Eating DisordersBBBNCT07914712
Be Body Brave: Digital Written Exposure Therapy for Eating Disorders
A study testing Imaginal exposure and Eating disorder journaling in people with Eating Disorders, run by University of Louisville.
Trial summary
Current eating disorder (ED) treatment options are both inaccessible (80% of people with EDs do not access treatment) and not entirely successful (most people with an ED do not reach full remission). Read more about this study
- Who is it for?
- Ages 18 to 65 years
- Conditions the study is for
- Eating Disorders
- What is being tested?
- Imaginal exposure and Eating disorder journaling
- Type of treatment
- Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 900 participants
- Where
- No sites listed yet
- Study dates
- 1 Jan 2027to 1 Jul 2031
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 to 65 years
- All sexes
- No healthy volunteers
- Adult, Older adult
Who may be able to join
- Current diagnosis of any active eating disorder except ARFID
- Ages 18-65
Who cannot join
- Active Suicidality
- Active Mania
- Active psychosis
Trial locations and contacts
No sites are listed yet. Contact the study team or a site near you to ask about taking part.
Rachel Butler contact
About this study
Official title: A Randomized Controlled Trial of Digital Written Exposure Therapy for Eating Disorders: Improving Access to Care
Current eating disorder (ED) treatment options are both inaccessible (80% of people with EDs do not access treatment) and not entirely successful (most people with an ED do not reach full remission). Imaginal exposure therapy, or what the investigators call Be Body Brave (BBB), is self-guided treatment that offers a solution to both of these issues: online modules reduce barriers to access treatment, and exposure therapy has the potential to shift cognitive beliefs in eating disorders, creating lasting change. This study aims to determine the effectiveness of BBB and identify the optimal timing for implementation of exposure therapy for eating disorders. Participants will complete five sessions of digital imaginal exposure and complete posttreatment, 1-month, 6-month, and 12-month follow-up questionnaires assessing eating disorder symptoms, quality of life, and clinical impairment.
- Conditions
- Eating Disorders
- Being tested
- Imaginal exposure, Eating disorder journaling
- Keywords
- Eating disorders, Treatment, Anorexia nervosa, Digital mental health interventions, Bulimia nervosa, Other specified feeding and eating disorder, Atypical anorexia nervosa, Binge eating disorder
- Medical subject headings
- Feeding and Eating Disorders, Anorexia Nervosa, Bulimia Nervosa, Binge-Eating Disorder
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Imaginal exposureBehavioural
Imaginal exposure related to eating disorders allows participants to be "exposed" to their eating disorder fear by imagining fear-based scenarios.
Eating disorder journalingBehavioural
Generic journaling about eating disorders allows for a comparable condition to the imaginal exposure condition.
| Study group | Role | What they receive |
|---|---|---|
| Eating Disorder Journaling Condition | Active comparator | Participants in the ED Journaling condition will receive five sessions of treatment, one week apart. They will be given general psychoeducation on eating disorders during the first session and will write about anything having to do with their ED during the remaining four sessions. Participants in the ED Journaling condition will also receive feedback and reminders between sessions. Receives: Behavioral: Eating disorder journaling |
| Be Body Brave Condition | Experimental | Participants randomly assigned to BBB will receive 5 weeks of exclusively remote treatment addressing ED-related fears, one week apart, delivered via REDCap. They will be given psychoeducation on exposure therapy during the first session and will write about and imagine an ED fear during the remaining four sessions. Between sessions, participants receive feedback and notifications reminding them to complete the next session and encouraging them to continue facing their fear. Receives: Behavioral: Imaginal exposure |
What is being measured
The primary outcome is the main question the study is designed to answer.
Eating disorder behaviors
Eating Disorder Examination Questionnaire 6.0 (EDE-Q) will be used to measure change in eating disorder symptoms. The EDE-Q has a minimum global score of 0 and a maximum global score of 132. Higher scores indicate more severe eating pathology.
