# A pilot evaluation of the efficacy and acceptability of a novel imaginal exposure prevention (I-ERP) group programme to treat core weight, shape and social fears or phobias in adolescents with anorexia nervosa in an inpatient setting

## TL;DR

This study tested a new group therapy for adolescents with anorexia nervosa, showing reduced anxiety around weight and shape, though no major changes in eating disorder symptoms.

## Contribution

The first study to adapt imaginal exposure response prevention (I-ERP) for adolescents with anorexia in a group format.

## Key findings

- Statistically significant reduction in anxiety related to weight and shape after the group intervention.
- No significant changes in eating disorder psychopathology were observed.
- Qualitative feedback indicated the intervention was acceptable to adolescents.

## Abstract

Anxiety due to a phobia of normal body weight is a core feature and maintenance factor of anorexia nervosa (AN). This is the first study to explore the efficacy and acceptability of using a novel imaginal exposure response prevention group to target fears associated with being a normal body weight to reduce anxiety in adolescents with AN.

The lead author adapted an I-ERP manual used to treat AN in adults in 1–1 therapy. Content was adapted for an adolescent population, sessions reduced from 10 to 4 and was delivered in a group format with audio recordings to be more accessible for patients. Nineteen patients with AN completed the group and the group therapist collected outcome measures before and after the intervention. A paired samples t-test was used to assess change in eating disorder psychopathology (EDEQ), anxiety and depression (RCAD) and fear of food (FOFM). Qualitative feedback to assess acceptability was also gathered.

Statistically significant reduction in anxiety in a variety of situations pertaining to weight and shape was found after completion of the group. There were no significant changes shown in eating disorder psychopathology. Adolescents provided qualitative feedback which suggested the intervention was acceptable for users.

I-ERP which has been adapted for adolescents with AN in a group format seems to improve eating disorder psychopathology and reduce weight, shape, social and separation anxiety and phobias when used as an adjuvant to inpatient treatment. Further controlled research is advised.

Level III.

The online version contains supplementary material available at 10.1007/s40519-025-01723-6.