Rationale for the application of Exposure and Response Prevention to the Treatment of Anorexia Nervosa

Columbia University, New York State Psychiatric Institute, New York 10032, New York, USA.
International Journal of Eating Disorders (Impact Factor: 3.03). 11/2010; 44(2):134-41. DOI: 10.1002/eat.20784
Source: PubMed

ABSTRACT Anorexia nervosa (AN) is a life threatening and difficult to treat illness with a high relapse rate. Current treatments are inadequate and new approaches to treatment are needed.
We review the data on anxiety in AN, the relationship between anxiety disorders and AN, and the use of Exposure and Response Prevention in treatment.
The overlap between AN and anxiety disorders suggest a model of AN in which baseline anxiety features yield eating related fears, avoidance behaviors, and ritualized safety behaviors that promote the underweight state and the perpetuation of the disorder. We propose an Exposure and Response Prevention treatment to prevent relapse in AN.
Overlap between AN and anxiety disorders suggests that Exposure and Response Prevention may be a new and beneficial approach to preventing relapse in individuals with AN.

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Available from: Anne Marie Albano, Jan 24, 2014
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    • "The approach has been found to be an effective treatment for a range of affective disorders that are often co-morbid with eating disorders such as social phobia [65] and obsessive–compulsive disorder [2]. Recent evidence-based theoretical models of AN confirm the pivotal role played by food-related anxiety in the onset and maintenance of the illness [137] [141] [146] [154]. "
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    • "Outliers were removed by excluding detection latencies that were beyond two standard deviations from their mean (i.e., from each individual's mean RTs across all stimuli). Unlike Shafran et al, (2007), the eating stimuli were not divided into emotional valences based on the caloric content of the food in our analysis, because patients with AN tend to rate all food stimuli, not just high caloric food, as aversive (Strober, 2004; Steinglass et al., 2011). Therefore, in this analysis, the different valences of eating stimuli were regarded altogether as negative valences and merged as overall eating stimuli to increase the statistical power. "
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    • "e l s e v i e r . c o m / l o c a t e / p sy c h i r e s which shares features of anxiety disorders including an intense fear response to specific stimuli (e.g., fear of fatness; Strober, 2004) and avoidance of fear-eliciting stimuli (e.g., avoidance of " unsafe " foods; Steinglass et al., 2011). Anxiety disorders are among the most commonly co-occurring disorders in those with AN, and evidence suggests that they may precede the onset of AN (Bulik et al., 1997; Kaye et al., 2004). "
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