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: 3.13). 11/2010; 44(2):134-41. DOI: 10.1002/eat.20784
Source: PubMed


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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    ABSTRACT: The aim of this paper is to map the possibility of new treatment approaches for eating disorders. Eating disorders have a protracted trajectory with over 50% of cases developing a severe and enduring stage of illness. Although a good response to family-based interventions occurs in the early phase, once the illness has become severe and enduring there is less of a response to any form of treatment. Neuroprogressive changes brought about by poor nutrition and abnormal eating patterns contribute to this loss of treatment responsivity. We have summarised the profile of symptoms at the various stages of illness and considered new treatments that might be applied. In the enduring stage of illness in addition to problems with body image, food and eating, there are additional problems of low mood, high anxiety and compulsivity and problems in social functioning. This suggests that there are dysfunctions in circuits subsuming reward, punishment, decision-making and social processes. New approaches have been developed targeting these areas. New interventions targeting both the primary and secondary symptoms seen in the enduring stage of eating disorders may improve the response to treatment. Copyright © 2015. Published by Elsevier Inc.
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    • "Although there is growing evidence supporting the idea that emotion regulation difficulties affect eating disorder symptoms in AN, few studies have examined the relationship between emotion regulation and other putative processes related to AN. There is concurrently increasing interest in the role that anxiety plays in influencing AN symptomology [14] [15]. It has been suggested that individuals who develop AN have elevated levels of anxiety resulting from a dysfunctional serotonin system, and that restrictive eating serves to reduce baseline levels of anxiety to a more manageable level [16]. "
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    ABSTRACT: There is growing interest in the role of emotion regulation in anorexia nervosa (AN). Although anxiety is also hypothesized to impact symptoms of AN, little is known about how emotion regulation, anxiety, and eating disorder symptoms interact in AN. In this study, we examined the associations between emotion regulation, anxiety, and eating disorder symptom severity in AN. Questionnaires and interviews assessing emotion regulation difficulties, anxiety, eating disorder symptoms, and eating disorder-related clinical impairment were collected from group of underweight individuals with AN (n=59) at admission to inpatient treatment. Hierarchical linear regressions were used to examine the associations of emotion regulation difficulties, anxiety, and the interaction of these constructs with eating disorder symptoms and eating disorder-related clinical impairment. Emotion regulation difficulties were significantly positively associated with eating disorder symptoms and related clinical impairment only when anxiety levels were low and anxiety was significantly positively associated with eating disorder symptoms and related clinical impairment only when emotion regulation problems were not elevated. This study adds to a growing literature suggesting that emotion regulation deficits are associated with eating disorder symptoms in AN. Certain individuals with AN may especially benefit from a focus on developing emotion regulation skills in the acute stages of illness. Copyright © 2015. Published by Elsevier Inc.
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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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    ABSTRACT: We examined the impact of oxytocin on attentional processes for eating, shape, and weight stimuli in patients with anorexia nervosa (AN). A double-blind, placebo-controlled within-subject crossover design was used. Intranasal oxytocin or placebo followed by a visual probe detection task with food, weight, and shape images was administered to 64 female subjects: 31 patients with AN and 33 control students. The AN group showed significant reductions in the attentional biases toward eating-related stimuli (p = 0.030, d = 0.516) and toward negative shape stimuli (p = 0.015, d = 0.498) under the influence of intranasal oxytocin. The effect of oxytocin was correlated with autistic spectrum traits in the AN group. Oxytocin had no effect on the amount of juice consumed in either group. The results of this study suggest that oxytocin attenuates the attentional vigilance to eating and fat shape stimuli in patients with AN. Further studies using oxytocin as a form of intervention for patients with AN are needed.
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