New Funding Supports Development of and Increased Access to Eating Disorder Treatment Options
Oct. 23, 2024
By Stephanie Godward, Communications and Marketing Director, College of Arts & Sciences
Christina Ralph-Nearman, Assistant Research Professor and Assistant Director of the Eating Anxiety Treatment (EAT) Laboratory in the Department of Psychological and Brain Sciences, recently received funding to advance two aspects of her work that are revolutionizing the treatment of eating disorders.
New National Eating Disorders Association (NEDA) Grant Advances Refinement of Virtual Reality Modules for Treatment
In addition to her work as Co-Investigator for many NIH grants within the EAT Lab, and being an awardee of the 2023 UofL Trailblazer Award for her work to develop novel personalized treatment tools for eating disorders, Ralph-Nearman has been recently awarded her third KYNETIC as principal investigator (PI). These KYNETIC grants have funded the team’s ability to develop and pilot the user experience of virtual reality modules used to target and treat eating disorders and the fears associated with them. Now, Ralph-Nearman is also principal investigator to take this Virtual Reality work forward with a newly awarded National Eating Disorder Association (NEDA) grant of $125,000 in direct costs for two years. The NEDA award allows Ralph-Nearman and the team to further refine and personalize the VR modules through clinician and patient feedback, and to test the modules at both higher and lower levels of care for eating disorders, including inpatient and residential, as well as outpatient and intensive outpatient.
“We can further develop these tools with all of their feedback,” Ralph-Nearman states. “We can also see where it works the best and what needs to be changed to best support the therapists and patients at these different levels of care so we can have maximum impact.”
Traditionally, eating disorders have been treated using Cognitive Behavioral Therapy. With a new approach, the EAT Lab is using exposure therapy through VR modules. Exposure therapy is typically used to treat PTSD, OCD, phobias, and fears.
"In many cases, people with eating disorders have a comorbidity or a co-occurring anxiety disorder, and we know that there are often some serious irrational fears around gaining weight. Someone might think, ‘If I drink this shake, I will become enormous,’ or their fear might center on physical sensation fears of feeling bloated despite not eating much, or fears of criticism — ‘If I gain a little weight, I will be disliked or criticized,’” Ralph-Nearman says. “There are a lot of food rules and body rules that are very disordered types of rules around what people will or won’t eat, how they eat, what clothes they wear, etc.”
The VR modules allow patients to safely immerse themselves into an environment that helps them to address and face these types of fears. While their anxiety initially spikes, eventually, those being treated are able to focus, feel what they feel through the VR modules, and eventually learn to train their body and brain that they are okay, instead of disassociating or avoiding the feelings associated with their specific fear.
“A component across the modules is they are able to build their own avatar as they see themselves, building their body, hair and skin color, etc.,” she said. “From there, they systematically face the fear – for example, weight gain, and they watch their body grow and it feels real. They see their body undergo this extreme fear they have, and it is a systematic and safe way to do that.”
New Funding Supports Digital Tool to Increase Access to Treatment for Pregnant and Post-Partum Women
Ralph-Nearman is also the principal investigator for the first time in her career by the National Institute of General Medical Sciences women’s supplement grant of over $300,000 for a year that will fund a clinical trial to identify personalized treatment targets for pregnant and postpartum women experiencing an eating disorder.
“We know that one in 10 women who are pregnant have disordered eating and we know it is extremely dangerous for both the woman and her infant,” Ralph-Nearman states. “This is going to be very accessible for anyone who has a phone and we can provide them if they do not have them, and so they can use it in everyday life and we will make the tool more personalized to this population.”
This self-guided therapeutic will be accessible through an app on a smartphone, in which a person seeking support for an eating disorder will interact with the HIPAA-secure digital tool for two weeks, answering questions and completing homework. After these tasks are completed and the app runs an algorithm based on the responses, the person seeking treatment will meet with a clinician. The original app funded by a PRePARE grant, allows a clinician to specify and tailor a care plan based on an individual’s personal responses. The self-guide will now make interventions available to those on waitlists are unable to access treatment in a timely manner.
“This personalized therapeutic shows the top two symptoms that drive or theorize that person’s eating disorder,” Ralph-Nearman states. “We don’t know why one person might be driven by sleep problems, while with another, their anorexia is driven by a fear of weight gain. Someone else might be driven by PTSD.”
The new tool will pinpoint that individual’s most problematic symptoms, and then the clinician (in the guide), or can walk themselves (in the self-guide_ through the evidence-based treatments to address that specific individual’s challenges.
“I am so excited because it is so needed and you can imagine someone who is pregnant, they are already going to a lot of doctor appointments, but often eating disorders are not even screened for at a regular doctor’s appointment the way anxiety is.”
Increasing Accessibility to Eating Disorder Treatment
Ralph-Nearman is driven by her own commitment to increasing access to treatment and also developing new therapeutics that are critical to helping people receive the life-saving help they need.
“The reason I got into this line of work is that at the time, eating disorders were the #1 killer of all mental health issues and it is now the #2 killer after opioids,” she said. “Typical treatments for eating disorders, such as anorexia nervosa or bulimia nervosa, only work for 50 percent of the people who seek the treatment out and actually have access to the treatment. Then, people often relapse after two to six months. When initially learning this, I just thought — we have to do something else.”
The new tools that are being developed in the EAT Lab could help to prevent people from relapsing, and also will create more access to support for people who cannot access or afford other treatments.
“When you are developing something new, you need to plough the land, plant the seeds, and water what looks like dirt – and roots are growing underneath but after a while it’s growing fruit that nourishes people, and you can see health coming back to people,” Ralph-Nearman states. “I think of this job as doing that.”
Stay updated on this work by following Ralph Nearman on Twitter/X @CRalphNearman.
