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Learn more about the results we get at Within
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Exposure therapy is a type of therapy used to treat numerous mental health conditions, including eating disorders. The method works by slowly and safely exposing someone to objects or situations that upset them, which can help reduce fear and anxiety around that subject.
For eating disorders in particular, exposure therapy can help reduce anxieties around certain feared foods or social situations that may contribute to someone's disordered thoughts or behaviors. Exposure therapy can also help with several mental health conditions that commonly co-occur with eating disorders.
Exposure therapy is an evidence-based treatment modality used to treat phobias, fears, and anxieties. The thought behind this type of treatment is that repeated, safe, and guided exposure to feared situations or objects can help someone dissociate their anxiety from the object or situation, and learn to more confidently confront the things that once disturbed them.
The technique can be performed in several ways, including:1
In vivo exposure: Facing a feared situation or object in real life, directly.
Imaginal exposure: "Exposing" oneself by visualizing or imagining a feared situation or object.
Virtual reality exposure: Using technology to have someone virtually face their fears.
Interoceptive exposure: Creating physical sensations that are harmless but may be attached to certain fears, such as inducing a raised heart rate to simulate the effects of a panic attack.
These exposures can start slow, with patients being exposed to less-feared objects or situations, or start with them being exposed to their primary fear. These sessions are also sometimes paired with relaxation exercises, both to help patients work through the process and to help associate the sensation of calm or relaxation with the feared object or situation.1
How does exposure therapy work?
When someone is nervous or anxious, they tend to avoid whatever it is that makes them feel this way, whether it’s a situation, behavior, person, or object. Yet, while this may be helpful in the short-term, in the long run, it often leads to increased anxiety.1
Exposure therapy breaks the pattern of avoidance by exposing the patient to their trigger, but utilizes a controlled, monitored setting, to help the patient feel safe throughout this process.
The technique is meant to help a patient build several important skills and perspectives, including:1
Self-efficacy: The feeling of being capable of confronting one's phobias and dealing with related anxiety.
Emotional processing: Associating more realistic beliefs and thoughts with the trigger.
Habituation: The reduced feelings of anxiety and fear around the trigger over time.
Extinction: A weakened link between the trigger and learned associations with negative feelings and outcomes.
How does exposure therapy for eating disorders work?
Many people with eating disorders have extreme fears or anxieties related to food, eating, body weight, and body image. These fears and anxieties may drive many of their disordered eating behaviors, such as food avoidance and compulsive exercising.
Exposure therapy may be used to treat many different eating disorders, including:2
Exposure therapy can be used to address many aspects of these conditions, including irrational fears around certain foods, eating habits, or activities.
For conditions like ARFID, where patients have deep anxieties tied to certain foods, food exposure therapy can be particularly helpful.
In these cases, exposure therapy can look like asking a patient to eat "feared foods" that are similar to—though not exactly the same as—foods they consider "safe," such as having whole grain bread instead of white bread. For children and younger patients, it can even involve drawing pictures or playing with toys that look like certain feared foods.8
Social anxiety has also been strongly linked to eating disorders, particularly bulimia nervosa. This is likely related to fears of being judged by others for one's weight or appearance.9
Exposure therapy in these cases could involve going out in public. It can also involve going to restaurants to expose patients to potentially uncomfortable situations.
Similarly, body image is a huge challenge for many people with eating disorders. To combat this using exposure therapy, patients may be asked to look at themselves in the mirror and describe what they see.
This technique has been found useful on its own, but can also be successfully paired with cognitive behavioral therapy (CBT) to reduce body dissatisfaction.3
Exposure therapy for co-occurring conditions
Aside from helping with eating disorders themselves, exposure therapy has been found to be a useful tool for combating many mental health conditions that commonly co-occur with eating disorders, including anxiety disorders, obsessive-compulsive disorders (OCD), and body-focused repetitive behaviors like trichotillomania.1
Anxiety is closely tied to a number of eating disorders, with as many as two-thirds of eating disorder patients in one study reporting a co-occurring anxiety disorder of some sort.4
But exposure therapy can be an effective tool for helping with generalized anxiety, particularly forms of the treatment that involve visualizing a feared object or scenario, or actually facing these objects or scenarios in real life.
