Traditional Workshop 2 - Exposure Therapy in the Treatment of Eating Disorders

Eating disorders (EDs) are associated with profound medical consequences and high mortality rates. Treatment outcomes from current evidence-based approaches are notoriously poor, with only 30-50% of patients achieving remission (Atwood & Friedman; Kaidesoja et al., 2022). In order to optimize treatment outcomes for EDs, new approaches must address core maintaining mechanisms. Emerging theory and research suggest that fear is a central maintaining factor in EDs, which drives disordered eating behaviors (Murray et al., 2018; Schaumberg et al., 2021). For example, fear of weight gain may lead to food avoidance, overexercise, or purging to prevent feared outcomes from materializing (Schaumberg et al., 2021). Although there is variability among individuals, common core fears experienced by those with EDs are transdiagnostic and include fears related to one’s body shape and weight, food, judgment by others, and loss of control (Butler et al., 2023). Conceptualization of EDs as fear-based disorders calls for the translation of exposure therapy to EDs (Butler & Heimberg 2020; Schaumberg et al., 2021). Despite the promising status of the literature, few clinicians currently use exposure therapy in practice with EDs (Waller et al., 2012, 2016). The current workshop seeks to bridge the gap between research and practice by teaching clinicians how to effectively apply exposure therapy with clients with EDs. The workshop will describe the theoretical and empirical rationale for using exposure therapy in ED treatment and provide training in evidence-based approaches to exposure therapy for EDs, including exposure to feared foods, body image exposures, imaginal exposures, and interoceptive exposures. Inclusive, justice-based exposure practices (Pinciotti et al., 2024) for clients across the weight spectrum will be discussed. Experiential methods will also be employed, including demonstrations, role play, and a clinical exercise applying exposure therapy with an ED case example. The workshop will conclude with a discussion of common challenges and methods to optimize exposure therapy outcomes (e.g., using inhibitory learning strategies (Craske et al., 2014). Attendees will have opportunities to discuss and receive feedback on cases.

Recommended Reading 1: Griffen, T. C., Naumann, E., & Hildebrandt, T. (2018). Mirror exposure therapy for body image disturbances and eating disorders: A review. Clinical Psychology Review, 65, 163-174.

Recommended Reading 2: Butler, R. M., & Heimberg, R. G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical Psychology Review, 78, 101851.

Recommended Reading 3: Reilly, E. E., Anderson, L. M., Gorrell, S., Schaumberg, K., & Anderson, D. A. (2017). Expanding exposure‐based interventions for eating disorders. International Journal of Eating Disorders, 50(10), 1137-1141.

Recommended Reading 4: Schaumberg, K., Reilly, E. E., Gorrell, S., Levinson, C. A., Farrell, N. R., Brown, T. A., ... & Anderson, L. M. (2021). Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research. Clinical Psychology Review, 83, 101952.

Recommended Reading 5:

Outline:
• Rationale and evidence for using exposure therapy in the treatment of eating disorders (30-45 min)
• Approaches to exposure therapy for eating disorders
Imaginal exposure (15 min)
Feared food exposure (15 min)
Body image and mirror exposure (15 min)
Interoceptive exposure (15 min)
Weight-inclusive exposure approaches (15 min)
• Clinical application with a case example (45 min)
• Troubleshooting common difficulties and optimization of exposure therapy (15 min)