3 - (SYM 1) Breaking the Habit: REACH+ Intervention for Disrupting Maladaptive Eating Behaviors in Anorexia Nervosa

Abstract Body
Anorexia nervosa (AN) presents a perplexing challenge: maladaptive eating behaviors are remarkably persistent, even among individuals invested in treatment. The habit-centered hypothesis of AN proposes that these behaviors become entrenched as part of a process of shifting from goal-directed to habitual, rendering them cue-dependent and outcome-insensitive. As such, reward processes may be complicated in treatment. Relapse Prevention and Changing Habits (REACH+) is a behaviorally oriented psychotherapy intervention that specifically targets habits in AN. By targeting habit sequences, using behavioral experiments, REACH+ aims to disrupt maladaptive habits and reinforce new, rewarding routines. Support for the habit hypothesis comes from behavioral and neural data. One, habit strength, measured by the Self Report Habit Index (SRHI), is significantly higher among individuals with AN compared to healthy controls, indicating the habitual nature of maladaptive eating behaviors. Two, the habit-focused intervention demonstrated improvements in habit strength, eating disorder severity, and food intake in a laboratory meal among hospitalized patients with AN. Three, neuroimaging studies show that individuals with AN engage habit circuitry when deciding what to eat. REACH+ integrates psychoeducation about habits, including neural and cognitive aspects, to promote adaptive eating behavior post-discharge. With a focus on behavior change techniques, including habit reversal, stimulus control, and exposure, REACH+ facilitates the development of adaptive behaviors in the face of environmental cues for maladaptive habits. Furthermore, REACH+ emphasizes the identification and amplification of rewards to reinforce new routines, addressing the challenge of sustaining behavior change in AN. Overall, REACH+ represents a promising intervention for individuals with AN, offering a novel approach to targeting habitual behaviors and promoting long-term recovery.