Introduction
Noah, a creative 13-year-old, reclaimed his health and confidence through Anxiety Institute’s specialized Intensive Outpatient Program (IOP) for ARFID. With a tailored treatment plan that addressed his avoidance of new foods, sensory sensitivities, fear of choking, and underlying anxiety, Noah learned to overcome avoidance behaviors, embrace variety in his diet, and reconnect with his family and social activities.
“Meals used to be a daily battle. Now we see Noah exploring new foods, laughing at the table, and enjoying family time in ways we haven’t seen in years. This program has truly been life-changing.”
– Parents of Noah
Background
For most of his childhood, Noah was considered a “picky eater,” but his food restrictions worsened significantly over time after he experienced an adverse reaction to a few different types of foods.
By the time he began treatment, Noah’s meals consisted almost exclusively of plain pasta and chicken fingers, leaving him underweight and lacking energy for school, sports, or socializing. Meals became a source of conflict at home, and Noah often avoided events involving food altogether.
Noah had tried previous therapists to address his challenges, but his progress remained limited. Recognizing the need for a more tailored approach, Noah’s pediatrician referred him to Anxiety Institute, where his care team identified Avoidant/Restrictive Food Intake Disorder (ARFID). We designed a comprehensive approach to tackle both Noah’s specific eating challenges and the anxiety driving his avoidance.
Anxiety Institute’s Approach
We used a combination of CBT-AR (Cognitive Behavioral Therapy for ARFID) and Exposure Response Prevention (ERP), integrating evidence-based interventions to address Noah’s fears and reduce his avoidance of new foods.
ERP for Food Challenges: Drawing on techniques originally developed for anxiety and OCD, Noah was gradually exposed to feared foods in low-pressure settings. Exposure exercises included exploring new foods using all of his senses, increasing volume and variety of foods, eating in new environments, and engaging in interoceptive exercises—all while resisting avoidance behaviors. Through repeated exposures, Noah’s anxiety around food decreased, fostering a sense of mastery.
Facilitation of Inhibitory Learning: Through ERP, Noah developed tolerance to novel foods and a willingness to challenge his conditioned fear response. This helped to reinforce new positive associations with eating experiences.
Core Anxiety Reduction: CBT-AR addressed Noah’s specific cognitive fears, such as negative feelings and predictions about choking, helping him understand and reframe his emotional responses.
Sensory Integration: Exercises targeting sensitivity to food textures and smells helped Noah become more comfortable exploring diverse foods.
Family-Based Treatment: Noah’s parents were actively involved, learning to create supportive mealtime environments while practicing food exposures. This promoted consistent progress at home.
Noah made significant strides during treatment, moving from simply observing new foods to successfully incorporating them into his meals.
Transformative Results
By the end of his IOP treatment, Noah experienced a life-changing transformation.
His accomplishments included:
- Expanding his food choices, including an increase in nutrient-dense options.
- Gaining the confidence to participate in social meals with peers, such as pizza nights and celebrations.
- Rejoining his family at the dinner table without conflict or anxiety.
- Reestablishing a health weight and recovering his energy to engage fully in school and recreational activities.
Measurable Results
Noah’s Measurement-Based Outcomes at Discharge:
About this case study
The client’s name, photo, and identifying features have been changed to protect confidentiality.
Clinically reviewed by Dina Nunziato, PhD Chief Clinical Officer
