Exposure Therapy for Eating Disorders

Exposure therapy is a core component of evidence-based treatments for eating disorders (EDs), including cognitive-behavioral therapy and family-based treatment. Despite this, existing treatment guides give relatively limited attention to the clinical issues associated with good implementation of exposure. This book is designed to augment a wide variety of treatment manuals by providing ED clinicians with practical advice for maximizing the effectiveness of exposure, regardless of which evidence-based treatment they use or the profession to which they belong. Written in an easy-to-understand format, this book not only translates the most up-to-date empirical research on exposure for EDs, it also extrapolates clinical advice from the anxiety disorders literature to help busy clinicians become more effective in treating EDs. Readers will walk away with a solid foundation in the theoretical underpinnings of exposure therapy, as well as an understanding of how to utilize this information to sell the rationale for exposure to their ED patients. Clinically rich chapters, with ample case material, demonstrate how to prepare to embark on exposure therapy with a wide range of ED patients, including those with anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant/restrictive food intake disorder. Specific types of ED exposure are covered in detail, including exposure to food and eating, cue exposure for binge eating, weighing and weight exposure, body image exposure, emotion and interpersonally focused exposure, and novel forms of exposure for EDs. Clinicians also will walk away with strategies for overcoming obstacles to implementation of exposure therapy, including institutional resistance.

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Why Do People Get Better With Exposure Therapy?

Exposure Therapy for Eating Disorders ◽

10.1093/med-psych/9780190069742.003.0003 ◽

2019 ◽

pp. 19-32

Author(s):

Carolyn Black Becker ◽

Nicholas R. Farrell ◽

Glenn Waller

Keyword(s):

Eating Disorders ◽

Anxiety Disorders ◽

Therapeutic Intervention ◽

Exposure Therapy ◽

Therapeutic Benefit ◽

Evidence Based ◽

Systematic Desensitization ◽

Evidence Based Treatments ◽

Inhibitory Learning

This chapter outlines a theoretically based rationale for using exposure consistently in the treatment of individuals with eating disorders. Due to the substantial overlap between eating disorders and anxiety disorders (both in symptom content and in comorbidity between the conditions), exposure therapy is a sound choice for therapeutic intervention. Indeed, the most evidence-based treatments for eating disorders contain a number of exposure-based strategies that drive much of the therapeutic benefit. The chapter discusses habituation, systematic desensitization, and inhibitory learning and differentiates exposure therapy from systematic desensitization. Using a case study to consider how exposure therapists can help patients learn to tolerate their anxiety by leaning into it rather than engaging in safety behaviors, this chapter lays the foundation for the application of exposure therapy to patients with eating disorders.

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Treatments for Eating Disorders

10.1093/med:psych/9780199342211.003.0020 ◽

2015 ◽

Cited By ~ 4

Author(s):

Kathleen M. Pike ◽

Loren M. Gianini ◽

Katharine L. Loeb ◽

Daniel Le Grange

Keyword(s):

Eating Disorders ◽

Weight Loss ◽

Eating Disorder ◽

Bulimia Nervosa ◽

Binge Eating ◽

Binge Eating Disorder ◽

Behavioral Therapy ◽

Treatment Options ◽

Evidence Based Treatments ◽

Substantial Progress

Substantial progress in advancing evidence-based treatments for eating disorders has been made. Many well-designed studies provide cumulative support for cognitive-behavioral therapy (CBT) as the treatment of choice for bulimia nervosa. Interpersonal psychotherapy (IPT) and pharmacotherapy are considered appropriate alternative treatments for bulimia nervosa. While CBT, IPT and pharmacotherapy often produce significant reductions in binge eating and compensatory behaviors, these treatment options need to be improved to help more individuals achieve full and lasting recovery. In the treatment of binge eating disorder, CBT and IPT have been shown to be the most efficacious in reducing symptoms and improving psychological outcomes. Weight loss is often an additional goal of those entering treatment for binge eating disorder; however, existing treatments have generally been unsuccessful in producing significant maintainable weight loss. Initial studies suggest that CBT may be associated with improved outcome both in the acute and maintenance phases of treatment for anorexia nervosa.

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Psychopharmacology in the Treatment of Eating Disorders

10.1542/9781610021883-psychopharmacology ◽

2018 ◽

pp. 384-403

Author(s):

Lindsay J. Moskowitz ◽

Benson Ku ◽

Shervin Shadianloo ◽

Victor M. Fornari

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Eating Disorder ◽

Bulimia Nervosa ◽

Binge Eating ◽

Binge Eating Disorder ◽

Behavioral Therapy ◽

Mood Stabilizers ◽

United States Food ◽

Family Based

Given the high morbidity and mortality rates associated with eating disorders (EDs), many studies have examined the use of medications to treat these disorders. However, with the exception of fluoxetine (for those 12 years and older with bulimia nervosa) and lisdexamfetamine (for adults with moderate-to-severe binge eating disorder), no other medications have been approved by the United States Food and Drug Administration to treat any eating disorder. This article will review many of the positive and negative studies for use of medication in the treatment of eating disorders, including anorexia nervosa, bulimia nervosa, atypical anorexia nervosa, avoidant/restrictive food intake disorder, and binge eating disorder. Various classes of medication will be reviewed, including antidepressants, antipsychotics, mood stabilizers, and anxiolytics. Although the information in this article is important in the education of both patients and their parents, medications should be used cautiously in those with EDs. It should be emphasized that to date, therapy—family-based therapy and enhanced cognitive behavioral therapy—is the mainstay of treatment, with nutrition therapy and correction of malnutrition as the crucial first step in treatment.