Measured: 6 weeks
Fear of weight gain
Fear of weight gain will be assessed via the Fear of Food Measure, which assesses three cognitive-behavioral dimensions of fear of food: anxiety about food, avoidance behaviors, and fear of weight gain. The fear of weight gain has a minimum global score of 0 and a maximum global score of 2,900. Higher scores indicate worse fear of weight gain.
Measured: 6 weeks
Body image disturbance (State Body Disturbances)
Body Disturbances will be collected via the Eating Disorder-15 (ED-15), which is a 15-item measure of eating disorder cognitions and behaviors, which will be collected at the beginning of each treatment session. The ED-15 includes ten questions that together have a minimum global score of 0 and a maximum global score of 60. There are also 5 items that are open-ended integer questions. Higher scores indicate worse body and eating disturbances.
Measured: 6 weeks
Food avoidance
Avoidance will be measured with the Fear Approach and Avoidance Measure (FAAM), a measure that quantifies approach and avoidance behaviors related to food, body, and weight. The FAAM has a minimum global score of 0 and a maximum global score of 495. Higher scores indicate worse food avoidance.
Measured: 6 weeks
Fear of food
The Fear of Food Measure (FOFM) assesses three cognitive-behavioral dimensions of fear of food: anxiety about food, avoidance behaviors, and fear of weight gain. It has strong factor, convergent, divergent, and construct validity. The FOFM includes 23 questions that have a minimum global score of 23 and a maximum global score of 161. There are also ten items that together have a minimum global score of 0 and a maximum global score of 1000. All together, the scale has a minimum global score of 23 and a maximum global score of 1,161. Higher scores indicate worse fear of food.
Measured: 6 weeks
Eating disorder fears
The Eating Disorder Fear Inventory (EFI) assesses ED fears, such as fear of weight gain and associated consequences. It will be used to generate the "most feared" consequence of weight gain to focus on during exposure therapy. The EFI has a minimum global score of 28 and a maximum global score of 280. Higher scores indicate worse eating disorder fears.
Measured: 6 weeks
Secondary outcomes (5)
BMI
We will assess BMI by measuring weight and height via scale during assessments. We will calculate BMI using the formula kg/m^2.
Measured: 6 weeks
Barriers to Treatment Access
The Barriers to Treatment Access measure is a 15-item questionnaire assessing factors that may have hindered or prevented participants' access to eating disorder treatment due to financial, sociocultural, geographical, and identification barriers. The BTA is a qualitative measure, so there is no range of values or a "score."
Measured: 6 weeks
Quality of Life Scale
Quality of Life Scale (QOLS) asks about various facets of life satisfaction. The QOLS is a valid instrument for measuring quality of life across groups and cultures. The QOLS has a minimum global score of 16 and a maximum global score of 112. Lower scores indicate worse quality of life.
Measured: 6 weeks
Clinical Impairment Assessment
The Clinical Impairment Assessment (CIA) assesses how eating habits, exercising, or feelings about eating, shape or weight have affected participant livelihood. The CIA is a reliable and valid global measure of psychosocial impairment secondary to ED symptoms. The CIA has a minimum global score of 0 and a maximum global score of 88. Higher scores indicate worse clinical impairment.
Measured: 6 weeks
Weight suppression
We will record highest adult weight to assess weight suppression (i.e., difference between highest weight since reaching adult height and current body weight), to partially account for medical, nutritional status, and the impact of weight loss and/or gain. Weight will be measured in pounds.
Measured: 6 weeks
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted4 Nov 2026
- Study start1 Jan 2027 (estimated)
- Primary completion1 Jan 2030 (estimated)
- Study completion1 Jul 2031 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (7)Papers the sponsor has linked to this study.
- Other trials for Eating DisordersStudies of the same condition, open and under way.
