Helen Burton Murray1,2,3, Kendra R Becker2,3, Lauren Breithaupt2,3, Melissa J Dreier2, Kamryn T Eddy2,3, Jennifer J Thomas2,3. 1. Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA. 2. Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA. 3. Harvard Medical School, Boston, Massachusetts, USA.
Abstract
OBJECTIVE: The mechanisms through which cognitive-behavioral therapies (CBTs) for avoidant/restrictive food intake disorder (ARFID) may work have yet to be elucidated. To inform future treatment revisions to increase parsimony and potency of CBT for ARFID (CBT-AR), we evaluated change in food neophobia during CBT-AR treatment of a sensory sensitivity ARFID presentation via a single case study. METHOD: An adolescent male completed 21, twice-weekly sessions of CBT-AR via live video delivery. From pre- to mid- to post-treatment and at 2-month follow-up, we calculated percent change in food neophobia and ARFID symptom severity measures. Via visual inspection, we explored trajectories of week-by-week food neophobia in relation to clinical improvements (e.g., when the patient incorporated foods into daily life). RESULTS: By post-treatment, the patient achieved reductions across food neophobia (45%), and ARFID severity (53-57%) measures and no longer met criteria for ARFID, with sustained improvement at 2-month follow-up. Via visual inspection of week-by-week food neophobia trajectories, we identified that decreases occurred after mid-treatment and were associated with incorporation of a food directly tied to the patient's main treatment motivation. DISCUSSION: This study provides hypothesis-generating findings on candidate CBT-AR mechanisms, showing that changes in food neophobia were related to food exposures most connected to the patient's treatment motivations. PUBLIC SIGNIFICANCE: Cognitive-behavioral therapies (CBTs) can be effective for treating avoidant/restrictive food intake disorder (ARFID). However, we do not yet have evidence to show how they work. This report of a single patient shows that willingness to try new foods (i.e., food neophobia), changed the most when the patient experienced a clinical improvement most relevant to his motivation for seeking treatment.
OBJECTIVE: The mechanisms through which cognitive-behavioral therapies (CBTs) for avoidant/restrictive food intake disorder (ARFID) may work have yet to be elucidated. To inform future treatment revisions to increase parsimony and potency of CBT for ARFID (CBT-AR), we evaluated change in food neophobia during CBT-AR treatment of a sensory sensitivity ARFID presentation via a single case study. METHOD: An adolescent male completed 21, twice-weekly sessions of CBT-AR via live video delivery. From pre- to mid- to post-treatment and at 2-month follow-up, we calculated percent change in food neophobia and ARFID symptom severity measures. Via visual inspection, we explored trajectories of week-by-week food neophobia in relation to clinical improvements (e.g., when the patient incorporated foods into daily life). RESULTS: By post-treatment, the patient achieved reductions across food neophobia (45%), and ARFID severity (53-57%) measures and no longer met criteria for ARFID, with sustained improvement at 2-month follow-up. Via visual inspection of week-by-week food neophobia trajectories, we identified that decreases occurred after mid-treatment and were associated with incorporation of a food directly tied to the patient's main treatment motivation. DISCUSSION: This study provides hypothesis-generating findings on candidate CBT-AR mechanisms, showing that changes in food neophobia were related to food exposures most connected to the patient's treatment motivations. PUBLIC SIGNIFICANCE: Cognitive-behavioral therapies (CBTs) can be effective for treating avoidant/restrictive food intake disorder (ARFID). However, we do not yet have evidence to show how they work. This report of a single patient shows that willingness to try new foods (i.e., food neophobia), changed the most when the patient experienced a clinical improvement most relevant to his motivation for seeking treatment.
Authors: Jennifer J Thomas; Kendra R Becker; Megan C Kuhnle; Jenny H Jo; Stephanie G Harshman; Olivia B Wons; Ani C Keshishian; Kristine Hauser; Lauren Breithaupt; Rachel E Liebman; Madhusmita Misra; Sabine Wilhelm; Elizabeth A Lawson; Kamryn T Eddy Journal: Int J Eat Disord Date: 2020-08-09 Impact factor: 4.861
Authors: Helen Burton Murray; Melissa J Dreier; Hana F Zickgraf; Kendra R Becker; Lauren Breithaupt; Kamryn T Eddy; Jennifer J Thomas Journal: Int J Eat Disord Date: 2021-04-22 Impact factor: 4.861
Authors: Jennifer J Thomas; Kendra R Becker; Lauren Breithaupt; Helen Burton Murray; Jenny H Jo; Megan C Kuhnle; Melissa J Dreier; Stephanie Harshman; Danielle L Kahn; Kristine Hauser; Meghan Slattery; Madhusmita Misra; Elizabeth A Lawson; Kamryn T Eddy Journal: J Behav Cogn Ther Date: 2021-03-03