Tuesday, August 2, 2016

To Treat Anorexia Nervosa, Experts Say You Must First Identify Core Fears

To effectively treat patients with anorexia nervosa with exposure therapy, practitioners must first disentangle the feared stimuli and feared outcomes of patients with the disorder, Stuart Murray, Ph.D., of the University of California, San Francisco, and colleagues advised in an article in JAMA Psychiatry

“The treatment of AN [anorexia nervosa], by virtue of directly targeting the primary phobic content (i.e., weight gain), inherently centralizes exposure-driven processes. Thus, a comprehensive distillation of the core fear is both novel and necessary in optimizing the potency of treatments,” they wrote. For instance, if food consumption is conceptualized as the core feared stimulus, and weight gain as the feared outcome, it is possible that the introduction of previously eliminated/feared foods alongside the necessary weight gain throughout weight restoration may confirm the notion that these foods are indeed ‘dangerous’ as weight increases. … Alternatively, if one conceptualizes weight gain as the feared cue and aversive self-concept–related consequences as the feared outcome, treatment focusing entirely on food and weight gain may not provide adequate exposure training for violation of this fear.”

The diverse core fears associated with weight gain influence how patients with anorexia will respond to treatment. “For instance, the process of weight restoration may likely impart different cognitive outcomes depending on whether a patient’s core fear association relates to food consumption resulting in weight gain ... or weight gain resulting in self-concept–related aversive outcomes. ...”

The authors concluded, “It is only after the precise delineation of core fear associations in AN that targeted efforts to promote the long-term consolidation of their extinction may be effectively undertaken and tested. The application of exposure therapy without clearly delineating which fear-based expectancy one is attempting to violate is, at best, nonspecific or, at worst, contraindicated.”

For more on eating disorders, see the Psychiatric News column “Recognizing When Food Restriction Has Little to Do With Weight,” by B. Timothy Walsh, M.D., and Evelyn Attia, M.D.

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