Objective: This randomized controlled study tested the effect of interoceptive exposure on anterior insula function and connectivity for the extinction of palatable and rotten food-cue associations in female adolescents with low weight eating disorders (LWED).
Method: Thirty-nine female adolescents with LWED and 19 matched controls performed a food-related conditioning paradigm during functional magnetic resonance imaging (fMRI). Adolescents with LWED were then randomized to six sessions of either interoceptive exposure (n = 18) or family-based (n = 21) treatment, followed by a second fMRI. Whole brain activation and insula-driven connectivity for the extinction of palatable and rotten food-cue associations were compared between groups and changes over treatment were compared between the two therapies.
Results: Adolescents with LWED exhibited diminished bilateral anterior insula activation for the extinction of palatable food-cue associations compared to controls (T = 3.9-4.1, p values < .001; Hedges g = 0.47-0.55). Brief interoceptive exposure treatment increased left anterior insula activation for the extinction of palatable food-cue associations (T = 5.10, p <.001; Hedges g = 1.59) and non-significantly improved palatability ratings for these associations during extinction compared to family-based treatment (β = -1.492, p =.087). There were no effects of group or therapy on connectivity or activation for rotten food-cue associations.
Conclusion: These results suggest that targeting food avoidance in female adolescents with LWED using interoceptive exposure engages anterior insula regions that mediate the visceral sensation of disgust and may underlie the resistance to extinction. The findings present a window into possible pathophysiological mechanisms of anorexia nervosa and other LWED.
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