For many with eating disorders, anxiety is a common emotional experience. Obsessive compulsive disorder (OCD) is a specific form of anxiety that tends to occur along with eating disorders. A new study examines how one type of therapy can address symptoms of both OCD and eating disorders.
The study, released online last week, was led by a Columbia University psychologist and brought together researchers from across the United States. They examined how cognitive behavioral therapy helped 56 patients in a residential treatment program.
There are many components of cognitive behavioral therapy including a technique that has been well established for treating OCD - exposure and response prevention (ERP). In ERP, patients are asked to gradually face their fears (exposure) without relying on otherwise problematic behaviors to cope with those fears (response prevention). As part of treatment, patients make a hierarchical list of situations from least to most anxiety provoking. For people afraid of germs/disease who wash their hands repeatedly, one step on the list might involve taking public transit (exposure) and learning to tolerate the resulting anxiety without immediately washing their hands (response prevention). This would be just one piece of a more complicated and personalized plan for treatment.
In the new study, ERP was applied for both OCD and eating disorders. To address their eating disorders, patients were asked to create lists of anxiety-provoking situations related to food and body image. These fears were addressed in residential treatment using ERP similar to how it’s done for OCD.
The treatment program included people with all types of eating disorders including 25% with bulimia and 34% with an unspecified eating disorder (which includes what will soon be called binge eating disorder). Combining these disorders with anorexia presents some challenges; for example, the ERP treatment probably varied a lot among the patients. Nevertheless, most people’s OCD and eating disorder symptoms improved with treatment.
We can’t tell how much patients improved compared to no treatment or compared to another type of treatment because the study focused exclusively on people in a residential program (no control group). There are also so many different aspects to treatment in a residential program that it’s difficult to know what role the ERP played in recovery. However, other studies have independently examined ERP for the treatment of eating disorders (here and here), and it seems promising.
For binge eating and bulimia, cognitive behavior therapy has been empirically demonstrated to help many people. If you’re suffering from both OCD and an eating disorder, it’s best to look for a psychologist specializing in CBT. Based on this study, you may also consider looking for treatment incorporating ERP, but it’s not totally clear yet how much that one piece would help over and above others parts of treatment. Other research suggests finding a qualified therapist is easier said than done.
Dr. Gupta is a professor at Barnard College of Columbia University and provides individual therapy at Tribeca Psychology
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