A new cognitive behavior therapy for adolescents with avoidant/restrictive food intake disorder in a day treatment setting: A clinical case series

Objective Avoidant/restrictive food intake disorder (ARFID) is a new diagnosis in the DSM-5 Feeding and Eating Disorders section, for which very limited treatment research has been carried out, yet. A new, 4-week exposure based cognitive behavioral therapy (CBT) day treatment, which integrated the inhibitory learning principles, was developed for adolescents with ARFID, and tested in the current study. Method A nonconcurrent multiple baseline design was used in a clinical case series of eleven 10- to 18-year-old patients. After baseline, the 4-week CBT followed. Measurements of DSM-5 ARFID diagnosis, food neophobia and related measures such as body weight and length, were taken at baseline (t1), at the end of the 4-week intensive day treatment (t2) and 3 months after treatment (follow-up, t3). A food selectivity test, a 1-week food diary, and behavioral measures on food intake were also taken at baseline and at 3-month follow-up. Furthermore, continuous measurements of believability of dysfunctional cognitions, anxiety, and food acceptance were taken throughout the 4-weeks day treatment. Results At follow-up, 10 out of 11 patients were in remission and had a healthy body weight and an average, age-adequate nutritional intake. For most patients, food neophobia scores decreased to a nonclinical range. The belief in dysfunctional cognitions and anxiety levels decreased during treatment. Discussion This new exposure-based CBT for adolescents with ARFID seems promising. These results may be very useful for clinical practice and stimulate further development of effective CBT interventions in the area of ARFID.