Dietetic-Led Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Feasibility, Acceptability, and Proof-of-Concept.

OBJECTIVE

Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR) is an emerging treatment for ARFID, but to date, it has only been delivered by mental health clinicians. Given the relevance of nutrition to treatment goals, we adapted the treatment to be dietetic-led (D-CBT-AR).

METHOD: We conducted a pilot trial of D-CBT-AR. Participants self-referred to a multidisciplinary eating-disorder clinic in Brisbane, Australia, and attended in person or virtually. Participants rated D-CBT-AR on acceptability and feasibility. We also measured changes in ARFID psychopathology, Body Mass Index, and co-morbid psychopathology.

RESULTS

Of the 12 participants offered D-CBT-AR, 92% (n = 11) took up the treatment, and 72% (n = 8) completed, with a median treatment length of 33 weeks. The majority of completers rated D-CBT-AR above benchmarks on feasibility (89%) and acceptability (78%). Using intent-to-treat analyses, participants reported large and significant improvements in ARFID psychopathology on all subscales of the Pica, ARFID and Rumination Disorder Interview. They incorporated a median of 26 new foods. For those who were weight-suppressed, Body Mass Index increased by 1.5 bands from pre- to post-treatment, though effects were non-significant. Participants also reported large and significant reductions in clinical impairment, depression, and stress. Additionally, at 6-months post-treatment, five participants met remission criteria.

DISCUSSION: The trial shows proof-of-concept for the feasibility and acceptability of D-CBT-AR. Although requiring replication in larger and randomized controlled trials, our findings highlight the potential of D-CBT-AR to expand the types of professionals who could effectively deliver CBT-AR, thereby increasing access to care for individuals living with ARFID.