Facing Eating Disorder Fears for Anorexia Nervosa: A Virtual Relapse Prevention Program Targeted at Approach and Avoidance Behaviors

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PROJECT SUMMARY/ABSTRACT Anorexia nervosa (AN) is chronic and disabling; most individuals never achieve full remission, even after acute treatment, and 50% of those who access acute treatment will relapse within 6- months of discharge. AN relapse-prevention treatments are urgently needed that can disrupt the persistent cycle of admission and discharge from acute treatment. Importantly, existing treatments do not differ from control treatments in the ability to alter cognitive-behavioral AN pathology, which is the primary remaining symptomatology at discharge from acute care. The inability to alter cognitive-behavioral pathology is a function of the limited availability of treatments that include skills training to promote behavior change in a “real-world” context, outside of treatment facilities. As such, relapse-prevention treatments should explicitly target core cognitive-behavioral pathology to facilitate approach behaviors (e.g., facing fear foods) in the real-world. Our scientific premise, developed from our past work, is that the application of a virtual format of Facing Eating Disorder Fears (FED-F) for AN will facilitate engagement in approach behaviors and minimize avoidance behaviors - improving outcomes, enhancing full recovery, and decreasing the likelihood of relapse. FED-F is a modular treatment that enhances exposure therapy with psychoeducation and cognitive skills teaching how to face fears of (a) food, (b) weight gain, (c) interoception/body, and (d) social situations. Our study goals are to (1) refine and test the acceptability and feasibility of FED-F delivered post-acute treatment as adjunctive to step-down specialty care, (2) test if this treatment outperforms treatment as usual (TAU), and (3) to examine if treatment targets our hypothesized mechanism of action: approach behaviors. These goals will lead to a highly deployable and accessible virtual treatment targeted at core AN mechanisms that predict relapse. The proposed research uses highly innovative methods; we will use an all-remote technology-based approach, combining a virtual, non- therapist assisted treatment with remote behavioral and momentary assessment of approach/avoidance behaviors. Specific aims are to (1) refine FED-F into a fully virtual format with input from patients and stakeholders and collect preliminary data (N=10) on its feasibility and acceptability, (2) conduct a small pilot RCT of FED-F (n=30) as compared to TAU (n=30), and (3) examine if FED-F targets approach/avoidance behaviors and test if this mechanism is associated with clinical outcomes. Ultimately, this proposal will lead to the creation and dissemination of a highly user-friendly, easily accessible and deployable intervention, delivered during a critical period of care, that can prevent AN relapse, which will decrease mortality, morbidity, and the high costs associated with chronic treatment.