Symposia
Eating Disorders
Julia K. Nicholas, B.S.
PhD Student
University of Louisville
Louisville, Kentucky
Claire Cusack, M.A.
Doctoral Student
The University of Louisville
Louisville, Kentucky
Cheri Levinson, Ph.D.
Associate Professor
University of Louisville
Louisville, Kentucky
Individuals with eating disorders (EDs) exhibit fears related to food, eating, body image, and social evaluation (Levinson et al., 2019; Levinson & Byrne, 2015). ED behaviors are theorized to serve an avoidance function that alleviates acute distress but maintains ED fears over time (Butler & Heimberg, 2020). One intervention that targets fear is exposure therapy. Exposure therapy has shown promise for treating EDs (Butler & Heimberg, 2020); however, it is unknown which fears should be targeted to produce maximal change in ED symptoms. This study examined changes in ED symptoms and fears over the course of an online, self-guided, imaginal exposure intervention. We used a novel approach to network analysis to identify symptoms and fears associated with the greatest change in overall ED pathology. Individuals with an ED (N = 143; ages 16 to 61 [M = 29.44, SD = 9.79], 97% female, 83% non-Hispanic White) participated in four online sessions of self-guided imaginal exposure in which they wrote about an ED fear. Participants completed measures of ED symptoms and fears at pre-treatment, post-treatment, and six-month follow-up. We constructed three models: networks of ED symptoms (Model 1), ED fears (Model 2), and combined symptoms and fears (Model 3). Change trajectory networks from the slopes of symptoms/fears across timepoints were estimated to identify how change in ED symptoms/fears related to change in overall ED pathology. In Model 3, bridge strength centrality was calculated to identify pathways between changes in fears and symptoms. Results indicated that the most central changing symptoms and fears were feeling fat, fear of weight gain, guilt about one’s weight/shape, and feared concerns about the consequences of eating. In Model 3, change in ED fears bridged to change in desire to lose weight, desiring a flat stomach, following food rules, concern about eating with others, and guilt about one’s weight/shape. These findings indicate that fears of weight gain and consequences of eating may be optimal targets for ED exposure therapy, as changes in these fears were associated with the greatest change in global ED pathology. The finding that feeling fat and guilt were the most central changing symptoms suggests that increased distress tolerance may be an important mechanism of change in ED exposure therapy. In addition to identifying potential fear targets and mechanisms of change in exposure therapy for EDs, this study demonstrates the utility of slope networks to elucidate mechanisms of change across a range of psychological interventions.