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Psychodynamic and Supportive Psychotherapy

Depression ◽

10.1093/med/9780190929565.003.0018 ◽

2019 ◽

pp. 298-317

Author(s):

David J. Hellerstein ◽

Alexander Kane

Keyword(s):

Behavioral Therapy ◽

Primary Treatment ◽

Theoretical Background ◽

Evidence Based ◽

Therapeutic Approaches ◽

Supportive Psychotherapy ◽

Interpersonal Therapy ◽

Treatment Of Depression ◽

Wide Range ◽

Evidence Based Treatments

Patients with mood disorders often can benefit from psychotherapy, whether as a primary treatment for depression or as an adjunct to medications or other biological treatments. Today, therapeutic approaches such as cognitive–behavioral therapy and interpersonal therapy are commonly thought of as first-line evidence-based treatments of depression, yet there is also evidence that psychodynamic psychotherapy (PDT) and supportive psychotherapy (SPT) can be effective treatments of depression. Both PDT and SPT are commonly used in clinical practice, by a wide range of clinicians and in many different settings. This chapter describes the theoretical background of each of these therapies, therapeutic techniques, how they can be adapted for treatment of depression, and patient populations for which they may be indicated.

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Emotion Regulation and Eating Disorders

Emotion Regulation and Psychopathology in Children and Adolescents ◽

10.1093/med:psych/9780198765844.003.0010 ◽

2017 ◽

pp. 196-209

Author(s):

Julian Baudinet ◽

Lisa Dawson ◽

Sloane Madden ◽

Phillipa Hay

Keyword(s):

Eating Disorders ◽

Emotion Regulation ◽

Anorexia Nervosa ◽

Evidence Based ◽

Improve Treatment ◽

Novel Approach ◽

Evidence Based Treatments ◽

Regulation Strategies ◽

Family Based ◽

Adolescent Eating Disorders

Chapter 10 discusses the prevalence and manifestation of childhood and adolescent eating disorders focusing on Anorexia Nervosa (AN), due to its prevalence. Implementation of maladaptive emotion regulation strategies, with a reduced ability to label and describe emotions leads to the development and propagation of AN. Family based treatments have been widely recognized, as the leading intervention for adolescents with AN, with efficacy rates from 20% to 60%. However, this chapter focuses on a novel approach to AN treatment, centered on emotion regulation in its management, as this may improve treatment outcomes. Programs include: Maudsley Model of Anorexia Nervosa Treatment for Adults and Emotion Acceptance Behavior Therapy, in addition to the modification or adaption of existing, evidence based treatments, such as Radically-Open DBT, although many programs require empirical validation in adolescent samples.

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Treatment of Eating Disorders

Treating and Preventing Adolescent Mental Health Disorders ◽

10.1093/med-psych/9780199928163.003.0014 ◽

2017 ◽

pp. 315-334

Author(s):

Evelyn Attia ◽

Anne E. Becker ◽

Cynthia M. Bulik ◽

Alison E. Field ◽

Neville H. Golden ◽

...

Keyword(s):

Eating Disorders ◽

Randomized Controlled Trials ◽

Behavioral Therapy ◽

Controlled Trials ◽

Randomized Controlled ◽

Empirically Supported ◽

Duration Of Illness ◽

Evidence Based Treatments ◽

Family Based Treatment ◽

Family Based

This chapter focuses on treatments for adolescents with eating disorders, using information derived from randomized controlled trials and evidence-based treatments for eating disorders in adults. Available data provide some guidance in selecting treatments, but there are significant limitations in research on psychological and pharmacological interventions. Family-based treatment is effective for adolescents with anorexia nervosa, especially for those with a short duration of illness. For adolescents with bulimia nervosa, both family-based treatment and guided self-help based on cognitive-behavioral therapy are empirically supported interventions. At this time, there are no randomized controlled trials on the treatment of adolescents with binge-eating disorder, and, despite the widespread use of psychotropic medications, there is little empirical information about the utility and safety of such interventions for adolescents. Additional large well-controlled systematic studies with adolescents are needed to inform best care practices.

