Examining Within-Session and Between-Session Change in Exposure-Meal-Related Distress During Intensive Outpatient Treatment for Eating Disorders

There has been increasing theoretical interest in adapting exposure therapy for eating disorders (EDs), and preliminary data tentatively support the utility of meal-based exposures for targeting eating-related distress. Drawing upon existing work examining habituation processes and theories of inhibitory learning in anxiety disorders, we evaluated patterns of between- and within-session change in subjective units of distress (SUDS) during meal exposures in a mixed diagnostic sample of individuals enrolled in an intensive outpatient program for EDs. Participants (N = 178) who were enrolled in an intensive outpatient program completed SUDS at regular intervals during exposure meals over the course of treatment, M(SD)_{TreatmentDuration} = 13.67(10.27) weeks. Results from multilevel models suggested significant between-session decreases in SUDS; no significant changes in within-session SUDS occurred over the course of treatment. Models examining associations between average self-reported eating disorder symptoms and global functioning and SUDS trajectories indicated that individuals with higher global functioning reported slightly lower within-session decreases in SUDS compared with those with lower global functioning. Overall, results provide an initial descriptive examination of habituation processes associated with the use of meal-based exposures for EDs and contribute to a growing body of evidence suggesting benefits of adapting exposure-based intervention approaches for EDs.