Objective: Aversive emotions toward food and the consequences of eating are at the core of anorexia nervosa. Exposure therapy is effective to reduce anxiety and avoidance toward feared stimuli. Based on the inhibitory learning framework, this study examined the feasibility to induce social support or positive mood to enhance the impact of a single session virtual food exposure on food‐related anxiety in anorexia nervosa.Method: One hundred and forty‐five patients were randomized to: (1) virtual food exposure (i.e., baseline condition), (2) virtual food exposure plus positive mood induction (i.e., positive mood condition), or (3) virtual food exposure plus social support (i.e., social support condition). They completed self‐report assessments of anxiety toward virtual foods, general anxiety, positive mood, social support, and hunger, before and after virtual food exposure. Number of eye gazes and touches toward foods were recorded during the virtual reality exposure.Results: Patients had lower levels of anxiety toward virtual foods in the positive mood condition, compared to the baseline condition [F_(2,141) = 4.36, p = .015; medium effect size]. They also touched food items more often in the baseline condition. No other significant changes were found.Discussion: Virtual food exposure enhanced by positive mood induction seems a feasible approach to strengthen the impact of food exposure in anorexia nervosa.Public Significance: This research contributes to the understanding of how patients with anorexia nervosa can be supported to overcome fear and anxiety around food. Virtual reality enables patients to expose themselves to difficult situations (e.g., kitchen with foods of various calorie contents) while experiencing positive stimuli, such as a loving and kind pet or a supportive avatar.

The emotion of disgust is thought to play a critical role in maintaining restrictive eating among individuals with anorexia nervosa. This exploratory cross-sectional study examined correlations between food-specific trait and state disgust, eating disorder psychopathology, illness severity (body mass index: BMI), and interactions with virtual foods in people with anorexia nervosa. Food-specific trait disgust and eating disorder symptoms were measured before exposure to virtual foods in one of three virtual reality (VR) kitchens to which participants were randomly allocated. Food interactions (eye gaze and reaching towards virtual foods) were measured during the VR exposure. Food-specific state disgust ratings were collected after the VR exposure. In the entire sample, eating disorder symptoms correlated positively with food-specific trait disgust (rs (68) = 0.45, p < 0.001). We also found a significant association between food-specific state disgust and eating disorder symptoms in each virtual kitchen scenario: virtual kitchen only (rs (22) = 0.40, p = 0.05), virtual kitchen plus pet (rs (22) = 0.80, p < 0.001), and virtual kitchen plus avatar (rs (20) = 0.78, p < 0.001). No significant correlation was observed for the link between food-specific disgust measures and food-related touch. Correlations between food-specific trait disgust and food-related eye gaze differed across scenarios. The current experimental paradigm needs to be improved to draw firm conclusions. Both food-specific trait and state disgust are associated with eating disorder psychopathology, and therefore, effective strategies are warranted to attenuate food-specific disgust.

Childhood and adolescence psychopathology is associated with an increased risk of psychological difficulties in adulthood. Early interventions for youth should provide carers and teachers with knowledge and skills to respond to adolescents’ risky behaviours. This study evaluated the acceptability and effectiveness of a single 3-h workshop, combining psychoeducation and skills training to promote knowledge about, and confidence to address, adolescents’ risky behaviours in carers and teachers of adolescents aged 10–14. Demographics and perceived self-efficacy in the parental or teaching role were collected at baseline using self-report questionnaires. Motivation and confidence to respond to adolescents’ risky behaviours were measured before and after the workshop using motivational rulers. Participants provided written feedback about their experience about the workshop. Twenty-seven carers and 27 teachers attended the workshops. Teachers reported a significant increase in both importance (p = 0.021) and confidence (p < 0.001) to respond to risky behaviours following the workshop. This change was associated with baseline self-efficacy levels (importance: p = 0.011; confidence: p = 0.002). Carers also reported greater confidence to address risky behaviours following the workshop (p = 0.002). Participants found the contents and methods of the workshop highly acceptable. Online and multiple-session workshops might increase reach and effectiveness.

Objective: Patients with eating disorders report the experience of living with an eating disorder voice, a second‐ or third‐person, negative commentary about eating, weight, shape and their implications for self‐esteem. Qualitative and cross‐sectional studies suggest that the severity and characteristics of the eating disorder voice might play a role in the maintenance of eating disorder symptoms. The goal of this study was to expand the evidence base as to how the eating disorder voice changes over time and whether the characteristics of the voice are associated with changes in eating disorder symptoms during treatment.Method: Seventy‐two patients with anorexia nervosa receiving intensive eating disorder treatment were recruited. They completed self‐report measures of eating disorder symptoms, psychological distress and eating disorder voice's severity and characteristics (e.g., malevolence, benevolence and omnipotence) at baseline and approximately 6 months later.Results: Over time, patients reported lower levels of eating and weight concern (small effect size), shape concern (large effect size) and anxiety (small effect size).They also reported a reduction in the severity, perceived malevolence (medium effect size) and omnipotence (small effect size) of the eating disorder voice. Greater severity and malevolence of the voice, and lower benevolence at baseline predicted greater reductions in eating disorder symptoms (i.e., restraint and shape concern).Conclusion: Beliefs about the eating disorder voice (i.e., malevolence) and severity of the voice appear to be malleable to treatment and are associated with a reduction of eating disorder symptoms. The potential of using dialogical approaches to target the eating disorder voice is discussed.

The COVID-19 pandemic has profoundly impacted anorexia nervosa (AN), increasing pressure on healthcare services and causing specific psychopathological changes. However, the characterization of changes in presentation patterns across the pandemic remains unclear. This study aimed to address this gap by comparing symptom networks in patients with pre- and post-pandemic AN onset. Data from 189 patients diagnosed with AN from 2016 to 2022 were analyzed. Patients were divided into pre-COVID (n = 101) and post-COVID (n = 88) onset groups. Network analysis was employed to examine interconnections among eating disorder symptoms measured by EDI-1, general psychopathology measured by SCL-90, and perceived social support. Regularized partial correlation networks were estimated and compared. The post-COVID group showed increased centrality of obsessive-compulsive symptoms and body dissatisfaction. Stronger associations were found between interoceptive awareness and obsessive-compulsive symptoms, perfectionism and body dissatisfaction, perceived support by friends and bulimic behaviors. The pre-pandemic group showed a unique connection between drive for thinness and somatization, while the post-pandemic group showed a negative association between family support and drive for thinness. These findings suggest pandemic-related factors have altered AN psychopathology and highlight the peculiar role of social relationships. Understanding these changes can enhance clinical approaches to treating AN amid ongoing and future global challenges.