Center for Neurointestinal Health, Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Eating Disorders Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA.
Int J Eat Disord. 2022 Aug;55(8):1156-1161. doi: 10.1002/eat.23761. Epub 2022 Jul 2.
The mechanisms through which cognitive-behavioral therapies (CBTs) for avoidant/restrictive food intake disorder (ARFID) may work have yet to be elucidated. To inform future treatment revisions to increase parsimony and potency of CBT for ARFID (CBT-AR), we evaluated change in food neophobia during CBT-AR treatment of a sensory sensitivity ARFID presentation via a single case study.
An adolescent male completed 21, twice-weekly sessions of CBT-AR via live video delivery. From pre- to mid- to post-treatment and at 2-month follow-up, we calculated percent change in food neophobia and ARFID symptom severity measures. Via visual inspection, we explored trajectories of week-by-week food neophobia in relation to clinical improvements (e.g., when the patient incorporated foods into daily life).
By post-treatment, the patient achieved reductions across food neophobia (45%), and ARFID severity (53-57%) measures and no longer met criteria for ARFID, with sustained improvement at 2-month follow-up. Via visual inspection of week-by-week food neophobia trajectories, we identified that decreases occurred after mid-treatment and were associated with incorporation of a food directly tied to the patient's main treatment motivation.
This study provides hypothesis-generating findings on candidate CBT-AR mechanisms, showing that changes in food neophobia were related to food exposures most connected to the patient's treatment motivations.
Cognitive-behavioral therapies (CBTs) can be effective for treating avoidant/restrictive food intake disorder (ARFID). However, we do not yet have evidence to show how they work. This report of a single patient shows that willingness to try new foods (i.e., food neophobia), changed the most when the patient experienced a clinical improvement most relevant to his motivation for seeking treatment.
认知行为疗法（CBT）治疗回避/限制型食物摄入障碍（ARFID）的机制尚未阐明。为了为增加 ARFID 的 CBT 治疗的简约性和效力提供信息（CBT-AR），我们通过单一案例研究评估了 CBT-AR 治疗感官敏感性 ARFID 表现过程中食物恐惧的变化。
一名青少年男性通过实时视频完成了 21 次，每周两次的 CBT-AR 治疗。在治疗前、中期和后期以及 2 个月的随访中，我们计算了食物恐惧和 ARFID 症状严重程度的百分比变化。通过视觉检查，我们探索了每周食物恐惧与临床改善（例如，当患者将食物纳入日常生活时）的关系。
治疗后，患者的食物恐惧（45%）和 ARFID 严重程度（53-57%）均有降低，且不再符合 ARFID 的标准，2 个月随访时仍有持续改善。通过对每周食物恐惧轨迹的视觉检查，我们发现，在中期治疗后出现了下降，并且与直接与患者主要治疗动机相关的食物摄入有关。
这项研究提供了关于候选 CBT-AR 机制的产生假说的发现，表明食物恐惧的变化与与患者治疗动机最相关的食物暴露有关。
认知行为疗法（CBT）可以有效治疗回避/限制型食物摄入障碍（ARFID）。但是，我们还没有证据表明它们是如何起作用的。本报告中的单一患者病例表明，当患者经历与寻求治疗动机最相关的临床改善时，对新食物的意愿（即食物恐惧）变化最大。
