Exploring Mechanisms of Action in Exposure-Based Cognitive Behavioral Therapy for Eating Disorders: The Role of Eating-Related Fears and Body-Related Safety Behaviors. Issue 6 (November 2019)

• Record Type: Journal Article
• Authors: Farrell, Nicholas R.; Brosof, Leigh C.; Vanzhula, Irina A.; Christian, Caroline; Bowie, Owen R.; Levinson, Cheri A.
• Is Part Of: Behavior therapy. Volume 50:Issue 6(2019)
• Page Start: 1125
• Page End: 1135
• Publication Date: 2019-11
• Subjects: exposure therapy -- cognitive behavioral therapy -- eating disorders -- mechanisms of action; Behavior therapy -- Periodicals; 616.8914205
• DOI: 10.1016/j.beth.2019.01.008
• Languages: English
• ISSNs: 0005-7894

Abstract

Abstract: Evidence-based cognitive behavioral therapy for eating disorders includes a component of exposure therapy, which involves patients confronting feared eating and body-related stimuli while preventing safety behaviors. With recent research demonstrating that eating-related fears and safety behaviors are central to eating disorder pathology, there is increased emphasis on improving the efficacy of exposure therapy in eating disorders. Doing so will require a better understanding of important mechanisms of action in this treatment. The present study explored how changes during treatment in eating-related fears and avoidance as well as body-related safety behaviors influence overall treatment outcomes. Individuals with eating disorders ( N = 71) receiving exposure-based treatment completed measures of global eating disorder severity at admission and discharge. Hypothesized mechanisms of action were also assessed at admission and discharge as well as at a 2-week time point after beginning treatment. Path modeling analyses showed that decreased eating-related cognitions (feared concerns about eating) and emotions (anxiety about eating) at the 2-week time point were prospectively predictive of lowered global eating disorder symptom severity at discharge. Additionally, reduced body checking and avoidance behaviors after 2 weeks of treatment were also associated with lower eating disorder severity at discharge. These findings highlight the importance of exposure-based therapy in eating disorders and the need to uniquely address eating-related fears and safety behaviors. Highlights: Exposure-based therapy was highly effective in reducing eating disorder symptoms Lowered anxiety and feared concerns about eating predicted better treatment outcome Reduced frequency of body-related safety behaviors also predicted better outcome No hypothesized change mechanisms mediated changes in global symptom severity