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Are we really delivering evidence-based treatments for eating disorders? How eating-disordered patients describe their experience of cognitive behavioral therapy

Behaviour Research and Therapy ◽

10.1016/j.brat.2015.10.009 ◽

2015 ◽

Vol 75 ◽

pp. 72-77 ◽

Cited By ~ 18

Author(s):

Natasha D. Cowdrey ◽

Glenn Waller

Keyword(s):

Eating Disorders ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Evidence Based ◽

Eating Disordered ◽

Evidence Based Treatments

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Neurobiology and Treatment of OCD

Neurobiology of Mental Illness ◽

10.1093/med/9780199934959.003.0048 ◽

2013 ◽

pp. 646-661

Author(s):

Susanne E. Ahmari ◽

H. Blair Simpson

Keyword(s):

Environmental Factors ◽

Behavioral Therapy ◽

Treatment Strategies ◽

Current Evidence ◽

Evidence Based ◽

Preclinical Studies ◽

Obsessive Compulsive ◽

Compulsive Disorder ◽

Evidence Based Treatments ◽

Genetic And Environmental Factors

Obsessive Compulsive Disorder (OCD) is a chronic, disabling disorder with a lifetime prevalence of up to 2-3%, and is a leading cause of illness-related disability. OCD is characterized by recurrent intrusive thoughts, images, or impulses (obsessions) that cause anxiety or distress, and repetitive mental or behavioral acts (compulsions). Though the etiology of OCD is unclear, current evidence implicates both genetic and environmental factors in its development. Our understanding of the neurobiology underlying OCD is still evolving, with convergent evidence from clinical and preclinical studies highlighting the importance of abnormalities in cortico-striatal-thalamo-cortical (CSTC) circuits. Evidence-based treatments for OCD include both pharmacotherapy and cognitive-behavioral therapy. This chapter will review the etiology and neurobiology of OCD, and will provide an overview of treatment strategies.

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The Complex Relationship Between Eating Disorders and Substance Use Disorders

Clinical Handbook of Complex and Atypical Eating Disorders ◽

10.1093/med-psych/9780190630409.003.0004 ◽

2017 ◽

pp. 60-78

Author(s):

Amy Baker Dennis ◽

Tamara Pryor

Keyword(s):

Eating Disorders ◽

Substance Use ◽

Substance Use Disorders ◽

Treatment Plan ◽

Integrated Treatment ◽

Evidence Based ◽

Complex Relationship ◽

Adaptive Function ◽

Case Examples ◽

Evidence Based Treatments

Eating disorders (ED) and substance use disorders (SUD) frequently co-occur but are rarely treated in a comprehensive integrated manner. This chapter elucidates the complex relationship between ED and SUD to help the treating professional create an integrated treatment plan that addresses both disorders and any other co-occurring conditions. Evidence-based treatments for each disorder are discussed, and recommendations on how to take “best practices” from both fields to formulate a treatment plan that addresses the specific needs of the patient are presented. The chapter includes case examples that demonstrate the importance of understanding the adaptive function of both disorders when developing an effective intervention.

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Family-based treatment for children and adolescents with eating disorders: a mixed-methods evaluation of a blended evidence-based implementation approach

Translational Behavioral Medicine ◽

10.1093/tbm/ibz160 ◽

2019 ◽

Author(s):

Jennifer Couturier ◽

Melissa Kimber ◽

Melanie Barwick ◽

Tracy Woodford ◽

Gail Mcvey ◽

...

Keyword(s):

Eating Disorders ◽

Qualitative Interviews ◽

Readiness For Change ◽

Qualitative Description ◽

Evidence Based ◽

Organizational Readiness For Change ◽

Implementation Approach ◽

Fidelity Assessment ◽

Family Based Treatment ◽

Family Based

Abstract In this study, we evaluated a blended implementation approach with teams learning to provide family-based treatment (FBT) to adolescents with eating disorders. Four sites participated in a sequential mixed method pre–post study to evaluate the implementation of FBT in their clinical settings. The implementation approach included: (a) preparatory site visits; (b) the establishment of implementation teams; (c) a training workshop; (d) monthly clinical consultation; (e) monthly implementation consultation; and (f) fidelity assessment. Quantitative measures examining attitudes toward evidence-based practice, organizational learning environment and organizational readiness for change, as well as, individual readiness for change were delivered pre- and postimplementation. Correlational analyses were used to examine associations between baseline variables and therapist fidelity to FBT. Fundamental qualitative description guided the sampling and data collection for the qualitative interviews performed at the conclusion of the study. Seventeen individuals participated in this study (nine therapists, four medical practitioners, and four administrators). The predetermined threshold of implementation success of 80% fidelity in every FBT session was achieved by only one therapist. However, mean fidelity scores were similar to those reported in other studies. Participant attitudes, readiness, and self-efficacy were not associated with fidelity and did not change significantly from pre- to postimplementation. In qualitative interviews, all participants reported that the implementation intervention was helpful in adopting FBT. Our blended implementation approach was well received by participants. A larger trial is needed to determine which implementation factors predict FBT fidelity and impact patient outcomes.

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