- More trials run by University of LouisvilleThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 900 participants (estimated)
Sponsor and investigators
- Lead sponsor
- University of Louisville
- Sponsor type
- University, hospital or other
- Collaborators
- National Institute of Mental Health (NIMH)
- Responsible party
- Principal investigator, Cheri Levinson, University of Louisville
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07914712
- Sponsor's protocol ID
- 26.0140
- Other IDs
- 1R01MH143686-01
- Acronym
- BBB
- Status last verified
- Oct 2026
- First submitted
- 22 Oct 2026
- Last updated
- 4 Nov 2026
- Results posted
- No
- Data monitoring committee
- Yes
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No
Publications
Reilly EE, Anderson LM, Gorrell S, Schaumberg K, Anderson DA. Expanding exposure-based interventions for eating disorders. Int J Eat Disord. 2017 Oct;50(10):1137-1141. doi: 10.1002/eat.22761. Epub 2017 Aug 16.
PubMed 28815659Levinson CA, Rapp J, Riley EN. Addressing the fear of fat: extending imaginal exposure therapy for anxiety disorders to anorexia nervosa. Eat Weight Disord. 2014 Dec;19(4):521-4. doi: 10.1007/s40519-014-0115-6. Epub 2014 Apr 2. No abstract available.
PubMed 24691784Levinson CA, Ralph-Nearman C, Brown ML, Gardner T, Cardi V, Treasure J, Purves K, Eley TC. A pilot randomized control trial of online exposure for eating disorders and mechanisms of change delivered after discharge from intensive eating disorder care: A registered report. Int J Eat Disord. 2021 Nov;54(11):2066-2074. doi: 10.1002/eat.23603. Epub 2021 Sep 4.
PubMed 34480773Levinson CA, Christian C, Ram SS, Vanzhula I, Brosof LC, Michelson LP, Williams BM. Eating disorder symptoms and core eating disorder fears decrease during online imaginal exposure therapy for eating disorders. J Affect Disord. 2020 Nov 1;276:585-591. doi: 10.1016/j.jad.2020.07.075. Epub 2020 Jul 21.
PubMed 32794449Glasofer DR, Albano AM, Simpson HB, Steinglass JE. Overcoming fear of eating: A case study of a novel use of exposure and response prevention. Psychotherapy (Chic). 2016 Jun;53(2):223-31. doi: 10.1037/pst0000048.
PubMed 27267508Butler RM, Heimberg RG. Exposure therapy for eating disorders: A systematic review. Clin Psychol Rev. 2020 Jun;78:101851. doi: 10.1016/j.cpr.2020.101851. Epub 2020 Mar 21.
PubMed 32224363Butler RM, Crumby EK, Christian C, Brosof LC, Vanzhula IA, Levinson CA. Facing Eating Disorder Fears: An Open Trial Adapting Prolonged Exposure to the Treatment of Eating Disorders. Behav Ther. 2024 Mar;55(2):347-360. doi: 10.1016/j.beth.2023.07.008. Epub 2023 Jul 22.
PubMed 38418045
Study at a glance
From the registry record, last updated by the sponsor on 4 Nov 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- A Randomized Controlled Trial of Digital Written Exposure Therapy for Eating Disorders: Improving Access to Care
- ClinicalTrials.gov ID
- NCT07914712
- Acronym / sponsor ID
- BBB / 26.0140
- Conditions
- Eating Disorders
- Keywords
- Eating disorders, Treatment, Anorexia nervosa, Digital mental health interventions, Bulimia nervosa, Other specified feeding and eating disorder, Atypical anorexia nervosa, Binge eating disorder
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 900 participants (estimated)
- Lead sponsor
- University of LouisvilleUniversity, hospital or other
- Collaborators
- National Institute of Mental Health (NIMH)
- Study start
- 1 Jan 2027 (estimated)
- Primary completion
- 1 Jan 2030 (estimated)
- Study completion
- 1 Jul 2031 (estimated)
- First posted
- 4 Nov 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Current eating disorder (ED) treatment options are both inaccessible (80% of people with EDs do not access treatment) and not entirely successful (most people with an ED do not reach full remission). Imaginal exposure therapy, or what the investigators call Be Body Brave (BBB), is self-guided treatment that offers a solution to both of these issues: online modules reduce barriers to access treatment, and exposure therapy has the potential to shift cognitive beliefs in eating disorders, creating lasting change. This study aims to determine the effectiveness of BBB and identify the optimal timing for implementation of exposure therapy for eating disorders. Participants will complete five sessions of digital imaginal exposure and complete posttreatment, 1-month, 6-month, and 12-month follow-up questionnaires assessing eating disorder symptoms, quality of life, and clinical impairment.
