7 - (IOP 34) Analysis of Feedback Provided During a Self-guided Imaginal Exposure Intervention for Eating Disorders

Background: Self-guided exposure-based interventions have the potential to decrease anxiety and eating disorder symptoms and to increase access to care. Without therapist guidance in-session, it remains uncertain whether participants are able to effectively confront fears without engaging in avoidance behaviors, including emotional or cognitive avoidance. Analyzing feedback provided during a self-guided exposure-based intervention may identify areas of difficulty for participants and inform future intervention development.

Method: The current study utilizes the imaginal exposure condition within a randomized controlled trial investigating the efficacy of four sessions of online, self-guided imaginal exposure compared to writing and thinking. Participants (N = 56) were adults with any eating disorder who were discharged from a higher level of care within the past four months. A top fear was selected via assessment, and participants were instructed to write about and imagine their worst feared situation for an extended period of time. Participants received feedback on their imaginal exposure scripts after sessions one through three from a clinical psychologist. We categorized feedback provided via a coding manual with 13 feedback types (e.g., Confront Feared Consequences, Safety Behaviors/Avoidance, More Time, More Detail, Increase Anxiety, Distractions, Emotional Avoidance, Cognitive Avoidance, etc.). Feedback was coded by a trained rater, and second rater coded 20% of the feedback to assess reliability. Raters achieved 92.7% agreement on feedback type.

Results: Following session one, the frequencies of feedback types given were Confronting Feared Consequences (57.1%), More Time (46.4%), Safety Behaviors/Avoidance (39.3%), More Detail (14.3%), Emotional Avoidance (17.9%), Increase Anxiety (10.7%), Self-Harm/Suicidal Ideation (10.7%), Present Moment (8.9%), Top Fear (1.8%), Distraction (1.8%), and Other (1.8%). All participants received Positive Feedback within the feedback template. Proportion of participants receiving each feedback type across all three sessions will be presented.

Conclusions: The most common feedback provided focused on encouraging participants to confront the feared consequences related to their core fear. Additionally, participants were frequently encouraged to refrain from writing about safety behaviors or avoidance behaviors (e.g., restriction, purging, body checking). Participants were often encouraged to spend more time writing about and imagining their feared scenario, suggesting that sessions were shorter than a typical exposure session. These findings point to the need for consideration of specific areas of difficulty (i.e., confronting fears, use of safety behaviors) in the design of future self-guided exposure-based treatments, as these are core components of exposure therapy that may limit the efficacy of these interventions.