Exposure therapy to feared foods may help kids with eating disorders


Date:
April 5, 2023
Source:
Penn State
Summary:
Whether you're afraid of dogs, needles or enclosed spaces, one
of the most effective interventions for this type of anxiety
disorder is exposure therapy in which you confront your fear in a
safe environment. A new study finds that exposure therapy is also
a promising treatment for adolescents with eating disorders. They
found that exposure to feared foods -- such as candy bars and pizza
-- helped kids who were in a partial hospitalization program for
eating disorders experience decreased anxiety toward food.


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FULL STORY ========================================================================== Whether you're afraid of dogs, needles or enclosed spaces, one of the most effective interventions for this type of anxiety disorder is exposure
therapy in which you confront your fear in a safe environment. A new
study led by researchers at Penn State College of Medicine finds that
exposure therapy is also a promising treatment for adolescents with
eating disorders. They found that exposure to feared foods -- such as
candy bars and pizza -- helped kids who were in a partial hospitalization program for eating disorders experience decreased anxiety toward food.


==========================================================================
"As a society that is so heavily influenced by diet culture, our
relationships with our bodies can be dysfunctional," said Jamal Essayli, assistant professor of pediatrics and of psychiatry and behavioral
health. "I came out as gay in high school, and by the time I got
to college, I noticed an increased emphasis on body image among gay
men. That's partly what inspired my interest in researching and working
with patients with eating disorders." According to the National Eating Disorders Association, approximately 30 million Americans will struggle
with eating disorders, including anorexia nervosa, bulimia nervosa, binge-eating disorder and others, at some point in their lives. In
addition to the LGBTQ+ community, adolescents and young adults are
particularly vulnerable, and the COVID-19 pandemic didn't help. Recent
research by co-author Jennifer Shook, assistant professor of pediatrics at
the Penn State College of Medicine, and others demonstrated a significant increase in eating disorder-associated inpatient and outpatient visits
to emergency departments among adolescents and young adults during
the pandemic.

"While this is an active area of research, the causes of eating disorders
are typically thought to be a combination of biological predisposition
and environment," said Essayli. "For example, having an anxious or perfectionistic predisposition and being teased about your body size
or weight can both increase a person's risk for developing an eating
disorder." In the current study, which was published in theInternational Journal of Eating Disorders, Essayli and his colleagues recruited 54 adolescents with a median age of 14 years who were participating in a
partial hospitalization program for eating disorders. The program ran
five days a week for an average of eight weeks per individual. Each day,
the clinical team exposed the patients to a feared food. For example, participants were given a full-sized candy bar on Mondays, a baked good
such as a cookie on Tuesdays, pizza on Wednesdays, a dessert on Thursdays
and a breakfast item such as pancakes on Fridays.

"Many of these patients were underweight or weight suppressed, and had
intense anxiety about these foods," said Essayli. "It was important
for them to learn that there's nothing horrible about having pizza
and ice cream at a party, for example, that it's actually part of a
fulfilling life." Patients provided subjective units of distress (SUDS) ratings on a scale from 0 (no distress) to 10 (extremely high distress) immediately before and after each food exposure. In addition, patients
were periodically given the Children's Eating Attitudes Test and Fear
of Food Measure, which are aimed at determining levels of anxiety about
eating and food avoidance behaviors. Finally, the adolescents were
encouraged to discuss their feelings about the exposure challenges in
weekly therapy sessions.

"One of the things we wanted to test was whether within-session and
between- session habituation were important for weight gain," said
Essayli. "Say, you're afraid of dogs. If you're doing exposure therapy
by spending time around a dog, within-session habituation is when your
anxiety decreases while you're with the dog. Between-session habituation
is when your anxiety decreases from session to session across days."
This distinction is important, Essayli said, because the extent to which clinicians should emphasize or disregard fear-reduction during exposure
therapy sessions for eating disorders was previously unknown.

Overall, the team found that SUDS decreased significantly over time prior
to exposure to feared foods, providing some evidence that between-session habituation occurred. However, the difference between pre-exposure
and post- exposure SUDS did not decrease over time, indicating that within-session habituation did not occur. Therefore, the team concluded
that between-session habituation, but not within-session habituation,
predicted favorable treatment outcomes, including weight gain and
improvements on the Children's Eating Attitudes Test and Fear of Food
Measure.

"Our findings provide support for integrating food exposure into partial hospitalization programs for adolescents with eating disorders who are undergoing weight restoration," said Essayli. "And while more research
is needed, our results may begin to help clinicians determine how much
emphasis to place on within-session habituation and between-session habituation." Other Penn State authors on the paper include Lauren
Forrest, assistant professor of psychiatry and behavioral health;
Kathleen Keller, professor of nutritional sciences and food science;
and Susan Lane-Loney, associate professor of pediatrics and of psychiatry
and behavioral health. Hana Zickgraf, assistant professor of pediatrics,
Emory University, and Emily Stefano, assistant professor, Bariatric and
Weight Management Center, Wake Forest University, also are authors.

The National Institutes of Health supported this research.

* RELATED_TOPICS
o Health_&_Medicine
# Eating_Disorder_Research # Diet_and_Weight_Loss #
Obesity # Nutrition
o Mind_&_Brain
# Eating_Disorders # Nutrition_Research # Psychiatry #
Dieting_and_Weight_Control
* RELATED_TERMS
o Panic_attack o Mental_illness o Eating_disorder o
Therapy_dog o General_anxiety_disorder o Sleep_disorder o
Chinese_food_therapy o Anxiety

========================================================================== Story Source: Materials provided by Penn_State. Original written by Sara LaJeunesse. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Jamal H. Essayli, Lauren N. Forrest, Hana F. Zickgraf, Emily
C. Stefano,
Kathleen L. Keller, Susan E. Lane‐Loney. The impact of
between‐session habituation, within‐session habituation,
and weight gain on response to food exposure for adolescents with
eating disorders. International Journal of Eating Disorders, 2023;
56 (3): 637 DOI: 10.1002/eat.23894 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2023/04/230405161354.htm

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