Exposure and Response Prevention Therapy: Tools for Mitigating Fear

Contributor: Rachel Wood, Ph.D. PSY, Executive Director of Admissions and Business Relations Center For Discovery

Anxiety and obsessive compulsive disorder (OCD) often co-occur with eating disorders. The eating disorder behaviors, in part fueled by an intense fear of weight gain, become compulsive and ritualistic in nature- if the behaviors are not performed, the anxiety becomes too intense to bear.

Exposure Response Prevention (ERP) is a therapy that stems from Cognitive Behavioral Therapy (CBT) principles and has been shown to be an effective treatment for anxiety and OCD.

Some eating disorder treatment programs also treat clients using ERP; Center for Discovery residential programs utilize ERP to assist clients in conquering their fear foods. Reducing anxiety and mitigating behaviors is a formula for lasting recovery, and ERP is a promising modality for helping clients achieve their treatment goals.

What is Exposure and Response Prevention?

Imagine being terrified of spiders, to the point that being in any proximity to the insect brings on severe panic attacks. Such a fear may even lead you to begin checking around the rooms in your house, looking for spiders, before you can relax.

This checking behavior becomes compulsive- in other words, you can’t relax until it’s been done. The problem is that even if you’ve checked once, your anxiety may still be so high you feel the need to check again and again. This becomes a time-consuming, and ultimately life-interrupting, process.

According to the International OCD Foundation, there is a difference between confronting your obsessions and choosing to not engage in the compensatory behavior. ERP asks clients to both confront fears and stop using behaviors. The benefit to this approach, while scary and anxiety-producing in and of itself, is that repeated and prolonged exposure to the fear will eventually result in a drop in anxiety levels.

ERP in Action

How does this work for eating disorder clients? Consider someone who is terrified to use butter. She is unable to even consider trying it because she is afraid it will make her gain weight. ERP would focus on exposing this client to butter over time…initially it might mean just looking at the container, then moving on to holding the container, opening the lid, touching the butter, and eventually tasting the butter and becoming able to ingest it.

As the client gains confidence in her ability to not engage in behaviors, the anxiety begins to reduce. The act of saying no to compulsive behaviors, even though it can be terrifying, is habituated over time.

The fear and anxiety that surface around food and eating can be addressed successfully through ERP. For patients with anorexia nervosa, a new approach to ERP has been developed: AN-EXRP. According to an article in Eating Disorders Review, there are three phases to this treatment approach:

• Initial Phase: In this phase, the therapist works to discover the client’s experience of anxiety as it relates to their eating disorder and the rituals and compulsions developed to cope with the anxiety around food and eating. Here the client learns about how exposure challenges will reduce anxiety over time. Working together, the client and therapist will develop goals for in-session exposures and gradually work toward developing a plan for exposures the client can experience in between sessions.

• Middle Phase: Sessions will involve more intense challenges as the client becomes more adept at in- and –between session exposures. Any exposures that the client is unwilling to engage are repeated until mastered.

• End Phase: With a focus on relapse prevention, this phase indicates that the client has achieved 85% of his or her goals and is ready to take more initiative in the exposure process. The therapist’s role is to help the client develop strategies for different food-related situations and relapse prevention tools.

The authors of the Eating Disorders Review article report using the AN-EXRP approach with patients in their structured treatment program and found that after 12 sessions clients demonstrated a change in eating anxiety and food intake.

The fear and anxiety that are present with eating disorders, along with the overwhelming compulsions to engage in behaviors, can be tortuous. By consistently challenging fears through ERP, clients have a chance at a very different life.

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Dr. Rachel Wood is a licensed clinical psychologist and the Executive Director of Admissions and Business Relations at Center For Discovery. Rachel has served as Primary Therapist, Clinical Advisor to the Admissions Department and, most recently, Director of Admissions. Dr. Wood has been working in the mental health field for over 15 years and has experience in all levels of care (outpatient, intensive outpatient, partial hospitalization, residential and inpatient hospitalization). She earned her Masters of Arts and Doctor of Philosophy in Clinical Psychology from California School of Professional Psychology, San Francisco.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on January 31, 2016
Published on EatingDisorderHope.com