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Effects of Safety Behavior Fading on Bulimic Symptoms and Drive for Thinness



Conceptualizations of body image-related disorders suggest that targeting safety behaviors (SB) may help reduce eating disorder (ED) symptoms. No consensus exists regarding the mechanism underlying the relationship between SBs and ED symptoms, though one hypothesized construct is overvaluation of appearance.


The aim of the current study is to expand upon existing SB research and evaluate the effects of a technology-based SB fading manipulation on drive for thinness and bulimic symptoms. Further, we sought to test the mechanism of overvaluation of appearance in explaining the effects of SB fading on these outcomes.


Women (n = 84) with elevated appearance concerns completed the present study. Participants were randomized to a SB fading condition or a no instructions control condition. The SB fading group received daily text message reminders to fade SBs for the two-week manipulation period. Questionnaires were completed at baseline, post-manipulation, and two-week follow-up.


SB fading led to greater reductions in bulimic symptoms at post-assessment and drive for thinness at both post-assessment and two-week follow-up, relative to the control condition. Further, changes in appearance overvaluation accounted for the effects of SB fading on changes in bulimic symptoms and drive for thinness.


Results support the role of appearance-related SBs in ED outcomes and the mechanism of overvaluation of appearance in explaining these relationships. SB fading via text message reminders may be an effective transdiagnostic approach to treat eating pathology.

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Data Availability

The data that support the findings of this study are not publicly available due to containing information that could compromise the privacy of research participants. Anyone interested in accessing the data should contact the corresponding author.


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Correspondence to Jesse R. Cougle.

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This research received no specific grant from any funding agency, commercial or not-for-profit sectors.

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The present study was approved by an Institutional Review Board (#2019.26919). Study researchers and authors upheld the Ethical Principles of Psychologists and acted in accordance with the British Association of Behavioral and Cognitive Psychotherapies (BABCP) and Behavioral and Cognitive Psychotherapy (BACP) Code of Conduct principles.

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Stentz, L.A., Wilver, N.L., McDermott, K.A. et al. Effects of Safety Behavior Fading on Bulimic Symptoms and Drive for Thinness. Cogn Ther Res (2022).

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