Table 1 FBT + UP-C for ARFID session content

FBT Session 1

Collaborative weighing, psychoeducation (specific to ARFID patients), separating the eating problem from the child, charging parents with taking control of their child’s eating, and beginning the discussion of utilizing rewards.

FBT Session 2

Engage family in family meal to further assess patient’s eating, address any mealtime behaviors that are getting in the way of success, and work to empower parents to begin helping their child make changes to their eating.

FBT Sessions 3+

For very underweight patients, additional FBT sessions focus on building the parental alliance and discussing ways to improve the parent’s ability to work together on the task of weight gain and related symptoms (food avoidance, anxieties around eating, etc). For patients who are not underweight or are gaining weight appropriately, the UP session content may begin to be added.

FBT + UP-C Module 1: Introduction to the Unified Protocol for the Treatment of Emotional Disorders in Children

Introduces child/parents to the treatment model/structure and describes the CLUES skills (Consider how I feel, Look at my thoughts, Use detective thinking and problem solving, Experience my feelings, Stay healthy and happy), discusses the purpose of emotions and begins to build emotional awareness, and identifies top problems and treatment goals. Top problems may focus on ARFID related goals or be more wide-range to address other emotional avoidance or related diagnoses.

FBT + UP-C Module 2: Getting to Know Your Emotions

Learn to identify and rate intensity of different emotions, normalizes emotional experiences, discusses the three parts of the emotional experience and the cycle of avoidance, explains true/false alarms, and identifies rewards for new behaviors.

FBT + UP-C Module 3: Using Science Experiments to Change our Emotions and Behavior

Learn about the concept of “acting opposite” and using science experiments to help with acting opposite/emotional behaviors, explains the connection between activity and emotion and assigns emotion and activity tracking as an experiment.

FBT + UP-C Module 4: Our Body Clues

Describe the concept of body clues and their relation to strong emotions, learn to identify body clues for different emotions, teach the skill of body scanning to develop awareness of body clues, help child practice experiencing body clues without using avoidance/distraction through interoceptive exposures.

FBT + UP-C Module 5: Look at my Thoughts

Introduce the concept of flexible thinking and teach children to recognize common “thinking traps.”

FBT + UP-C Module 6: Use Detective Thinking

Introduce and apply detective thinking.

FBT + UP-C Module 7: Problem Solving and Conflict Management

Introduce and apply problem solving, discuss use of problem solving for interpersonal conflicts or challenges related to eating.

FBT + UP-C Module 8: Awareness of Emotional Experiences

Teach children about present moment awareness, introduce non-judgmental awareness- especially with relation to strong disgust responses.

FBT + UP-C Module 9: Introduction to Emotion Exposure

Review skills learned to date in the UP-C, review the concepts of emotional behaviors and “acting opposite” in preparation for a new type of science experiment called “exposure,” complete a demonstration of an exposure using a toy or other object, work together with child and parents to begin developing plans for upcoming exposures.

FBT + UP-C Module 10: Facing Our Feelings – Part 1

Review the concept of using science experiments to face strong emotions, introduce the idea of safety behaviors and subtle avoidance behaviors (e.g., distraction), practice a science experiment to face strong emotions (sample situational emotion exposure), make plans for future science experiments for facing strong emotions (individualized situational emotion exposures).

FBT + UP-C Module 11: Facing Our Feelings – Part 2

Plan and execute initial situational emotion exposure in session, plan and execute additional situational emotion exposure activities in future sessions and at home.

FBT + UP-C Module 12: Wrap Up and Relapse Prevention

Review Emotion Detective skills learned in the UP-C program, plan for facing strong emotions in the future, celebrate progress made in treatment program, create a plan for sustaining and furthering progress after treatment, distinguish lapses from relapses and help family recognize warning signs of relapse.