Exposure Therapy: Reducing Relapse Rates for Adults with AN

Could a commonly used intervention for anxiety & OCD-related disorders be key to curbing post-treatment relapse in adults with anorexia nervosa? Researchers out of New York Psychiatric Institute set out to demonstrate that Exposure & Response Prevention for anorexia nervosa (AN-EXRP) could prevent the return of ritualistic eating behaviors and pre-meal anxiety and promote long term recovery. Research has demonstrated that as many as 30-50% of adults receiving treatment on an inpatient hospital unit will relapse within a year of their program discharge. Longitudinal studies have demonstrated that after achieving weight restoration (the critical first step to recovery) there is a clear reduction in psychological symptoms, although many of the rituals and fears associated with caloric intake and pre-meal anxiety are under addressed post-treatment. Exposure and Response Prevention (AN-EXRP) has been targeted to engage patients in confronting these fears and decreasing anxiety around meal time in the hopes of promoting long-term recovery and decreasing relapse rates.

AN-EXRP research was conducted on a short-term hospital research unit at the New York State Psychiatric Institute (NYSPI) with participants ages 16-45. Once patients achieved weight restoration (quantified at a BLI of >18.5 kg/m2) they were provided 12 sessions of either AN-EXRP or Cognitive Remediation Therapy (an easy-to-use intervention aimed at reducing cognitive inflexibility). Results evaluated the change in caloric intake in a subsequent assessment of eating behavior upon the completion of 12 structured behavioral sessions.

Those participants who received AN-EXRP experienced a 50kcal increase in caloric intake post-treatment as compared to those who received CPT and demonstrated a 77kcal decrease in caloric intake post treatment. Historically, as research has demonstrated, food intake will rapidly decline after discharge from a structured inpatient setting. This 77kcal decrease in CRT recipients may be a potential demonstration of this known phenomenon at play. Initial review of AN-EXRP has demonstrated that it is a credible intervention technique and may been associated with better caloric intake over time. AN-EXRP may serve to promote the continuation of healthy behaviors obtained on the unit, provide recipients with management tools to be used once discharged and contribute to longer term recovery. Considering evaluations have been confined to an inpatient, research-based setting, more research must be done in a generalized setting, such as an outpatient treatment program, to prove whether it will lead to widespread, long-lasting reduction in relapse rates.

At Columbus Park Treatment Center in New York City, we know and practice AN-EXRP and can implement it with AN clients who are nearing weight restoration. We consider exposure work a regular part of our standard practice and an intervention we also use with BN and BED clients. Interested in learning more about the ways in which we utilize AN-EXRP and related treatments here at Columbus Park? Contact us HERE.



  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927538/