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As a society, we’ve labeled foods like ice cream, cake, and other indulgent snacks as bad or forbidden, assigning them a level of guilt when eaten. For someone with an eating disorder, that guilt becomes unbearable. Avoidance patterns and fear of certain foods—usually those high in calories, fat, or carbs—are common results of eating disorders, according to Dr. Nicholas Farrell, clinical supervisor, Eating Disorder Center at Rogers Behavioral Health–Oconomowoc. Thankfully, techniques used at Rogers like feared food exposure are able to tackle this issue and help patients continue toward recovery.
Food avoidance may start with something that lacks nutritional value, such as chocolate cake, but someone with the tendency for an eating disorder often removes a wider range of foods from the diet as time goes on, which Dr. Farrell says can lead to malnutrition and other health issues.
Feared food exposure is a component of exposure therapy, which involves exposing someone to a source of anxiety or fear, with the goal to help them overcome the trepidation caused by it. The basics of feared food exposure is that it introduces foods that evoke a mild fear response at first, slowly working up to what the patient considers the most difficult to eat. In the embedded video, Dr. Farrell demonstrates how a typical session on feared food exposure plays out.
Before any sessions involving feared food exposure begin, patients are educated on the process and benefits that result from this type of intervention. For some patients, it can take a while to be ready for this type of therapy, but others are ready to go right away.
“Some patients find it nearly overwhelming to simply include a greater volume of any food into their diet,” Dr. Farrell says. “Introducing this intervention before the patient is ready might backfire by overwhelming the patient too early in treatment. For other patients, there is more willingness to begin tackling the feared or avoided food items from day one.”
In the video demonstration above, Dr. Farrell participates by eating the pie along with the patient, which is something he says can be integral to seeing positive results.
“Of particular importance is the clinician’s participation in the exposure activity by eating the pie rather than merely directing the patient to do so,” Dr. Farrell explains. “There is a growing body of scientific literature that shows it’s helpful for the clinician to be actively engaged in exposure activities as opposed to passively observing them.”
In terms of effectiveness, Dr. Farrell says improvements with feared food exposure can be significant, even if implementation is done over a short period of time. He explains “feared food exposure intervention leads to significant decreases in food-related fear and avoidance as well as increases in overall dietary variety,” for patients who are only in the inpatient program at Rogers for two to three weeks.
Dr. Farrell has seen this therapy work with numerous patients, including one recent patient who was a mother of two young children. She would tremble and tear up just by looking at treats, but she wanted to become comfortable eating them around her kids.
“By the end of her treatment, she was enjoying these foods regularly in the presence of her kids,” Dr. Farrell says. “It was a beautiful transformation to witness.”
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