Exposure and Response Prevention

Anxiety and fear are core elements that underlie eating disorders and disordered eating behaviors. Research has established that anxiety symptoms almost always precede the onset of eating disorder behaviors and that anxiety disorders are also the most common co-occurring diagnoses present in eating disorders. It has also been well-established that anxiety symptoms persist long after weight restoration or remission of eating disorder symptoms, and that anxiety and eating disorders appear to share a common genetic vulnerability as well.

Our program was developed with this understanding of the link between anxiety, fear and eating disorders in mind. One of the most effective treatment approaches for anxiety-based disorders is Exposure and Response Prevention, which was originally developed for Obsessive-Compulsive Disorder, a disorder once thought to be untreatable before the application of exposure and response prevention principles in it’s treatment. There is now a
significant evidence base strongly supporting the effectiveness of exposure based treatments for OCD, Phobias, Panic Disorder, Post Traumatic Stress Disorder, and Eating Disorders. We drew upon this evidence base to develop many key components of the Reasons program, which is structured around an Exposure and Response Prevention approach.

The Basis of Exposure and Response Prevention

Exposure and Response Prevention involves having patients directly expose themselves to anxiety or fear evoking situations and then working with them to prevent the compensatory or avoidant behavior in which they have been engaging. The goal is to produce anxiety in a gradual, planned manner while demonstrating that engaging in the usual behavior is absolutely not necessary for that anxiety to decrease and, eventually, go away. By engaging in both real-life and imagined exposures, our patients learn how to break their patterns of avoidance and fear, and gain a sense of increased competence by learning to confront and manage anxiety rather than be controlled by it. All this takes place through intensive collaboration between the patient and the team, is done in a gradual and intentional way, and repeated to truly solidify the experience and allow for learning to occur.

Through an Exposure and Response Prevention based approach, our patients learn…

…that the impulse to reduce the discomfort of strong emotions by escape or avoidance of situations is the most natural instinct we all possess

…that anxiety is so strong because it is the core of our survival instinct, and can be both extremely beneficial and important as well as destructive and impairing

…that when fear and anxiety take over, as happens in those suffering from eating disorders, attempts to avoid or ward off anxiety (such as by following rigid eating rules and behaviors, eating only particular foods, or engaging in purging or excessive exercise) serve to make the fear worse, not better

…about the natural time course of anxiety, which is such that any fear, distress, or strong urge does not last forever and will eventually decrease without the use of any behavior, but you have to allow yourself to experience it

…that no matter how long someone has been engaging in a behavior, or how intensely they feel controlled by fear and anxiety, everyone is capable of challenging these fears.

We provide our patients with support and structure from the beginning of their treatment so that they can experience, in a variety of ways, that they are capable of change and deserving of healing.