ARFID Treatment: Taking Bite-Sized Challenges to Broaden Your Palete!

Build easy-to-use and rewarding skills to broaden the number of foods you can eat!

Future blog posts will include recipes with AFRID in mind - combining a few comfortable ingredients to slowly build up to more complex meals.

Something new? How about PBnJ

AFRID typically responds well and quickly to several Cognitive Behavioral (CBT) approaches to treatment, but these skills can also apply to anyone who is a picky eater or otherwise wants to broaden their pallette.

1. Define your food challenges

   When addressing any challenge, we need to do our best to understand it. Refer back to the 3 types of feeding challenges common to AFRID:

   1. Fear of physical consequences of eating

   2. Lack of hunger cues

   3. Sensory discomfort

   Does one or more of these categories best describe your difficulty with eating? Lets drill-down further. For example, one client of mine has all three of the above challenges, but most specifically has difficulty with certain sensory experiences with eating, namely foods he describes as "thick," "having heft," and "al dente." Things that require a large, forceful bite like hamburgers are the most difficult for him. Another client has only the 3rd category of challenges, but presents quite differently: she is a super-sensor and strong flavors are very difficult for her.

   
   

2. Mindfulness leading up to and during eating (I consider this an intermediate approach, not completely necessary, but helpful if the fear ladder, next step, is too overwhelming)

   Mindfulness can help us focus on the moment and become more comfortable with that moment. This can be part of exposure - part of exposure is response prevention (ie., exposure and response prevention therapy, ERP). Response prevention refers to NOT engaging in maladaptive coping that we are trying to change when facing the feared stimuli. Most of the maladaptive coping serves in some manner as avoidance. This could be stark, blatant avoidances like leaving the room or not eating the food (hence the word avoidance in the disorder, AFRID). It can also be psychological avoidance, like distracting via various means. Distracting can be a good coping skill at times, but does not really build our tolerance, or further yet, enjoyment of the stimuli. In fact, any form of avoidance does the opposite: rather than learning that the stimuli (food) isn't so bad, we learn "whoo, I feel good when I avoid!" and consequently we keep doing it (avoiding) and worsening AFRID and the related anxiety. This is basic reinforcement (avoidance is self-reinforcing because it avoids what is provoking anxiety and is consequently innately anxiety reducing in the short-term, but worsens anxiety in the long-term).

   
   

   Mindfulness, on the other hand, is the opposite: it is holding our focus on one specific thing intentionally. However, this mindfulness has to be maintained for a long enough period of time for our anxiety or discomfort to abate - this is an important part of any exposure therapy.

   1. Look at the food (in person or pictures)

   2. Smell the food

   3. Touch the food to explore it's texture

   4. Eating mindfully which means chewing at a slow-normal pace and attending to the experience, possibly focusing on one sensory attribute at a time (taste or texture).

      
      

3. Fear Ladder (future article on Yerkes Dodson Curve)

   The fear ladder is the crux of ARFID treatment and is an exposure therapy. It involves categorizing foods into groups depending on how anxiety provoking the food is to you, on a scale of 1 to 10. On this scale, 1 is "no challenge, I'm bored enough to fall asleep." The ideal range for a challenge is 4-6 out of 10. This range requires us to grow, but is not overwhelming. We experience it as a doable, rewarding challenge, even exciting, and engaging. Upper ranges, from 7 to 10, are excessively anxiety provoking. In fact, if we are hitting a 10 out of 10, we might have a panic attack. Some forms of therapy called "flooding" focus on this range, but this is not necessary nor suggested without significant competence in exposure therapy.

   
   

   Focus on foods that have health and social impacts on your life. In terms of health, it is recommended to consult a dietician or nutritionist, but, for example, many of us have an idea of what is considered a healthy, rounded breakfast - while this might not have a social impact, it will have broad impacts on your wellbeing. In terms of social impact, ARFID can have significant social detriments if you cannot eat at a restaurant, friend's house, or event like a wedding. People with ARFID might became embarrassed or ashamed and avoid these events or not eat. Try to build comfort with foods common to social events.

   
   

   Over time, foods become less anxiety provoking and easier to eat. Even ones you haven't challenged yet become less daunting - something that was a 7 out of 10 becomes a 6, and can now be challenged. The foods you select to focus on and challenge should be eaten regularly, such as a few times over a week, before exploring new challenges for the next week. You may need to return to foods you've already challenged for a "booster."

   
   

   Consider combining foods. For example, if you challenge noodles, tomato products and cheese over a few weeks, you may be ready for a basic pasta with red sauce! Combinations are harder for picky eaters and those with ARFID alike, but are common in adult social settings. See future posts in the ARFID cookbook for ways to make basic combinations.

   
   

   Challenging yourself to eat new foods on the fear ladder can be rewarding in and of itself for sense of accomplishment, positive feedback from friends and loved ones who know your eating habits, improved sense of wellbeing (many people notice feeling physically healthier), reporting successes to your therapist, and reduced anxiety and improved social functioning. However, we can also apply reinforcement plans to this. I plan to make a blog post on this topic in the future, but here are the basics. Consider "earning" something each time you complete a new food challenge or eat a food your focusing on from the food ladder. What you earn should be individualized to a) be reasonable considering the accomplishment, b) fit your budget, interests and lifestyle, and c) be sustainable and reinforcing. You might allot yourself $5 toward something you want to buy, or put a sticker on a chart and a certain number of stickers designates money toward a reward. This is called reinforcement. If this is not enough motivation, you can also add a consequence. For example, if you don't complete the designated food challenge for the week, you lose the $5 you gained last week or any other consequence (do another housemate's chores, donate money to a charity). This requires either being honest with yourself or engaging someone for accountability (an accountabilibuddy).

Key takeaways

This is doable! Many people find it rewarding, or you can use reinforcement to help motivate you. This is scalable and can be paced however you like. If you take a slower pace, it may be more important to make sure to go back and re-eat foods you already focused on so that they don't become triggers for anxiety again (you don't want to forget or unlearn the work you did over time). Team up with a friend or therapist if it is helpful - while most therapists don't specialize in this, the treatment is basic enough that they can provide adequate support. Also, I believe ARFID is much more common that it is recognized - you are not the only one out there. If you are reading this, you are probably ready to start making whatever change is right for you.