Meal-Based Exposure and Response Prevention in Anorexia Nervosa
Condition: Anorexia Nervosa
MeSH terms: Anorexia; Anorexia Nervosa
Study type: Interventional

Summary: 
      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.
    


Intervention name(s): Exposure and Response Prevention; Motivational Interviewing
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Exposure and Response Prevention involves collaboratively developing a list of food-related fears with the patient and planning treatment sessions in which the patient is exposed to the fear and inhibits safety behaviors. The explicit goal of these exposure sessions will be to violate the patient's expectation regarding the feared stimulus, rather than to reduce fear.; Motivational interviewing techniques including reflective listening to demonstrate empathy and understanding, asking questions to elicit change talk (speech that is "pro-change"), evaluating the decisional balance, and managing or "rolling with" resistance will be incorporated throughout the treatment sessions.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment