Utilizing Exposure Therapy in eating disorder recovery

We know that for those of us impacted by eating disorders recovery can feel daunting. Perhaps the idea of sitting around a pizza with a group of your friends, and eating two or more slices, while feeling totally fine about it may feel impossible. That is why we start by taking small steps toward recovery while using exposure therapy.

While the term exposure therapy can sound a little overwhelming, it’s actually about taking little baby steps toward recovery with the support of your therapist along the way. When engaging in exposure therapy we make sure to go at a pace that feels safe for you, we know that recovery is all about the long game.

The exposure ladder is a step-by-step tool used to help you gradually confront fears and anxieties related to food, eating, and body image. This technique is often used in Cognitive Behavioral Therapy (CBT) to help reduce avoidance behaviors, build tolerance, and decrease anxiety around feared situations.

At Wilder Wellness we collaborate with you to create your own individualized exposure ladder and support you through each step of the process.

How the Exposure Ladder Works:

1. Identifying Fearful Situations:

   • First, you'll identify specific situations, foods, or activities that cause you anxiety or that you tend to avoid. For example, you might have "fear foods" (like bread, pasta, or desserts) or feel uncomfortable eating in public or wearing certain types of clothes that make you focus on your body.

2. Ranking Fearful Situations:

   • Once you've identified these situations, you’ll rank them on a scale from least to most anxiety-provoking. This is often measured using a numeric scale rating the intensity of your distress from 1 to 10. For instance, you might rate eating a snack alone as a 2, but eating in a restaurant with friends might feel like a 9.

3. Building the Ladder:

   • Together with your therapist, you'll create an exposure ladder that begins with the situations that cause the least anxiety and works up to more challenging ones. Each step should feel manageable and help you build confidence gradually. For example:

     • Step 1: Eating a piece of toast with nut butter ( 1 )

     • Step 2: Eating a pastry while getting coffee with a friend ( 3 )

     • Step 3: Eating a meal alone in public ( 6 )

     • Step 4: Eating a "fear food" like pizza with your friends ( 8 )

4. Gradual Exposure:

   • You'll work through each step of the ladder at your own pace, starting with the least anxiety-provoking task and gradually moving up. The goal is to stay in the situation long enough for your anxiety to decrease naturally over time—a process called habituation. As you become more comfortable with each step, you'll move on to the next, helping you build tolerance to the feared situation.

5. Tracking Your Progress:

   • As you go through each exposure, you'll track your anxiety levels before, during, and after the activity. You might notice that your anxiety decreases the more you practice, and that the feared outcomes (e.g., weight gain or judgment from others) don’t happen or are less severe than you expected.

6. Challenging Irrational Beliefs:

   • While working through the exposure ladder, you'll also challenge any distorted beliefs you might have about food, eating, or your body. For instance, if you fear that eating a particular food will immediately cause weight gain, exposure helps you confront and disprove that belief over time.

Common Exposure Areas for Eating Disorders:

1. Fear Foods: You might feel anxious about eating certain foods that you view as “unsafe” or unhealthy. The exposure ladder helps you gradually reintroduce these foods into your diet, helping you overcome the anxiety without engaging in harmful compensatory behaviors (like restriction or purging).

2. Body Image Exposure: This type of exposure involves facing body-related fears, such as looking at yourself in the mirror, trying on clothes, or wearing a swimsuit. Over time, this helps reduce body image distress.

3. Social Eating: If eating in front of others feels overwhelming, you can start with smaller, less intimidating social situations (like eating with a close friend) and work your way up to larger or more public situations.

4. Meal Timing and Flexibility: You may also use the exposure ladder to break rigid meal plans or timing rules, helping you eat more flexibly and intuitively.

Benefits of Using the Exposure Ladder:

• Reduced Avoidance: You'll gradually face and overcome situations you've been avoiding, which helps break the cycle of avoidance that reinforces anxiety.

• Increased Flexibility: Exposure will help you become more comfortable with eating a wider range of foods and in various settings, which encourages more flexible and intuitive eating.

• Decreased Anxiety: By repeatedly exposing yourself to feared situations, your anxiety will naturally decrease, and you'll feel more confident in handling these challenges.

• Challenging Unhelpful Beliefs: Exposure will help you see that many of the fears you have around food or body image aren’t as dangerous or overwhelming as they seem.

Example of an Exposure Ladder for Eating Disorders:

If you’re struggling with anorexia nervosa and have a fear of high-calorie foods or eating in public, your exposure ladder might look like this:

Each step helps you gradually confront and reduce your anxiety around food and eating, allowing you to build a healthier, more balanced relationship with food and your body.

By working through the exposure ladder, you'll find that the situations that once felt impossible can become more manageable, helping you regain control over your eating patterns and reduce the grip of the eating disorder.