Exposure Therapy: A Guest Post from Casey Becker

There is not one approach to treating food and body image issues. I have seen first hand the importance of incorporating of variety of tools to treat these chronic problems. A few weeks ago I had the pleasure of eating lunch with Casey and was excited to hear about how she utilizes exposure therapy in her work. I hope you enjoy the post as she shares with you a little about exposure therapy and the benefits of this type of approach. Enjoy!

Have you ever seen a bug crawling across the floor, only to find yourself hoping on the nearest piece of furniture before you know what happened? Fear is an incredibly powerful emotion and can readily change how we think and act. Some fears are reasonable and keep us safe in dangerous situations. Occasionally though, unreasonable fears interfere with healthy living and may require a special set of skills to manage. 

As an eating disorder therapist, I am very interested in working with how people who have developed fears and anxieties around food and body image. For many with eating disorders, the same type of ‘fight or flight’ reactions that occur when seeing bugs develop around eating a meal, clothes shopping, and many more everyday occurrences. When you have an ED, a meal or going clothes shopping can be as scary and overwhelming as picking up a snake. Obviously, extreme fear reactions to something you need to stay alive or something that you need to leave house can make for a very difficult situation, indeed.

Luckily, there is a therapy available that is specifically designed to address this issue and one that I have found very helpful in dealing with the fears that occur in eating disorders. Exposure therapy is a behavioral technique intended to bring a person into a feared situation in such a way that it is no longer anxiety provoking. It is the considered a necessary part of treating anxiety, and as anxiety is a core feature of eating disorders; exposure is easily incorporated into standard treatment.1,2

For example, a person who is recovering from an eating disorder may need to buy new clothes, but finds shopping extremely difficult. The change in the size of clothes, while an indication that she is getting healthier, may trigger eating disorder thoughts or a panic attack. A person may even reengage in eating disorder behaviors to avoid the change in body size and shape. During the course of exposure therapy, she would be taught the skills to manage the acute symptoms of anxiety and act of shopping would be broken down into small steps. Together with the therapist, at the site where she would like to buy clothes, the person would complete each step. Every time she experienced anxiety, she would stop at that step and utilize her skills to reduce the distress. When the anxiety was sufficiently managed, the person and therapist would go on to the next step. Eventually, she is able to buy and wear the new clothes, making the weight gain easier and more likely.

By breaking the experience down into manageable steps and addressing the anxiety in increments, the situation becomes safe. The exposure may need to be repeated or used for other feared situations, depending on the person. However, in completing an exposure, she has reduced the risk of relapse and can continue making progress in her recovery.

In working with people with eating disorders, I see clients struggle with very real fears around food and body image. However, there is hope and there is relief. Exposure therapy, in conjunction with standard treatment, can help address the specific fears and anxieties that occur in eating disorders.

1 Steinglass JE, Sysko R, Glasofer D, Albano AM, Simpson HB, Walsh BT. Rationale for the application of exposure and response prevention to the treatment of anorexia nervosa. Int J Eat Disord. 2011; 44:134.
2 Pollice C, Kaye WH, Greeno CG, Weltzin TE. Relationship of depression, anxiety, and obsessionality to state of illness in anorexia nervosa. Int J Eat Disord. 1997; 21:367.


Do you have any body-image or food related fears? Are there situations you avoid because of these fears? What are your thoughts?

Casey W. Becker, LMHC, of Mended Wing Counseling, is now offering exposure therapy as an adjunct to standard outpatient treatment. To find out more, please call at (617)797-7949, send an email to info@mendedwingcounseling.com or visit the website at www.mendedwingcounseling.com.