Confronting fear using exposure and response prevention for anorexia nervosa: A randomized controlled pilot study
Open accessAbstract
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. Method: 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). Discussion: 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. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:174–180)
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The 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 [41]
The Results (Outcome; page not provided) report a 49-kcal increase in test-meal intake for the AN-EXRP group, supporting this paper as an example of another study with an increase. This source does not report the citing study’s increase, so it cannot establish that the citing study’s increase was larger. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe 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 [41]
The Discussion reports that the exposure-based intervention improved test-meal intake relative to the control group and suggests potential utility for treatment focused on anxiety and eating behavior. But the Results (Outcome > Anxiety) found no statistically significant difference between groups in anxiety change, so this pilot does not establish success in reducing anorectic fears themselves. (LLM, conf=0.84)
Experimental — accuracy not yet measuredCBT may be a promising treatment for anorexia nervosa.
“CBT may be a promising treatment (Calugi et al., 2017; Dalle Grave et al., 2016; Steinglass et al., 2014).”
From Feasibility of guided internet-based cognitive behavioral therapy for patients with anorexia nervosa (2022) · cites this paper as Steinglass et al., 2014
The paper describes AN-EXRP as a form of cognitive behavioral therapy and reports improved laboratory-meal caloric intake compared with cognitive remediation therapy (Abstract > Conclusions). Its Discussion calls the change modest and supports further investigation. The study tested a specific, short-term adjunctive CBT-based intervention, not CBT for anorexia nervosa broadly. (LLM, conf=0.83)
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 [41]
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“Still, the fear reductions we found on the questionnaires assessing eating disorder related fears are comparable or even stronger than the reductions found in previous research [43, 64, 65] and the increase in calorie intake in the pre-sent study was larger than in other studies [41, 42].”
ResultLevinson, 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
- Authors
- Steinglass, J. E., Albano, A. M., Simpson, H. B., Wang, Y., Zou, J., Attia, E., & Walsh, B. T.
- Affiliations
- New York State Psychiatric Institute (US)
- Columbia University (US)
- Corresponding author
- Steinglass, Joanna E.
- ORCID
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2013-11-08
- Volume
- 47
- Issue
- 2
- Pages
- 174-180
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- PMC
- PMC3927538
- OpenAlex
- W2171611171
- Cited by
- 158
- References
- 30
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 34 · 2023: 12 · 2022: 8 · 2021: 11 · 2020: 14 · 2019: 7 · 2018: 14 · 2017: 12 · 2016: 7 · 2015: 14 · 2014: 9
- FWCI
- 11.11
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (R01 MH08273602, K24MH091555, K23MH076195, R01MH082736)
- 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, exposure and response prevention, dietary habits, weight restoration, relapse prevention, cognitive remediation, energy intake, maladaptive eating behaviors, adjunctive therapy
- MeSH terms
- Adult, Anorexia Nervosa, Anxiety, Body Weight, Energy Intake, Fear, Feeding Behavior, Female, Humans, Implosive Therapy, Pilot Projects, Research Design, Cognitive Behavioral Therapy
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