CBT-AR Teletherapy for ARFID in a Gastroenterology Clinic Specializing in Celiac Disease: A Proof of Concept and Feasibility Case Series

• Four adults with Celiac Disease and ARFID completed 10 sessions of CBT-AR. • Three showed improvements on a measure of ARFID symptoms. • All four met some or all treatment goals and reported high acceptability. • Difficulties with participant recruitment in a tertiary CD clinic are discussed. Patients with gastrointestinal (GI) tract diseases are at high risk for developing avoidant/restrictive food intake disorder (ARFID). Patients with Celiac Disease (CD) may be particularly susceptible given their need to adhere to lifelong dietary restrictions. The current article presents the proof-of-concept stage of a planned clinical research program evaluating cognitive behavioral therapy (CBT) for ARFID (CBT-AR) delivered in a 10-session teletherapy format to adult patients in a CD clinic. We present data on the program feasibility and preliminary evidence for acceptability and proof of concept, i.e., that CBT-AR is associated with improvement in ARFID symptoms and engagement of targeted mechanisms of change. Over a 12-month period, 293 patients were screened for ARFID, and 18% screened as high-risk on a validated screener. Of these, approximately half agreed to be contacted by the study team, 8 completed an assessment, 6 entered, and 4 completed treatments. Three patients showed improvement on validated measures of symptom severity and clinical impairment, and both patients with clinically relevant fear ARFID symptoms showed improvement in cognitive/behavioral mechanisms hypothesized to maintain fear-ARFID symptoms. All 4 reported high acceptability and met some or all treatment goals. Implications of these preliminary findings and lessons learned for the design of the next phase of the research are discussed.