Inhibitory Learning during Exposure Treatment in Anorexia Nervosa: A Practical Guide
Open accessAbstract
Exposure therapy is known to be an effective intervention in the treatment of anxiety-related disorders. In eating disorders, such as anorexia nervosa, anxiety and avoidance are identified as maintenance factors. Therefore, they may constitute an important treatment target, suitable for the use of exposure therapy. Remarkably, exposure techniques to target fears and avoidance behaviors are not commonly used in the treatment of anorexia nervosa. We present a practical guide for the implementation of exposure therapy in the treatment of anorexia nervosa. We outline how exposure therapy is supposed to work according to the inhibitory learning model and how the exposure intervention can be designed for individuals with anorexia nervosa. Practical examples are provided through the case presentation of a patient with anorexia nervosa who completed 31 exposure sessions that focused on her fears of food, eating, weight, weight gain, their feared social consequences and the associated safety behaviors.
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A thorough understanding of patients' fears and safety behaviors is an inevitable pre-requisite to the success of exposure therapy.
“Since a thorough understanding of the patients’ fears and safety behaviors is considered an inevitable pre-requisite to the success of exposure therapy [16, 26] more needs to be learned about fears in anorexia nervosa.”
From Anxiety matters: a pilot lab study into food, weight, and virtual body exposure in anorexia nervosa (2024) · cites this paper as [26]
Section 3, “Before the Start of Exposure Therapy,” says understanding patients’ fears is important for maximizing an exposure session’s success and advises collecting information about safety behaviors. But it recommends collecting that information continuously, and Section 7, “Challenges and Future Directions,” suggests using exposures to discover a feared outcome. The paper therefore supports the importance of understanding fears and safety behaviors, not the claim that a thorough understanding is an inevitable prerequisite. (LLM, conf=0.88)
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 [26]
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Self-citationIntervention research in anorexia nervosa – a plea for single case experimental designs
Melles, H., Lemmens, L. H. J. M., & Jansen, A. T. M. (2025) · Eating Disorders · doi:10.1080/10640266.2025.2471218 · Cited by 3 · see citing works
Self-citationFriedberg, R. D., Neelley, M., Lee, T., Chen, R., Xie, I. Y., Zucker, J., & Greenberger, A. (2024) · Current Psychiatry Research and Reviews · doi:10.2174/0126660822284733240229042550 · Cited by 1 · see citing works
Don’t check after a snack: body checking increases eating-related threat perception
Spix, M., Martijn, C., & Jansen, A. T. M. (2025) · Appetite · doi:10.1016/j.appet.2025.108307 · Cited by 1 · see citing works
Self-citationMelles, H., Spix, M., Duijvis, S., & Jansen, A. T. M. (2026) · International Journal of Eating Disorders · doi:10.1002/eat.70078 · Cited by 1 · see citing works
Self-citationLinking maladaptive food avoidance and anorexia nervosa symptoms: An analogue study
Spix, M., & Jansen, A. (2024) · Journal of Experimental Psychopathology · doi:10.1177/20438087241271637 · Cited by 1 · see citing works
Self-citationMelles, H. (2024) · doi:10.26481/dis.20240704hm
Self-citationPeters, K., Peters, J. H., Wolstein, J. R., & Rauh, E. (2025) · Die Psychotherapie · doi:10.1007/s00278-025-00813-1
- Authors
- Melles, H., Duijvis, S., & Jansen, A.
- Affiliations
- Maastricht University (NL)
- Corresponding author
- Melles, Hanna
- Venue
- Behavioral Sciences
- Publisher
- MDPI AG
- Published
- 2023-04-29
- Volume
- 13
- Issue
- 5
- Pages
- 370
- ISSN
- 2076-328X (ISSN-L)
- PMC
- PMC10215383
- OpenAlex
- W4367598711
- Cited by
- 11
- References
- 92
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 5
- FWCI
- 3.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Behavioral Sciences (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Vogelgezang Foundation
- 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 therapy, inhibitory learning, avoidance, anxiety, eating disorders, safety behavior, fear of food, fear of weight gain, treatment design
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