Targeting Premeal Anxiety in Eating Disordered Clients and Normal Controls

marek-ben-porathDr Denise D. Ben-Porath is an Associate Professor of Psychology at John Carroll University. In addition to teaching, Dr. Ben-Porath has an active research program that involves the study of effective treatments for eating disorders and other psychological disorders. She has published numerous articles on these topics and has presented them both nationally and internationally. Dr. Ben-Porath is also currently the associate editor of the journal Cognitive and Behavioral Practice.

Mr. Ryan Marek is a doctoral student in Clinical Psychology with a minor in Quantitative Methodology at Kent State University. His personal program of research is currently focused on the role of psychological assessment in behavioral medicine. Mr. Marek has authored and co-authored numerous papers in journals including Obesity Surgery, International Journal of Eating Disorders, and Psychological Assessment.

Dr. Ben-Porath and Mr. Marek recently published their paper, titled Targeting premeal anxiety in eating disordered clients and normal controls: A preliminary investigation into the use of mindful eating vs. distraction during food exposure, in The International Journal of Eating Disorders.

Background of the study

In addition, to research and teaching, Dr. Ben-Porath is a practicing psychologist at Cleveland Center for Eating Disorders, a center devoted to the treatment and assessment of eating disorders, in Cleveland Ohio. In working with clients with anorexia it was painfully obvious to her the difficulties these clients encounter when approaching and consuming food. She wondered in what way could these patients best be helped to reduce their anxiety while consuming their required meal plans during their daily food exposures that occur in treatment.

Mr. Marek had just completed a summer internship program at the Cleveland Clinic in the area of eating disorders. He also was a student in Dr. Ben-Porath’s counseling techniques class. As such he was also interested in treatment effectiveness with this population. This clinical question became the impetus for their research project.


Past literature suggests that individuals struggling with an eating disorder tend to experience high levels of distress, anxiety, and/or depression prior to eating. Mindfulness – staying in the present moment and using a non-judgmental stance – is a therapeutic technique found to reduce high levels of distressing emotions in various treatment populations. Using a counterbalanced within subjects design, they exposed clients to a mindful eating technique (e.g., bringing attention to food and the process of eating) and then exposed them to a distraction technique (e.g., solving a word search while eating).

Their results found that anxiety was more greatly reduced when eating disordered patients used distraction vs. a mindfulness technique during food exposures. However, a normal control sample demonstrated more anxiety when exposed to the distraction method vs. the mindfulness condition. Attending to the process of eating may be particularly difficult for those with eating disorders due to delayed gastric emptying which can create feelings of excessive fullness, bloating, and stomach pains following food intake. Mindfulness may have led them to focus more on their fullness and possibly reporting more distress.


Several self help treatments for eating disorders in the popular media suggest mindful eating as an avenue to treat eating disorders. These results indicate that mindful eating may be counter-therapeutic, at least initially, for those with some types of an eating disorder. At the very least, more research is needed to determine when and if to employ mindful eating in the treatment of eating disorders. It is important to understand the differential effects within a treatment first to best optimize outcomes for these individuals. Many treatments work for a subset of individuals. As clinicians and researchers, it is important to constantly be searching for ways to improve our treatment protocols.

Advice from the field

Dr. Ben-Porath: Eating disorders is a specialty area in clinical psychology and as such requires additional training traditionally. This typically means a post-doctoral fellowship in this area after earning a doctorate in clinical psychology. Because this discipline crosses over into the medical field a solid understanding of the medical complications associated with eating disorders is needed. Thus, individuals interested in this area should not only have a solid background in clinical psychology but should also have familiarity in the area of nutrition, and medicine.

Mr. Marek: I can speak for students who are looking to obtain a Ph.D. in Clinical Psychology. First and foremost, you must do well in your coursework. It builds a strong foundation and understanding of the basics in the field. Further, do not wait until your senior year to take more difficult courses such as statistics or research methods. Having an understanding from what you learn in these courses opens the door for more competitive, research internships as an undergraduate. You must also have a passion for research and network as much as possible. It can be intimating to talk with your professors, but most are not there to make you feel inferior, many are there to meet you half way. Also, do not be afraid to share your ideas and thoughts with them. You may have a question that you and your professor can empirically attempt to answer.

About the departments

John Carroll University is a liberal arts Jesuit institution located in Cleveland Ohio. Faculty in the psychology department has varied areas of research, including neuroscience, cognition, industrial organization and forensic psychology. The undergraduate program of study in clinical psychology has two specialized tracks and associated internships in the areas of autism and eating disorders.

The Department of Psychology at Kent State University offers two Ph.D. tracks: Clinical Psychology and Experimental Psychology. We have training areas and faculty specializing in Assessment, Behavioral Neuroscience, General Clinical, Cognitive, Developmental, Health, and Social.

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