In our previous blog, we defined Avoidant Restrictive Food Intake Disorder (ARFID) and detailed the impact of ARFID on both health and quality of life. In this second blog of our ARFID series, we’ll talk about treatment for ARFID; specifically, Cognitive Behavioral Therapy for ARFID (CBT-AR).
Cognitive Behavioral Therapy for ARFID (CBT-AR)
Cognitive Behavioral Therapy for ARFID (CBT-AR) has shown promise as an intervention for children, adolescents, and adults with ARFID and is the treatment, we at Columbus Park, use most often for our patients (ages 10+).
What is CBT-AR?
CBT-AR consists of four treatment stages across 20-30 sessions between the therapist and patient. For younger patients, the treatment will incorporate parent/family involvement and support.
Four Stages of CBT-AR:
Stage One: The first stage of CBT-AR involves education about ARFID and highlighting the individual factors that are keeping the patient stuck in restrictive or avoidant patterns. In this first stage, the therapist will address the physical health of the patient, intervening if the patient is malnourished or underweight. The therapist might explore past negative experiences for the patient around food-related discomfort (i.e. pain), difficulty swallowing, or traumatic experiences of choking or vomiting. Additional key tasks of stage one include setting up self-monitoring in order to collect data on one’s eating patterns and working toward a schedule of regular eating (if not present already).
Stage Two: The second stage of CBT-AR focuses on setting goals and outlining the specific targets for Stage Three of the treatment. During this phase of treatment, it’s important for the patient and therapist to collaboratively explore any barriers to treatment progress.
Stage Three: The third stage of CBT-AR varies in terms of content and also the length of time to complete it. During this stage, the patient is systematically and actively working through their food fears and aversions. Through exposure, patients slowly acclimate to new food experiences and begin to increase their tolerance to accommodate a wider range (and in some cases, also a continued increase in volume).
Stage Four: The fourth and final stage sets the patient up for long term success by developing plans to prevent relapse. The patient has gained tools to effectively continue their exploration and expansion into new foods once treatment has ended.
CBT-AR sessions are highly structured with a clear agenda for each and every meeting. Practice between sessions is essential to a successful treatment so “homework” is assigned and then reviewed the following week.
The goal of CBT-AR is for the patient to no longer meet criteria for ARFID by treatment end. The expectation is that there will be a considerable expansion of the patient’s intake and that any nutritional deficiencies have been corrected. CBT-AR patients should be able to eat several foods in each of the major food group categories by the end of their CBT-AR course. Further, we would expect for the patient’s weight to be normalized – for younger patients, this means that they are back on their healthy growth trajectory (assuming low weight was a concern).
In our next blog, we’ll discuss an ARFID treatment designed specifically for children, ages 4-10. Developed by Nancy Zucker, Ph.D., and her colleagues and Duke Center for Eating Disorders, Feelings and Body Investigators is a novel treatment, designed to support the very specific needs of our youngest patients with ARFID.
ARFID Intervention Series at Columbus Park:
Food and Body Investigators (FBI) for children (ages 4-10) with ARFID – coming soon
If you or a loved one is struggling with an eating disorder, please reach out to our team at firstname.lastname@example.org to discuss treatment options.