Family-Based Interoceptive Exposure for Avoidant Restrictive Food Intake Disorder

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Project Summary/Abstract Avoidant/restrictive food intake disorder is commonly associated with severe nutritional deficiencies, low weight/growth for age and sex, and significant distress, and can cause serious psychological and medical sequelae and functional impairment across the lifespan. The core feature of ARFID is a pervasive pattern of food avoidance, related to a lack of interest in eating or food, sensory characteristics of food, or concern about the aversive consequences of eating. Studies examining interventions for ARFID are limited, and additional options for intervention are needed. Mind-body interventions are well-matched to individuals with ARFID because of their physiologically driven aversion to food-cues, with interoceptive experiences overwhelming the rewarding (natural reinforcing) properties of food and reduce approach behavior. Our group recently developed and tested a brief 6-session mindfulness-based interoceptive exposure intervention for families of patients with anorexia nervosa and related conditions. The intervention focused on families supporting adolescents to reach a threshold of increased tolerance of the aversive emotion of disgust and greater engagement in approach behavior during feeding. Although food avoidance is a shared feature across conditions, adolescents with ARFID and those with other eating disorders are distinct populations. Our success with this prior mechanistic study provides a framework for the use of interoceptive exposure. Given differences in the clinical presentations, this project will establish essential information about the feasibility and acceptability of a comprehensive mind and body family intervention for youth with ARFID; specifically a mindfulness-based interoceptive exposure (MBIE) for the high priority outcomes of health restoration and emotional well-being. A total of 57 adolescents with ARFID (aged 12-18) will be recruited to receive MBIE in an innovative dose-optimization approach to assess when a clinically-meaningful outcome is achieved, and assess tolerability and treatment characteristics, with the aim to distilling the most potent form of MBIE in 40 completers. We will: (1) explore the feasibility of recruitment, retention, and data collection procedures with youth with ARFID at end of treatment, (2) establish the acceptability and adherence of the MBIE intervention, and (3) evaluate the number of MBIE sessions required to observe changes in the number of foods avoided and mindfulness skills. These data can help to inform the utility of larger more definitive studies that have the potential to make a significant impact on the health and functioning of adolescents with ARFID.