Symposia
Eating Disorders
Nicholas Farrell, Ph.D.
NOCD
Wauwatosa, Wisconsin
Caroline Christian, M.S.
Doctoral Student
The University of Louisville
Fort Thomas, Kentucky
Cheri Levinson, Ph.D.
Associate Professor
University of Louisville
Louisville, Kentucky
Introduction: Despite its well documented efficacy, the precise therapeutic mechanisms of action in cognitive behavioral therapy for eating disorders (CBT-ED) are not well understood. Exposure therapy is an important component of CBT-ED and emphasizes prevention of safety behaviors, including body checking and body image avoidance behaviors. The objective of this study was to assess the role of early change in body checking and avoidance behaviors in predicting overall treatment response among adults receiving CBT-ED.
Methods: A mixed ED diagnosis sample of adults (N = 87; M age = 27.83 years, SD = 9.22; M body mass index = 23.38, SD = 10.56; 86.2% female; 80.4% European American) were treated with CBT-ED in a partial hospitalization program for an average treatment duration of 5.86 weeks (SD = 1.89). Global ED severity was assessed at baseline and posttreatment. Body checking and body image avoidance behaviors were also assessed at baseline and posttreatment as well as at a two-week time point after baseline to assess early change.
Results: As expected, there was a significant decrease in global ED severity from baseline to posttreatment, t(86) = 7.31, p< .001, d = 1.31. Path modeling analyses showed that while controlling for baseline ED severity and BMI, reductions in body checking (ß = .52, p < .001) and avoidance behaviors (ß = .44, p < .001) by the two-week time point were predictive of lower ED severity at posttreatment.
Discussion: The present findings indicate that there are multiple behavioral mechanisms of change underlying overall treatment benefit in CBT-ED, which is consistent with literature on mechanisms of action in CBT for anxiety disorders. Although emphasis on addressing body image disturbance tends to be done in the later phases of ED treatment, these data indicate that earlier emphasis on reducing body checking and body image avoidance behaviors may maximize overall treatment response in CBT-ED.