A randomized controlled trial of brief interoceptive exposure and family‐based treatment for adolescents with low‐weight eating disorders

BACKGROUND: Family-Based Treatment (FBT) is evidence based for patients younger than 18 with anorexia nervosa; however, continued refinement of FBT is needed to increase response and remission rates. AIMS: This study aimed to compare traditional FBT with an interoceptive exposure (IE) intervention that targets visceral sensitivity and autonomous eating in a family context. We hypothesized that IE would reduce food avoidance to a greater degree than FBT, as measured by laboratory feeding independent of weight gain. METHODS: Adolescents diagnosed with a low-weight eating disorder (LWED) were randomized to six sessions of FBT or IE. Before and after the intervention, patients completed interviews and self-report questionnaires, laboratory test meals (single and multi-item), and functional magnetic resonance imaging. Healthy controls provided a comparison group for these assessments. The study was registered as follows: clinicaltrials.gov NCT02795455 (https://clinicaltrials.gov/study/NCT02795455?term=NCT02795455&rank=1), GCO 15-0939 Reward Systems and Food Avoidance in Eating Disorders. RESULTS: = 301.85, d = 0.45) than the FBT group (n = 30). No significant differences were found for age and sex adjusted % expected body weight between groups. Adolescents with LWED reported significantly more symptoms on all clinical measures than controls (n = 27). CONCLUSIONS: Six sessions of a novel form of IE yielded significant changes in eating behavior, namely an approximately two-fold increase in energy consumed in both multi-item and single-item meals among those randomized to IE. Additional research using a fully expanded version of these treatments is needed.