Facing Eating Disorder Fears: An Open Trial Adapting Prolonged Exposure to the Treatment of Eating Disorders
Abstract
Eating disorders (EDs) are maintained by core fears, which lead to avoidance behaviors, such as food avoidance or compensatory behaviors. Previously tested exposure-based treatments for EDs have generally focused on proximal outcomes (e.g., food), rather than addressing core fears (e.g., fear of weight gain and its consequences). The current study tested the feasibility and initial clinical efficacy of 10 sessions of imaginal and in vivo exposure for core ED fears (termed "Facing Eating Disorder Fears"), mainly fear of weight gain and its associated consequences. Participants were 36 adults with anorexia nervosa (AN), bulimia nervosa, or other specified feeding and eating disorders determined by semistructured diagnostic interviews. ED symptoms, fears, and body mass index (BMI) were assessed at pretreatment, posttreatment, and 1-month follow-up. Treatment involved 10 sessions of imaginal and in vivo exposure to ED fears in combination with in vivo exposures to feared and avoided situations as homework. ED symptoms and fears decreased from pre- to posttreatment and at 1-month follow-up. BMI increased significantly from pre- to posttreatment, particularly for those with AN. Effect sizes ranged from small to very large. ED symptoms and fears decreased and BMI increased following exposure. Increases in BMI occurred without any direct intervention on eating, suggesting that weight gain can be achieved without a specific focus on food during ED treatment. Facing Eating Disorder Fears may be a feasible stand-alone intervention for EDs. Future research must test comparative efficacy through randomized controlled trials.
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The fear reductions found on questionnaires assessing eating disorder related fears are comparable or even stronger than the reductions found in previous research.
“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]”
From Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa (2024) · cites this paper as [64]
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 [64]
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Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa
Melles, H., & Jansen, A. (2024) · Journal of Eating Disorders · doi:10.1186/s40337-024-01094-w · Cited by 5 · see citing works
“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].”
ResultButler, R. M., Christian, C., Girard, J. M., Vanzhula, I. A., & Levinson, C. A. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104577 · Cited by 1 · see citing works
Self-citation
- Authors
- Butler, R. M., Crumby, E. K., Christian, C., Brosof, L. C., Vanzhula, I. A., & Levinson, C. A.
- Affiliations
- University of Louisville (US)
- Corresponding author
- Butler, Rachel M.
- ORCID
- Venue
- Behavior Therapy
- Publisher
- Elsevier BV
- Published
- 2024-03
- Volume
- 55
- Issue
- 2
- Pages
- 347-360
- ISSN
- 0005-7894 (ISSN-L)
- OpenAlex
- W4385143822
- Cited by
- 17
- References
- 46
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 6
- FWCI
- 4.96
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Behavior Therapy (publishedVersion)
- PubMed (publishedVersion)
- 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
- eating disorders, prolonged exposure, fear of weight gain, anorexia nervosa, bulimia nervosa, imaginal exposure, in vivo exposure, avoidance behavior, body mass index, treatment efficacy
- MeSH terms
- Adult, Anorexia Nervosa, Feeding and Eating Disorders, Fear, Humans, Weight Gain, Bulimia Nervosa, Binge-Eating Disorder
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