For those with co-occurring eating disorders, this could involve situations connected to food, eating, or body image that can lead to anxiety or trigger unhelpful behaviors.
Exposure therapy for OCD
Obsessive-compulsive disorder (OCD) is a specific anxiety disorder that also frequently co-occurs with eating disorders, particularly anorexia nervosa.4
Exposure and response prevention (ERP), a type of exposure therapy that incorporates “homework” along with therapy sessions, was found to effectively help those struggling with OCD.10 ERP involves exposing the person to their trigger while encouraging them to end their compulsions.
Exposure therapy for PTSD
A history of trauma is a very common experience for people with eating disorders, with many patients also meeting the criteria for post-traumatic stress disorder (PTSD).7
Exposure therapy can be used in these cases to help reduce feelings of anxiety and fear around certain scenarios, and help reduce avoidant behaviors, which could lead to subsequent issues.
Exposure therapy for social anxiety
Social anxiety is a specific type of anxiety disorder that manifests as extreme fear, self-consciousness, embarrassment, or anxiety caused by social interactions. When co-occurring with an eating disorder, it can be tied to situations that involve food and eating or scenarios that draw attention to someone’s appearance.
Once again, exposure therapy has been found to help in these cases, particularly in vivo exposure therapy, which involves directly facing a feared situation or object in real life.4
Within Health eating disorder treatment
At Within Health, we tailor our treatment plans to meet the unique needs and challenges of each patient, and that includes creating thoughtful and individual exposures to support our patients. This includes support around exposures to new or feared foods during programming.
Our movement groups are also exposure therapy groups. Some eating disorder patients are afraid of moving their bodies or exercising because this brings about awareness of their bodies. Exposure work may involve doing small increments of movements if nutritional intake is appropriate. We also individualize this movement exposure by finding movement that brings our patients joy or involves something they’d like to learn, such as dance.
Alternatively, some movement exposure groups may involve the cessation of movement. Here, the individual is exposed to being still and resting.
This is typically for patients with a history of compulsive exercise or exercise addiction. For example, if a patient typically engages in a rigid exercise regime, they may be asked to take more rest days or change the duration and intensity of their workouts, which can ultimately help them to overcome their fear of not exercising.
Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.
Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.
Becker, C. B., Farrell, N. R., & Waller, G. (2019, November 1). Exposure therapy for eating disorders. Oxford University Press. Retrieved January 21, 2023.
There is good evidence that exposure therapy for eating disorders can help reduce anxiety and improve disordered eating symptoms, but large randomized controlled trials isolating exposure therapy from other modalities, such as cognitive behavioral therapy or interpersonal psychotherapy, have yet to be conducted.3
Research indicates that mirror exposure on its own or within the context of CBT can increase body satisfaction. It has also been shown to help reduce a patient’s response to binge and purge cues. Direct exposure to feared foods has been shown to increase food intake and reduce anxiety, but more research is needed.3
Where can you receive exposure therapy for eating disorders?
Many different eating disorder treatment settings integrate exposure therapy into their treatment plans, such as:
Whether your treatment program officially refers to it as exposure therapy or not, eating disorder treatment often inherently involves exposure to things that patients are fearful of, such as eating certain foods, moving or not moving their bodies, refraining from purging behaviors, looking in the mirror, and coping with body changes.
A crucial part of eating disorder treatment is facing these fears in a trusted, safe environment under the care of treatment professionals. Confronting these fears can reduce avoidant behaviors in the future and, ultimately, allow individuals to recover from their eating disorders and live healthier and happier lives.
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