The Application of Exposure Therapy and D-Cycloserine to the Treatment of Anorexia Nervosa: A Preliminary Trial

College of Physicians & Surgeons of Columbia University, New York, NY 10032, USA.
Journal of Psychiatric Practice (Impact Factor: 1.34). 08/2007; 13(4):238-45. DOI: 10.1097/01.pra.0000281484.89075.a8
Source: PubMed

ABSTRACT Novel approaches to the treatment of anorexia nervosa (AN) are needed. This preliminary study examined the utility and safety of an exposure therapy intervention and D-cycloserine (DCS) in a population of patients with AN.
Eleven participants completed a series of 6 laboratory meals, including pre- and post-exposure test meals and four exposure sessions. Participants were randomly assigned to receive either DCS or placebo in double-blind fashion before each of the 4 exposure sessions. These results were compared to data from a previously studied group of patients who received treatment as usual.
Total caloric intake increased significantly from the baseline meal session to the post-test meal session in the patients who received the exposure therapy intervention. Caloric intake did not increase significantly in the comparison group.
These data suggest that an exposure therapy intervention specifically focused on meal consumption may be helpful in increasing intake of a test meal.

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    • "In support of this model, a previous study by our group found that patients, even after weight restoration and improvement in many psychological symptoms, continued to significantly restrict their eating during a laboratory test meal (Sysko, et al., 2005). A subsequent study demonstrated that repeated presentation of the same laboratory meal, with a therapist present for encouragement, led to increases in total intake (Steinglass, et al., 2007). To begin to address the question of the relationship between pre-meal anxiety and food intake in weight restored individuals with AN, we combined data from three ongoing studies that each include a laboratory-based eating assessment. "
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    ABSTRACT: Anorexia nervosa (AN) is a serious mental illness characterized by reduced caloric intake that often persists after acute weight restoration. This preliminary study assesses the relationship between pre-meal anxiety and food intake in recently weight-restored individuals with AN. We hypothesized that pre-meal anxiety is inversely related to caloric intake in AN. Caloric intake and pre-meal anxiety were measured in three laboratory-based assessments (yogurt snack, multi-item lunch, macaroni and cheese lunch). Anxiety was measured by Spielberger State-Trait Anxiety Inventory (STAI-S) administered prior to the meal. Acutely weight-restored patients with AN were compared with healthy controls (HCs). Associations between anxiety and intake were analyzed first within each meal type separately and then using a model to combine the sample. In the multi-item lunch and the macaroni and cheese lunch, AN ate significantly less than HC (p=0.01, p<0.001). Pre-meal anxiety was significantly correlated with intake among AN, but not HC. In the yogurt snack, there was no significant association between anxiety and intake among patients or controls, and the groups did not differ in caloric intake. The association between pre-meal anxiety and intake among weight-restored individuals with AN suggests a potential target for relapse prevention treatment.
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    ABSTRACT: Anorexia nervosa (AN) is a serious mental illness categorized by a failure to maintain a minimally normal weight, a fear of gaining weight or becoming fat, and preoccupations about body shape or weight. AN is associated with significant morbidity and a mortality rate as high as that seen in any psychiatric illness. Biological factors, including genetic predisposition, appear to play a role in the development of AN. Treatment is challenging both because interventions with clear empirical support have not been identified and because individuals affected by AN are typically reluctant to undergo weight restoration. Preliminary studies suggest that family-based treatment may be useful for younger patients with AN. Treatment development for adults with AN and pursuit of neurobiological correlates of AN remain high-priority research areas.
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