In-Congress Workshop 11 - Stepping up Our Game: Improving Use of Exposure Therapy for Eating Disorders

Although exposure therapy is widely recognized as one of the most effective strategies for reducing pathological anxiety in both eating and anxiety-based disorders, remarkably few eating disorder clinicians utilize this technique and even fewer optimize it. Exposure can be delivered in everyday practice; yet it often is delivered in ways that omit key elements, with a resulting loss of effectiveness. One reason commonly identified for this omission is the clinician’s fear of distressing the patient. Another key reason is a lack of acknowledgment in many evidence-based eating disorder treatment manuals that core components of eating disorder treatment involve exposure. This lack of explicit acknowledgment leads to lack of clarity about when the therapist should be using an exposure paradigm and when treatment is aimed at another goal. It also often results in clinicians’ failure to utilize best practices regularly employed by anxiety therapists. This workshop will detail the rationale for using exposure for eating disorders, how it works, and why it depends on both the patient and the therapist tolerating their own anxiety and overcoming their joint safety behaviors. This workshop also will discuss a) common elements of eating disorders treatment, b) how to use lessons learned from treatments for anxiety-based disorders to step up our game to maximize the efficacy of exposure and be more deliberate in its use, and c) newer more innovative uses of exposure (e.g., imaginal and interoceptive) to improve outcomes. Case examples will be used to illustrate how to introduce, deliver, and build on exposure in real-life settings, so that we can maximize the efficacy of eating disorders treatment with existing strategies.