Study design
- Primary purpose
- Treatment
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Eating Disorder Journaling Condition | Active comparator | Behavioral: Eating disorder journalingParticipants in the ED Journaling condition will receive five sessions of treatment, one week apart. They will be given general psychoeducation on eating disorders during the first session and will write about anything having to do with their ED during the remaining four sessions. Participants in the ED Journaling condition will also receive feedback and reminders between sessions. |
| Be Body Brave Condition | Experimental | Behavioral: Imaginal exposureParticipants randomly assigned to BBB will receive 5 weeks of exclusively remote treatment addressing ED-related fears, one week apart, delivered via REDCap. They will be given psychoeducation on exposure therapy during the first session and will write about and imagine an ED fear during the remaining four sessions. Between sessions, participants receive feedback and notifications reminding them to complete the next session and encouraging them to continue facing their fear. |
Who may qualify
- Ages
- 18 to 65 years
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Adult, Older adult
Key inclusion criteria (2 listed)
- Current diagnosis of any active eating disorder except ARFID
- Ages 18-65
Key exclusion criteria (3 listed)
- Active Suicidality
- Active Mania
- Active psychosis
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Imaginal exposureImaginal exposure related to eating disorders allows participants to be "exposed" to their eating disorder fear by imagining fear-based scenarios. | Behavioural | Be Body Brave Condition |
| Eating disorder journalingGeneric journaling about eating disorders allows for a comparable condition to the imaginal exposure condition. | Behavioural | Eating Disorder Journaling Condition |
Primary outcome
Eating disorder behaviors
Time frame: 6 weeks
Eating Disorder Examination Questionnaire 6.0 (EDE-Q) will be used to measure change in eating disorder symptoms. The EDE-Q has a minimum global score of 0 and a maximum global score of 132. Higher scores indicate more severe eating pathology.
Fear of weight gain
Time frame: 6 weeks
Fear of weight gain will be assessed via the Fear of Food Measure, which assesses three cognitive-behavioral dimensions of fear of food: anxiety about food, avoidance behaviors, and fear of weight gain. The fear of weight gain has a minimum global score of 0 and a maximum global score of 2,900. Higher scores indicate worse fear of weight gain.
Body image disturbance (State Body Disturbances)
Time frame: 6 weeks
Body Disturbances will be collected via the Eating Disorder-15 (ED-15), which is a 15-item measure of eating disorder cognitions and behaviors, which will be collected at the beginning of each treatment session. The ED-15 includes ten questions that together have a minimum global score of 0 and a maximum global score of 60. There are also 5 items that are open-ended integer questions. Higher scores indicate worse body and eating disturbances.
Food avoidance
Time frame: 6 weeks
Avoidance will be measured with the Fear Approach and Avoidance Measure (FAAM), a measure that quantifies approach and avoidance behaviors related to food, body, and weight. The FAAM has a minimum global score of 0 and a maximum global score of 495. Higher scores indicate worse food avoidance.
Fear of food
Time frame: 6 weeks
The Fear of Food Measure (FOFM) assesses three cognitive-behavioral dimensions of fear of food: anxiety about food, avoidance behaviors, and fear of weight gain. It has strong factor, convergent, divergent, and construct validity. The FOFM includes 23 questions that have a minimum global score of 23 and a maximum global score of 161. There are also ten items that together have a minimum global score of 0 and a maximum global score of 1000. All together, the scale has a minimum global score of 23 and a maximum global score of 1,161. Higher scores indicate worse fear of food.
