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Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder.

ABSTRACT: There are currently no evidence-based treatments for adults with avoidant/restrictive food intake disorder (ARFID). The purpose of this study was to evaluate the acceptability, feasibility, and proof-of-concept of cognitive-behavioral therapy for ARFID (CBT-AR) for adults. Males and females (ages 18-55 years) were offered 20-30 outpatient sessions of CBT-AR delivered by one of five therapists. Of 18 eligible adults offered CBT-AR, 15 chose to participate and 14 completed treatment. All patients endorsed high ratings of treatment credibility and expected improvement after the first session, and 93% of completers provided high ratings of satisfaction at the conclusion of treatment. Therapists rated the majority (80%) of patients as "much improved" or "very much improved." Based on intent-to-treat analyses, ARFID severity on the Pica, ARFID, and Rumination Disorder Interview (PARDI) showed a large and significant decrease from pre- to post-treatment; and patients incorporated a mean of 18.0 novel foods. The underweight subgroup (n = 4) gained an average of 11.38 pounds, showing a large and significant increase in mean BMI from the underweight to the normal-weight range. At post-treatment, 47% of patients no longer met criteria for ARFID. To our knowledge, this is the first prospective treatment study of ARFID in adults. The findings of this study provide preliminary evidence of feasibility, acceptability, and proof-of-concept of CBT-AR for heterogeneous presentations of ARFID in adults. Randomized controlled trials are needed to confirm these findings. ClinicalTrials.gov Identifier: NCT02963220.

SUBMITTER: Thomas JJ

PROVIDER: S-EPMC8375627 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder.

Thomas Jennifer J JJ Becker Kendra R KR Breithaupt Lauren L Murray Helen Burton HB Jo Jenny H JH Kuhnle Megan C MC Dreier Melissa J MJ Harshman Stephanie S Kahn Danielle L DL Hauser Kristine K Slattery Meghan M Misra Madhusmita M Lawson Elizabeth A EA Eddy Kamryn T KT

Journal of behavioral and cognitive therapy 20210303 1

There are currently no evidence-based treatments for adults with avoidant/restrictive food intake disorder (ARFID). The purpose of this study was to evaluate the acceptability, feasibility, and proof-of-concept of cognitive-behavioral therapy for ARFID (CBT-AR) for adults. Males and females (ages 18-55 years) were offered 20-30 outpatient sessions of CBT-AR delivered by one of five therapists. Of 18 eligible adults offered CBT-AR, 15 chose to participate and 14 completed treatment. All patients ...[more]

PMID: 34423319

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Project description:ImportanceThe neurobiology of avoidant/restrictive food intake disorder (ARFID) is poorly understood.ObjectiveTo evaluate whether individuals with ARFID exhibit disruptions in fear, appetite, and disgust brain regions compared with healthy control (HC) participants when shown images of food and objects.Design, setting, and participantsIn this case-control study conducted from July 2016 to January 2021, children, adolescents, and young adults completed structured interviews and a validated functional magnetic resonance imaging (fMRI) food cue paradigm. The study was conducted at a single academic medical center. Data analysis was conducted from April 2023 to August 2024.ExposuresPresence vs absence of ARFID and its phenotypes (ARFID-fear, ARFID-lack of interest in eating, ARFID-sensory sensitivity); pictures of food vs objects during fMRI food cue paradigm.Main outcomes and measuresBlood oxygenation level-dependent activation in regions of interest (ROIs; amygdala, hypothalamus, insula, anterior cingulate cortex [ACC]) and the whole brain.ResultsParticipants were 110 children, adolescents, and young adults with full or subthreshold ARFID (75 participants; mean [SD] age, 16.2 [3.8] years; 41 [55%] female) and age-matched HC participants (35 participants; mean [SD] age, 17.3 [4.0] years; 27 [69%] female) recruited for studies of the neurobiology of ARFID and restrictive eating disorders. Participants with ARFID demonstrated greater activation than HC participants of the ACC (mean difference, 0.48 [95% CI, 0.19 to 0.77]; P = .009), sensory association cortex (mean difference on left side, 0.54 [95% CI, 0.29 to 0.79]; P = .005; right side, 0.52 [95% CI, 0.28 to 0.76]; P = .02), and supplementary motor cortex (mean difference, 0.81 [95% CI, 0.47 to 1.15]; P = .04). The ARFID-fear group showed greater amygdala activation vs HC (mean difference, 0.49 [95% CI, 0.16 to 0.82]; P = .04), and greater lack of interest was associated with lower hypothalamus activation in the ARFID-lack of interest group (r = -0.38 [95% CI, -0.69 to -0.11]; P = .03). The ARFID-sensory sensitivity group did not show greater insula activation vs HC but showed greater activation of the ACC (mean difference, 0.48 [95% CI, 0.22 to 0.74]; P = .005) and somatosensory cortex (mean difference on left side, 0.60 [95% CI, 0.33-0.87]; P = .001; right side, 0.54 [95% CI, 0.29 to 0.80]; P = .03).Conclusions and relevanceResults indicate generalized hyperactivation of ACC, sensory association cortex, and supplementary motor cortex in response to visual food stimuli in children, adolescents, and young adults with ARFID, suggesting a novel neurobiological circuit associated with this disorder. Activation appears consistent with ARFID phenotypic rationales for food avoidance, with hyperactivation of fear regions in ARFID-fear and hypoactivation of appetite regions with increasing ARFID-lack of interest severity.

