Meal‐Based Exposure and Response Prevention in Anorexia Nervosa

Patients with anorexia nervosa (AN), a serious psychiatric disorder, exhibit restricted
dietary intake and endorse fear of consuming calorie-dense foods, which in turn drives weight
loss. Premorbid anxious personality traits and comorbid anxiety disorders are common in
patients with AN. Although intensive behavioral treatment programs can achieve weight
restoration in a majority of adults with AN, relapse rates are high. Predictors of relapse
include elevated state anxiety and low dietary variety, including lower intake of fat, after
discharge, which suggests that relapse following weight restoration may be related to
inadequate fear extinction to high energy density (ED) foods during treatment and consequent
resumption of restrictive eating patterns. Despite evidence of anxiety's role in the onset
and maintenance of restricted eating behavior, utilizing exposure and response prevention
(EX-RP) and meal-based interventions to reduce food-related fears is understudied. EX-RP is
the gold standard of treatment for Obsessive Compulsive Disorder (OCD). This proposal aims to
test the efficacy of an adjunct meal-based EX-RP intervention to reduce food-related fears
during intensive behavioral weight restoration in hospitalized patients with AN in comparison
to a control treatment, Motivational Interviewing. The investigators will assess changes in
a) self-reported anxiety regarding consumption of high-ED foods, b) physiological (skin
conductance and heart rate variability) responses to imagined consumption of food items
elicited utilizing a visual food cue task, and c) caloric intake of a challenging test meal
pre- and post-treatment. A secondary aim is to assess the relationship of early treatment
response to EX-RP, operationalized as a reduction in self-reported anxiety within the first
three weeks of treatment, and end-of-treatment as well as six-month post-discharge outcomes.
Helping patients tolerate food-related anxiety and increase dietary variety across meal
contexts may augment treatment effectiveness in adult patients during intensive treatment for
AN and has potential to decrease relapse rates.