Exposure Therapy for Eating Disorders

Synopsis

Exposure Therapy for Eating Disorders is designed to augment existing eating disorder treatment manuals by providing clinicians with practical advice for maximizing the effectiveness of exposure, regardless of clinical background or evidence-based treatment used. Suitable for use with a range of diagnoses, this easy-to-use guide describes the most up to date empirical research on exposure for eating disorders, extrapolating clinical advice from the anxiety disorders literature in order to help busy clinicians become more effective in treating these challenging illnesses. Readers will gain solid understanding of the theoretical underpinnings of exposure therapy, as well as how to utilize this information to explain the rationale for exposure to patients. Specific types of eating disorder exposure are covered in detail, including exposure to food and eating, cue exposure for binge eating, weighing and weight exposure, novel forms of exposure for eating disorders, and more. The book also provides strategies for overcoming obstacles, including institutional resistance to implementation of exposure therapy.

Summary

Chapter 1: Overview of Exposure Therapy for Eating Disorders

* Summary: Introduces exposure therapy, its principles, effectiveness, and applicability to eating disorders.
* Real Example: A case study of Sarah, a 25-year-old woman with anorexia nervosa, who avoids eating in public due to intense anxiety.

Chapter 2: Cognitive-Behavioral Model of Eating Disorders

* Summary: Explores the cognitive-behavioral factors that contribute to eating disorders, including distorted body image, fear of weight gain, and restrictive eating patterns.
* Real Example: Sarah's belief that she is "too fat" and her consequent avoidance of certain foods due to fear of weight gain.

Chapter 3: Types of Exposure Therapy

* Summary: Discusses different types of exposure therapy, including in vivo exposure, imaginal exposure, and interoceptive exposure.
* Real Example: In vivo exposure for Sarah involves gradually exposing her to feared foods in public settings. Imaginal exposure entails visualizing herself eating in front of others.

Chapter 4: Preparing for Exposure Therapy

* Summary: Describes the importance of therapist-patient collaboration, developing a treatment plan, and building a strong therapeutic relationship.
* Real Example: Sarah and her therapist agree on a hierarchy of feared foods and public eating situations, starting with less challenging exposures.

Chapter 5: Initial Exposure Sessions

* Summary: Explains how to conduct initial exposure sessions, including setting clear goals, providing support, and gradual exposure to feared stimuli.
* Real Example: Sarah starts by eating a small portion of her feared food in a safe setting, gradually increasing the amount and location of exposure.

Chapter 6: Intermediate Exposure Sessions

* Summary: Discusses strategies for managing anxiety during intermediate exposure sessions, such as cognitive restructuring, relaxation techniques, and supportive dialogue.
* Real Example: While eating in a crowded restaurant, Sarah experiences anxiety, but she challenges her negative thoughts and uses relaxation techniques to cope.

Chapter 7: Advanced Exposure Sessions

* Summary: Focuses on addressing more challenging exposures, such as eating in highly triggering situations and managing body size fluctuations.
* Real Example: Sarah confronts her fear of weight gain by monitoring her weight without engaging in restrictive behaviors.

Chapter 8: Preventing Relapse and Maintaining Gains

* Summary: Emphasizes the importance of developing relapse prevention plans, including coping mechanisms, self-monitoring, and ongoing support.
* Real Example: Sarah continues to practice her exposure strategies, attends support groups, and engages in regular check-ins with her therapist.

Chapter 9: Special Considerations for Specific Eating Disorders

* Summary: Addresses unique challenges and adaptations of exposure therapy for different eating disorders, such as anorexia nervosa, bulimia nervosa, and binge-eating disorder.
* Real Example: For Sarah with anorexia nervosa, exposure to caloric intake and normal body weight is crucial. For bulimia nervosa, interoceptive exposure is emphasized to challenge the urge to purge.