A therapy for ARFID. Here’s how it works, and whether it be delivered by dieticians
STUDY: Winten CG et al, International Journal of Eating Disorders 2026;
STUDY TYPE: Pilot feasibility trial
FUNDING: Rubenstein Charitable Foundation; National Institute of Mental Health; Australian Government Research Training Program Scholarship
Background
Avoidant/restrictive food intake disorder (ARFID) is characterized by severely limited intake or variety of foods. Unlike anorexia, it is not driven by body image concerns but by:
- Sensory sensitivity
- Fear of adverse reactions like vomiting, choking, or allergies
- Low interest in eating
Cognitive-behavioral therapy for ARFID (CBT-AR) is the most evidence-based approach, and this trial asks whether it can be delivered by a dietician.
How CBT-AR Works
- Stage 1 (Education & Early Changes): Build a foundation by understanding the factors that maintain the patterns, using food diaries. If underweight, the initial focus is simply increasing the volume of preferred foods to correct nutritional deficits.
- Stage 2 (Reducing Avoidance): Use cognitive strategies to challenge the thoughts that prevent trying new foods.
- Stage 3 (Food Challenges & Exposures): Gradually introduce feared or novel foods, starting with very small tastes and progressing to full portions.
- Stage 4 (Relapse Prevention): Consolidate gains and build a long-term plan to maintain dietary flexibility.
The Study
- Eleven adults received 20–30 weekly sessions of CBT-AR, supplemented with dietetic-specific worksheets and nutrition education in Australia.
- Measured ARFID symptom severity, food variety, BMI, depression, stress, and psychosocial functioning at baseline, post-treatment, and 6-month follow-up.
Results
Uptake was high. Most (92%) who were offered the therapy started it, and 73% completed it.
ARFID symptom severity improved with large effects in all symptoms. On average, they added 26 new foods. BMI improved, but not significantly. The benefits were sustained up to 6-month after stopping, with 45% of participants met remission criteria.
Limitations
Small, not controlled, all therapy delivered by a single dietician.
Practice Implications
- The study is a step toward feasibility with dieticians. Other studies have confirmed the benefits of CBT-AR.
- Learn more in the free patient guide and the therapist manual.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
