I’m going to now walk you through step-by-step of how we implement what is called Exposure-Based Therapy in the treatment of males with eating disorders.
Let’s start with a brief overview of Exposure-Based Therapy, for those of you who are unfamiliar with this approach.
Historically, Exposure-Based Therapy is a very effective approach or addressing a wide variety of anxiety and fear-based problem.
What it involves, in a nutshell, is encouraging individuals to gradually begin to approach or confront scenarios, situations, and stimuli that evoke fear and to couple this with the prevention of what we call safety behaviors.
Safety behaviors are any kind of action, or mental activity that a person can engage in that is aimed at trying to, in some way, reduce anxiety or fear and prevent some kind of negative outcome from occurring.
Foundations of Exposure-Based Therapy
The first major foundation of Exposure-Based Therapy is that, as the individuals begin to confront fear-evoking scenarios, we know that their fear will gradually tend to dissipate and fade over time.
This is going to occur not only within a specific situation but, as the individually repeatedly confronts feared situations, their fear response is going to gradually diminish globally across repeated exposures.
Another major foundation of this approach is that exposure-based therapeutic activities allow patients to have good experiences where they can put their fear anticipated outcomes to the test.
What we know tends to occur is that in most cases, patients are going to learn one of two things:
- The outcome that they fear is either a lot less likely to occur than they had anticipated
- The patient comes to learn they can tolerate better than they had anticipated at the outset of treatment
Now, let me show you how we know that fear and anxiety based conditions can be maintained over a long period of time.
What we view as the most central feature across fear and anxiety based conditions is what we call “catastrophic beliefs,” which pertain to a feared situation or stimuli that the person might try to avoid.
To model this, let’s use a relatively straightforward example of a dog phobia.
Imagine that an individual with a dog phobia might endorse this catastrophic belief that dogs are violent, dangerous animals.
The effect of endorsing this belief is that this individual cannot help the fact that his attention is going to become naturally drawn more toward dogs or any kind of dog-related stimuli.
We can’t help the fact that when we fear some concept, our attention is naturally drawn or clued into that concept.
What this means is that, as this individual goes about day-to-day activities, there’s going to be a lot of increased perception or picking up on potential dog-related threats in the environment.
As such, when one encounters a dog, this is what will give rise to what we call a “threat forecast,” which is some kind of specific prediction that is unique to one that is in the situation.
Imagine that a dog is approaching this individual as he is walking down the street.
A threat forecast might pop into mind such as “this dog is going to bite me if I don’t get out of here fast.”
This situation-specific threat forecast is what we know contributes to the high degree of fear that is experienced in this situation.
A lot of uncomfortable physiological sensations then accompany that fear such as increased heart rate and breathlessness, just to name a couple of common ones.
This is what is going to drive the individual’s motivation to engage in those safety behaviors. Thinking, “I’ve got to escape the situation, I’ve got to get out of here, in some way, I’ve got to prevent this feared outcome from occurring or else I’m going to be violently attacked by this dog.”
It is the safety behaviors themselves that we view as the directly maintaining factor in fear and anxiety based conditions.
We know that safety behaviors prevent individuals from having what we call a “disconfirmatory experience,” some type of experience where an individual might experience disconfirmation of their catastrophic belief.
In this situation, by virtue of this individual never encountering dogs, the individuals never going to have an experience that would disconfirm the belief that dogs are in fact violent and dangerous.
This is what’s going to fuel or maintain this catastrophic belief that “dogs are in fact violent and dangerous animals and I only escaped a really really awful outcome by virtue of my avoiding or escaping them.”
Delving a bit more into what Exposure-Based Therapy involves, there’s kind of two major components to it
First, individuals who are undergoing this treatment are encouraged to begin confronting the stimuli in the situations that they fear.
At the same time, we have to couple this with the gradual elimination of those safety behaviors
Returning to the individual with a dog phobia, this individual might be encouraged to gradually begin petting dogs.
Three core aims that we’re trying to accomplish in the implementation of Exposure-Based Therapy are to:
- Help our patients experience reduced anxiety and fear in relation to the stimuli that they try to avoid while
- Help individuals to develop more healthy or realistic beliefs or conclusions about their feared stimuli
- Helping the individual to experience increased tolerance of the distress that they encounter in feared situations.
Again, we know this is a very highly effective strategy that dates back even to the 1960s and the treatment of individuals with anxiety in fear-based conditions.
Virtual Presentation by Dr. Nicholas Farrell in the Dec. 7, 2017 Eating Disorder Hope Inaugural Online Conference & link to the press release at https://www.prnewswire.com/news-releases/eating-disorder-hope-offers-inaugural-online-conference-300550890.html
About the Presenter: Dr. Nicholas R. Farrell, Ph.D. is a licensed clinical psychologist who directs and supervises the treatment of patients in eating disorder programs at Rogers Memorial Hospital. Dr. Farrell specializes in the use of empirically-supported cognitive behavioral therapy (CBT) treatment strategies that are used to help patients in our eating disorders programs.
Additionally, Dr. Farrell is a regular contributor to scientific research on the effectiveness and dissemination of CBT for eating, anxiety, and mood disorders and has published over 20 peer-reviewed journal articles and book chapters. Dr. Farrell has been the gracious recipient of federal grant funding to study the role of social stigma in the context of eating disorders.
About the Transcript Editor: Margot Rittenhouse is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
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 a 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.
Published on June 10, 2018.
Reviewed on June 10, 2018 by Jacquelyn Ekern, MS, LPC
Published on EatingDisorderHope.com