Symposia
Eating Disorders
Brenna Williams, M.S.
Doctoral student
University of Louisville
Louisville, Kentucky
Mackenzie L. Brown, PhD
Doctoral Student
University of Louisville
Louisville, KY
Cheri Levinson, Ph.D.
Associate Professor
University of Louisville
Louisville, Kentucky
A growing body of research suggests that exposure therapy is efficacious for the treatment of EDs (Butler & Heimberg, 2020). However, there is currently little research investigating mechanisms of change during exposure therapy for EDs. The current study (N=143 individuals with a current ED diagnosis) expanded on an open series trial of imaginal exposure for EDs that found significant reductions in ED symptoms and core ED fears (Levinson et al., 2020). There are several other potential mechanisms that may be important over the course of exposure treatments for EDs, including anxiety, drive for thinness, and body dissatisfaction. However, these factors have yet to be empirically tested as mechanisms driving change during ED treatment. Research showing that these mechanisms mediate changes in ED pathology would suggest that targeting these symptoms could improve treatment outcomes.
In the current study (N=143) we investigated the potential within-session anxiety (e.g., pre-exposure anxiety, anxiety during exposures, and post-exposure anxiety) and body-related mechanisms (i.e., drive for thinness, body dissatisfaction) underpinning change in ED symptoms and core ED fears (e.g., anxiety about eating, food anxiety behaviors, feared concerns, fear of weight gain, fear of social consequences, fear of personal consequences, fear of physical sensations, and fear of social eating) during four sessions of online imaginal exposure treatment for EDs. We used the PROCESS tool (Hayes, 2013) in SPSS V26 to conduct mediational analyses.
We found that pre-exposure anxiety, anxiety during exposures, post-exposure anxiety, drive for thinness, and body dissatisfaction were all mechanisms of change for ED symptoms and/or core ED fears (ps< .05).
Our findings suggest that anxiety and body-related symptoms may be mechanisms driving change during exposure therapy for EDs. Targeting these mechanisms, especially anxiety and drive for thinness, may be especially important when using exposure therapy for those with EDs. Furthermore, our findings suggest that for successful exposure to occur, it is necessary for patients to experience higher levels of anxiety. Clinicians might target drive for thinness by encouraging patients to focus their scripts on gaining large amounts of weight. Clinicians might target body dissatisfaction by asking patients to focus their script on how their body looks or using interoceptive exposures.