Imaginal Exposure for Disordered Eating Related Fears: A Pilot Randomized Controlled Trial

Abstract

Exposure therapy has been investigated as a potential treatment for eating disorders, but prior research has largely neglected to target core fears driving the disorder. New research suggests that disordered eating behaviors may be driven by underlying feared consequences such as rejection, abandonment, disgust, and loss of control, among others. Targeting these core fears may be best achieved through imaginal exposure, a type of exposure that involves imagining the feared consequences to be true. To test imaginal exposure as an intervention for disordered eating related fears, we randomized participants (N = 47) with high scores on the Eating Disorder Examination - Self-Report Questionnaire to one of three conditions: imaginal exposure (IE), imaginal exposure preceded by a brief food exposure (IE + Food), or an assessment control (AC). Participants attended two in-person laboratory visits and completed pretreatment, posttreatment, and one-month follow-up questionnaires. Disordered eating symptoms, food and eating related fears, preoccupations, and rituals decreased following treatment, but no differences were found between conditions on the degree of change. Within- and between-session habituation occurred for subjective distress and believability of feared outcomes, suggesting that imaginal exposure effectively activates and targets disordered eating related fears. Distress tolerance and confidence in ability to change improved following the active interventions. Our study demonstrates that imaginal exposure is an acceptable intervention for disordered eating related fears, and future research must examine these questions within a longer course of treatment.