(PS5-79) Understanding experiences with feared food exposures: A qualitative study of adults with eating disorders

Abstract Text: Feared food exposures are a core component of cognitive behavioural therapy (CBT) for eating disorders (Weissman et al., 2017) and entail eating an anxiety-eliciting food without engaging in compensatory behaviours like vomiting or over-exercising to ‘undo’ the calories consumed. Although individuals with eating disorders can experience reduced anxiety about the foods they expose themselves to through these exposures (Levinson & Williams, 2020), eating disorder clinicians only have somewhat favorable views of these exposures and some clinicians view them as contributing to high treatment dropout rates (Levinson et al., 2019). Moreover, clinical anecdotes reveal that exposures evoke complex emotions for clients. Taken together, it seems there are important nuances to feared food exposure experiences that might only be apparent through dialogue with people with lived experience engaging in these exposures.

In this vein, the current study sought to gain a richer understanding of how people undergoing CBT for their eating disorder experience and navigate feared food exposures. We recruited 19 Canadian adults (Mage=30.84) who had completed a feared food exposure within eating disorder treatment, and who continued to meet criteria for an eating disorder at the time of participation. A 90-minute interview explored participants’ in-depth experience with a particularly salient planned feared food exposure completed without a therapist present. Specific attention was paid to the dynamic unfolding of their urges, behaviours, thoughts, and feelings leading up to, throughout, and after the exposure.

Thematic analysis identified four superordinate themes: (1) the distress during exposures is about much more than just eating the food (e.g., there are fears of increased expectations if successful, fears of changes to relationships); (2) being motivated by self-presentation or competition adds additional distress (i.e., distress is heightened when focused on accomplishing the exposure over the experience and intent, when comparing to others); (3) individuals adjust their experience in various ways to meet themselves where they are at (e.g., choosing to recruit support from others, adjusting one’s level of awareness/presence), and (4) control is a double-edge sword: distressing and empowering (e.g., greater responsibility for choices makes exposures feel more meaningful, autonomy increases guilt for breaking food rules).

Taken together, results illustrate the complex and nuanced experience of feared food exposures. Eating disorder clinicians and clients will benefit from considering these findings during exposure planning and preparation. This study also highlights the value of qualitatively understanding how clients experience aspects of CBT.