By Danielle Keenan-Miller, Ph.D.
Therapists have long known that the key to conquering fears is facing them and learning that you can survive. In fact, the therapy based on that concept, called exposure therapy, is the treatment of choice for a number of psychological problems, including obsessive-compulsive disorder, panic disorder, phobias, anxiety disorders, and PTSD (1). For example, if you went to therapy because you were afraid of dogs, that therapy should include things like looking at pictures or movies of dogs, going to dog parks, petting dogs, and maybe even engaging with dogs that seem scary. Current theory of how exposure therapy works is that it helps people learn something new about their feared situation-- that the outcome that they fear is unlikely to happen, or that if it does happen, it’s not the end of the world (2).
Despite the well-proven success of exposure therapy in reducing fear, this idea is not applied often enough in the treatment of eating disorders and food-related anxiety. Fears of certain foods or types of foods are pretty common in eating disorders, with some people refusing to even let roommates keep feared foods (like sweets or cereal or peanut butter) in the house. Many people feel like they can’t “trust themselves” around a particular kind of food-- like if they eat even one bite, they’ll end up binging. Other people have an irrational fear of gaining weight from even a modest amount of a food that they believe to be “unhealthy.” Similarly, people may have fears of certain kinds of physical sensations, like fullness or hunger, associating those sensations with catastrophic outcomes. Other people avoid looking in the mirror or wearing certain clothes. These kinds of irrational thoughts and avoidant behaviors get in the way of a healthy, joyful, sustainable relationship with food.
As described by Dr. Reilly and colleagues (2017, 3), using the principles of exposure can help in conquering food-related fears. Some ways that you can use exposure therapy to improve your own recovery (with or without the help of a therapist) include:
Begin reintroducing foods that you avoid into your diet, even foods that you think are “unhealthy”. Enjoy a small portion of a feared food, without doing anything to “compensate” for it-- so no extra exercise or dieting.
If your fear is that you won’t be able to control yourself around a particular kind of food and will binge, it’s smart to start by putting yourself in a situation where you’re likely to have success. For example, eating one doughnut on the way to class or a meeting where food is not present lessens the risk of a continuing binge.
Train yourself to get comfortable with a range of physical sensations. For example, you might drink a lot of water to simulate fullness, and allow yourself to really be present to that sensation rather than trying to avoid or reduce the feeling. If you have clothes that you avoid wearing because of the way that they feel against your body, try wearing them around the house to get used to that feeling and learn that it doesn’t mean anything terrible about you or your body.
Spend time looking in the mirror. Try to take in your whole body, without avoiding the parts that trigger negative thoughts or sensations. On the other hand, also take note of the parts of your body that you appreciate or value.
If you avoid eating in front of others, practice doing so. You might start small, somewhere that has few people or where you don’t know many of the people around you, and progress up to eating in situations that feel more frightening.
In each of these activities, check in with yourself first to see what you’re afraid will happen. Then check in with yourself afterwards to see if that feared outcome came true. If you’re unsure, asking the opinion of someone you trust can help. Even if the “worst” does happen (which is probably less likely than you imagine), note the ways in which you were able to cope and move forward. In time, repeated practice will loosen the grip of these fears on you, and will help you treat food and yourself in a freer, happier way.
2. Craske, M.G., Treanor, M., Conway, C., Zbozinek, T., & Vervilet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10-23.
3. Reilley, E.E., Anderson, L.M., Gorrell, S., Schaumber, K., & Anderson, D.A. (2017). Expanding exposure-based interventions for eating disorders. Eating Disorders, 50, 1137-1141.