Eating disorder fears
Time frame: 6 weeks
The Eating Disorder Fear Inventory (EFI) assesses ED fears, such as fear of weight gain and associated consequences. It will be used to generate the "most feared" consequence of weight gain to focus on during exposure therapy. The EFI has a minimum global score of 28 and a maximum global score of 280. Higher scores indicate worse eating disorder fears.
5 secondary outcomes
BMI
Time frame: 6 weeks
Barriers to Treatment Access
Time frame: 6 weeks
Quality of Life Scale
Time frame: 6 weeks
Clinical Impairment Assessment
Time frame: 6 weeks
Weight suppression
Time frame: 6 weeks
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 4 Nov 2026.
- Background: PubMed 28815659Reilly EE, Anderson LM, Gorrell S, Schaumberg K, Anderson DA. Expanding exposure-based interventions for eating disorders. Int J Eat Disord. 2017 Oct;50(10):1137-1141. doi: 10.1002/eat.22761. Epub 2017 Aug 16.
- Background: PubMed 24691784Levinson CA, Rapp J, Riley EN. Addressing the fear of fat: extending imaginal exposure therapy for anxiety disorders to anorexia nervosa. Eat Weight Disord. 2014 Dec;19(4):521-4. doi: 10.1007/s40519-014-0115-6. Epub 2014 Apr 2. No abstract available.
- Background: PubMed 34480773Levinson CA, Ralph-Nearman C, Brown ML, Gardner T, Cardi V, Treasure J, Purves K, Eley TC. A pilot randomized control trial of online exposure for eating disorders and mechanisms of change delivered after discharge from intensive eating disorder care: A registered report. Int J Eat Disord. 2021 Nov;54(11):2066-2074. doi: 10.1002/eat.23603. Epub 2021 Sep 4.
- Background: PubMed 32794449Levinson CA, Christian C, Ram SS, Vanzhula I, Brosof LC, Michelson LP, Williams BM. Eating disorder symptoms and core eating disorder fears decrease during online imaginal exposure therapy for eating disorders. J Affect Disord. 2020 Nov 1;276:585-591. doi: 10.1016/j.jad.2020.07.075. Epub 2020 Jul 21.
- Background: PubMed 27267508Glasofer DR, Albano AM, Simpson HB, Steinglass JE. Overcoming fear of eating: A case study of a novel use of exposure and response prevention. Psychotherapy (Chic). 2016 Jun;53(2):223-31. doi: 10.1037/pst0000048.
- Background: PubMed 32224363Butler RM, Heimberg RG. Exposure therapy for eating disorders: A systematic review. Clin Psychol Rev. 2020 Jun;78:101851. doi: 10.1016/j.cpr.2020.101851. Epub 2020 Mar 21.
- Background: PubMed 38418045Butler RM, Crumby EK, Christian C, Brosof LC, Vanzhula IA, Levinson CA. Facing Eating Disorder Fears: An Open Trial Adapting Prolonged Exposure to the Treatment of Eating Disorders. Behav Ther. 2024 Mar;55(2):347-360. doi: 10.1016/j.beth.2023.07.008. Epub 2023 Jul 22.
- Individual participant dataSharing planned: No
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
Rachel Butler contact
Questions about this trial
What is this clinical trial studying?
A study testing Imaginal exposure and Eating disorder journaling in people with Eating Disorders, run by University of Louisville.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 3 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 4 Nov 2026. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Cheri A Levinson, Ph.D. (502-852-7795, cheri.levinson@louisville.edu), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Eating disorder behaviors (time frame: 6 weeks). The study lists 6 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT07914712, which also lists 7 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 Nov 2026; AzTrials last refreshed its copy on 6 Nov 2026.