Imaginal exposure therapy is an ideal form of exposure to target fears centered on weight gain, as it is impossible to recreate rapid weight gain or feared consequences associated with weight gain. One form of exposure therapy is “imaginal exposure therapy” (i.e., imagining a feared stimuli) and is used for treatment of feared stimuli that are inaccessible in vivo (e.g., recreation of past trauma in PTSD Berman, Summers, Weingarden, & Wilhelm, 2019). Exposure therapy outperforms control treatments in hundreds of RCTs ( Bryant et al., 2008) and is efficacious in naturalistic treatment settings ( Matthews, Maunder, Scanlan, & Kirkby, 2017). This treatment has been adapted to all anxiety disorders, post-traumatic stress disorder (PTSD), and obsessive–compulsive disorder (OCD Foa & McLean, 2016). This treatment relies on decades of research establishing exposure therapy as the treatment with the strongest evidence base for reduction of severe fear and anxiety, which targets cognitive-affective pathology ( Murray et al., 2016).Įxposure therapy is the standard of care for anxiety disorders ( Abramowitz, Deacon, & Whiteside, 2011), by means of systematic exposure to feared stimuli. Our team has developed the only treatment specifically engaging fear of weight gain in EDs, which was found to be feasible with large effects sizes for changes in ED symptoms and fears of weight gain ( Levinson et al., 2020). Fear of weight gain is central to the definition of EDs in every iteration of diagnostic frameworks ( Levinson et al., 2017) and is fundamental in maintaining other cognitive-behavioral symptoms of EDs, as well as predicts treatment outcomes ( Levinson, Vanzhula, & Brosof, 2018). Exposure therapy explicitly targeting food produces a statistically significant, but clinically modest increase in caloric intake ( Steinglass et al., 2012). Most literature targeting fear learning in EDs has focused on the fear of food, which is important, but neglects other key ED fears, such as fear of weight gain. Despite known overlap among anxiety disorders and EDs ( Keel, Klump, Miller, McGue, & Iacono, 2005), little is known about the precise mechanisms of fear learning in EDs. Ultimately, this research will lead to the development of an easily deployable readmission prevention treatment based on fear conditioning targets.įear learning (i.e., acquisition, development, and maintenance of fear from a conditioned response to a stimuli, originating from the anxiety disorder literature), is a central cognitive-affective component of EDs ( Murray et al., 2018). We will test the efficacy of the imaginal exposure treatment in reducing ED symptoms and fears of food and weight gain, and whether fear learning is a mechanism of change related to ED pathology. We will examine the feasibility and acceptability of the treatment conditions and whether imaginal exposure is more effective in preventing readmission than the control condition. Exposure participants write about and imagine an ED fear and control participants will write about their ED generally.
MAIL PILOT 2.3.1 REVIEW TRIAL
In the current pilot randomized control trial (RCT), participants will be randomly assigned to a five-session online imaginal exposure condition ( n = 65) or a control online writing and thinking intervention ( n = 65) within a month of discharge from intensive treatment. Imaginal exposure therapy facilitates the approach of feared stimuli not accessible in everyday life (e.g., rapidly gaining weight). Interventions addressing unremitted cognitive ED pathology following discharge from intensive treatment are crucial to prevent readmission.
More than 50% of individuals with an eating disorder (ED) will readmit to treatment within 6 months of treatment discharge and often due to persistent cognitive ED pathology.
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