Project description:ObjectiveThis study explored the preliminary effectiveness of a partial hospitalization program (PHP) for children/adolescents with avoidant/restrictive food intake disorder (ARFID). We evaluated how ARFID symptoms changed from admission to discharge, and collected follow-up data on symptoms and outpatient care following PHP discharge.MethodTwenty-two children/adolescents with ARFID (77.3% White, 63.6% female) completed measures assessing ARFID symptomatology at admission and discharge from a PHP for eating disorders. Six months and twelve months following their discharge, participants were contacted to complete study measures again and take part in an interview assessing follow-up care.ResultsPaired samples t tests indicated that participants demonstrated increases in weight and decreases in ARFID symptomatology from admission to discharge with medium to large effects. All participants reported receiving some form of outpatient treatment following discharge, with the type of outpatient services varying across participants. Data from the 86% of participants who completed the six-month follow-up and 50% who completed the twelve-month follow-up suggest that participants generally maintained treatment gains following PHP discharge.DiscussionParticipants experienced symptom improvements from admission to discharge and appeared to maintain these gains after discharge. These results provide preliminary evidence that PHPs are an effective treatment option for children and adolescents with ARFID.Public significance statementThis study provides preliminary evidence that intensive, evidence-based PHPs are effective in treating ARFID. Our findings suggest that children and adolescents with ARFID who receive flexible, cognitive-behavioral, family-centered treatment in a PHP for EDs experience improvements in weight and ARFID symptomatology from admission to discharge. Despite receiving variable and nonstandardized outpatient treatment, individuals with ARFID appear to maintain treatment gains 6 and 12 months after discharge in a PHP.

Project description:BackgroundAvoidant/restrictive food intake disorder (ARFID), an eating disorder not associated with weight and shape concerns, results in nutrient or energy deficiencies related with further health consequences and a pronounced need for specialized treatment. These interventions need to be tailored to individual health behavior. However, research about health behavior and treatment utilization in ARFID is scarce, particularly in adults, as ARFID is more common in children despite occurring across the lifespan. One important aspect of health behavior is the individual's health regulatory focus (i.e., health prevention and health promotion). Additionally, symptoms of eating disorders have generally been associated with various health risk behaviors, such as smoking, drinking, or unhealthy physical (in)activity. Therefore, the present study aimed to investigate health behavior and psychological treatment utilization in adults with symptoms of ARFID.MethodsA representative adult population sample (N = 2415) completed several self-report questionnaires assessing symptoms of eating disorders and health behavior. Differences between groups (symptoms of ARFID vs. no symptoms of ARFID) were tested with analysis of variance, Mann-Whitney-U-tests, and binary logistic regression.ResultsIndividuals with symptoms of ARFID (n = 20) did not differ in their health regulatory focus, smoking status, physical activity or psychological treatment utilization from individuals without symptoms of ARFID (n = 2395). However, they reported higher alcohol misuse than individuals without symptoms of ARFID.ConclusionThe findings suggest a relevance of further exploration of the relationship between alcohol misuse and ARFID, given the preliminary nature of these results. This exploration could inform treatment strategies for addressing potential comorbid substance misuse. Furthermore, the low psychological treatment utilization in adults with symptoms of ARFID suggest a need for more specialized psychological treatment services, public education about ARFID being an indication for psychological treatment, and further research about treatment barriers.

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Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder.

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Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder.

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