 · 2016: 5 · 2015: 10 · 2014: 11 · 2013: 14 · 2012: 2
- FWCI
- 9.99
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Eli Lilly and Company
- Klarman Family Foundation
- National Alliance for Research on Schizophrenia and Depression
- University of Oxford
- National Institute of Mental Health (R01 MH08273602, K24MH091555, K23MH076195, R01MH082736)
- Janssen Pharmaceuticals
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- anorexia nervosa, fear of food, exposure and response prevention, dietary habits, energy intake, weight restoration
- MeSH terms
- Adolescent, Adult, Anorexia Nervosa, Anxiety, Fear, Feeding Behavior, Female, Humans, Implosive Therapy, Pilot Projects, Treatment Outcome, Self Report
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