What are Food Exposures?
Exposures are a common practice in eating disorder treatment, but there can be a lot of misunderstanding around what they are and why they can be helpful.
When we talk about exposures, we are referring to a way of gradually increasing tolerance, in a safe environment, to a food or situation that is associated with anxiety or fear. The goal of the increased exposure is to lessen the anxiety or fear that normally arises when encountering the particular food or situation.
How Food Exposures Help with Picky Eating and Eating Disorders
There are numerous ways that exposures can be helpful in eating disorder recovery. First, the more contact people have with a particular food or situation, the more the fear about it decreases. Avoidance of these situations actually causes the fear to increase. Second, exposures can help change negative associations to something more positive. For example, if someone previously choked on a certain food, they may avoid eating that food for fear of choking again. Exposure work can help them return to the enjoyment they used to have of the food prior to choking on it. Finally, exposures can build self-confidence as clients realize they’re capable of overcoming their fears.
What to Expect from Food Exposure Therapy
While exposure work will vary to some degree based on the client and the situation, there are several steps that tend to be consistent across most of our exposure work. To start, we often create a hierarchy of foods or situations that we will use to guide the exposure work, ranking them based on the level of distress each one would cause. When starting to work on exposures, we aim to start with something less stressful and slowly work our way up to more stressful foods. We don’t want to start with the most stressful item on the list, as that would be more traumatic than helpful.
Second, we talk with clients ahead of time about what to expect so that they have an idea of what the experience will look like. When the time comes for the exposure session, it can be helpful to start with some grounding to calm the nervous system, since most clients feel anxious coming into an exposure. After grounding, we may start with asking clients to begin by just looking at the food and describing it using neutral words. We might have them touch the food and again describe the texture in neutral terms. Sometimes that’s enough exposure to the food for one day; other times we may progress to having them take a bite. However, we’re always moving at the client’s pace.
Toward the end of the exposure session, we will debrief the experience, checking in with how the client is feeling and doing more grounding if needed. Our ultimate goal with exposure work is that clients feel safe and supported in taking steps toward a more peaceful relationship with food.
