Therapists' Attitudes and Exclusion Criteria for Prolonged Exposure and EMDR in Patients With Eating Disorders and PTSD

Objective: A significant proportion of patients with eating disorders (EDs) also meet criteria for posttraumatic stress disorder (PTSD). Guidelines recommend exposure‐based treatments for PTSD, including prolonged exposure (PE) and eye movement
desensitisation and reprocessing (EMDR). Investigating therapist‐related factors could lead to improve their use when ED and PTSD co‐occur.
Method: A cross‐sectional survey was conducted among 81 EDs therapists (88% female; M age = 40.4, SD = 10.4) in 2023 in the Netherlands. Hierarchical multiple regression analyses assessed predictors of excluding patients with EDs and comorbid PTSD from exposure‐based treatments for PTSD.
Results: Therapists held more favourable beliefs about EMDR (M = 10.5, SD = 7.5) than PE (M = 13.9, SD = 6.9), and were less likely to exclude patients with EDs and comorbid PTSD from EMDR (M = 15.5, SD = 9.3) than PE (M = 17.7, SD = 9.3) (t(80) = 3.47, p < 0.002). Beliefs about exposure‐based interventions predicted the likelihood of exclusion from both PE (β = 0.56, p < 0.002) and EMDR (β = 0.69, p < 0.002).
Conclusions: Therapists' beliefs influence the use of exposure‐based treatments for PTSD in patients with EDs and comorbid PTSD. Addressing these beliefs in training, may support broader implementation.