(PS14-14) The Effectiveness of Adding Exposure Therapy to Eating Disorder Protocols

Research on the use of exposure therapy as part of a protocol for the treatment of eating disorders has been described as inconclusive based on qualitative analysis of published studies (Butler & Heimberg, 2020). This finding is inconsistent with the incidence of anxiety in eating disorders and the demonstrated effectiveness of exposure and response prevention based on the inhibitory learning model (Craske, Liao, Brown, & Vervliet, 2012; Abramowitz, Deacon & Whiteside, 2019). The current study was designed to determine the degree to which the addition of exposure strategies increased the clinical effectiveness of eating disorder treatment protocols. A literature search through psycINFO, PubMed, and Google Scholar identified 73 studies published between 1984 and 2022 with the key search words ‘exposure,’ ‘exposure therapy,’ ‘eating disorders,' 'anorexia,’ ‘anorexia nervosa,’ ‘bulimia,’ ‘bulimia nervosa,’ and ‘binge eating.’ Of these, 43 met the following criteria: between group pre-post measurement, inclusion of comparison or control groups, assessment of one or more of the following dependent variable areas: biological (BMI), cognitive, behavioral, depression, and anxiety. Effect sizes were calculated for each study for each of the dependent variable areas. Pooled weighted effect sizes were then calculated for each of the dependent variables. Results found medium pooled weighted mean effect sizes for changes in eating disorder behaviors (d= -.47) and changes in eating disorder related cognitions (d=-.36). In addition, a large pooled effect size was found for changes in depression (d=-1.03). Efforts to assess the relationship to empirically validated components of exposure and response prevention were prevented due to the lack of clear descriptions of procedures labeled “exposure.” These results provide support for the inclusion of exposure interventions as components of existing protocols for eating disorders. However, it is suggested that future research focus on the lack of consistency in descriptions of exposure and response prevention and examination of the relationship between fidelity to empirically validated components of exposure therapy and the increased effectiveness of eating disorder protocols when exposure therapy interventions are included.