Tom Hildebrandt1, Deena Peyser1, Robyn Sysko1. 1. Eating and Weight Disorders Program, Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Abstract
BACKGROUND: Anorexia nervosa (AN) usually develops in early adolescence and is characterized by high rates of morbidity and mortality. Family-based therapy (FBT) is the leading evidence-based treatment for adolescents with AN, but not all patients experience sufficient improvement. The purpose of this manuscript is to describe the development and subsequent experience with a Family-Based Interoceptive Exposure (FBT-IE) for adolescents with a broader form of low-weight eating disorders. METHODS: The novel IE-based behavioral intervention is a six-session family-based treatment module designed to directly target and modify disgust by altering the prefrontal regulation of the insula response to aversive stimuli by decreasing visceral sensitivity (e.g., bloating). Each session teaches a new skill regarding tolerating distress to visceral sensations associated with disgust and an in-vivo "IE exercise," in which the family is provided with a meal replacement shake of unknown content and caloric density. RESULTS: In this novel treatment, the patient learns to tolerate disgust in the context of a challenging food stimulus as a way to increase consumption of restricted foods outside of session. CONCLUSION: We discuss successes and challenges executing this treatment with patients with low-weight eating disorders and propose future directions for the intervention.
BACKGROUND: Anorexia nervosa (AN) usually develops in early adolescence and is characterized by high rates of morbidity and mortality. Family-based therapy (FBT) is the leading evidence-based treatment for adolescents with AN, but not all patients experience sufficient improvement. The purpose of this manuscript is to describe the development and subsequent experience with a Family-Based Interoceptive Exposure (FBT-IE) for adolescents with a broader form of low-weight eating disorders. METHODS: The novel IE-based behavioral intervention is a six-session family-based treatment module designed to directly target and modify disgust by altering the prefrontal regulation of the insula response to aversive stimuli by decreasing visceral sensitivity (e.g., bloating). Each session teaches a new skill regarding tolerating distress to visceral sensations associated with disgust and an in-vivo "IE exercise," in which the family is provided with a meal replacement shake of unknown content and caloric density. RESULTS: In this novel treatment, the patient learns to tolerate disgust in the context of a challenging food stimulus as a way to increase consumption of restricted foods outside of session. CONCLUSION: We discuss successes and challenges executing this treatment with patients with low-weight eating disorders and propose future directions for the intervention.
Authors: Beate Herpertz-Dahlmann; Reinhild Schwarte; Melanie Krei; Karin Egberts; Andreas Warnke; Christoph Wewetzer; Ernst Pfeiffer; Christian Fleischhaker; André Scherag; Kristian Holtkamp; Ulrich Hagenah; Katharina Bühren; Kerstin Konrad; Ulrike Schmidt; Carmen Schade-Brittinger; Nina Timmesfeld; Astrid Dempfle Journal: Lancet Date: 2014-01-17 Impact factor: 79.321
Authors: Sevgi Bektas; Johanna Louise Keeler; Lisa M Anderson; Hiba Mutwalli; Hubertus Himmerich; Janet Treasure Journal: Nutrients Date: 2022-04-21 Impact factor: 6.706