Article

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). 01/2010; 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.

Download full-text

Full-text

Available from: Anne Marie Albano, Jan 24, 2014
0 Followers
 · 
273 Views
  • Source
    • "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]. "
    [Show abstract] [Hide abstract]
    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.
    Physiology & Behavior 06/2015; DOI:10.1016/j.physbeh.2015.06.007 · 3.03 Impact Factor
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Psychoneuroendocrinology 06/2014; DOI:10.1016/j.psyneuen.2014.02.019 · 5.59 Impact Factor
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examined the unique associations between eating disorder symptoms and two emotion-related constructs (affective lability and anxiousness) assessed via distinct methodologies in anorexia nervosa (AN). Women (N = 116) with full or subthreshold AN completed baseline emotion and eating disorder assessments, followed by two weeks of ecological momentary assessment (EMA). Hierarchical regressions were used to examine unique contributions of baseline and EMA measures of affective lability and anxiousness in accounting for variance in baseline eating disorder symptoms and EMA dietary restriction, controlling for age, body mass index, depression, and AN diagnostic subtype. Only EMA affective lability was uniquely associated with baseline eating disorder symptoms and EMA dietary restriction. Anxiousness was uniquely associated with baseline eating disorder symptoms regardless of assessment method; neither of the anxiousness measures was uniquely associated with EMA dietary restriction. Affective lability and anxiousness account for variance in global eating disorder symptomatology; AN treatments targeting these emotion-related constructs may prove useful.
    Journal of Psychiatric Research 07/2013; 47(10). DOI:10.1016/j.jpsychires.2013.06.021 · 4.09 Impact Factor