Innovative treatment approaches to bulimia nervosa.

Aman et al. (1987) wrote a narrative review. They asked what to do when standard bulimia treatment fails.

They described two add-on tools: temptation with exposure plus response prevention (TERP) and implosive therapy (IT). No new data were collected.

The paper gives a road map, not numbers. TERP exposes clients to binge foods while blocking purging. IT floods the client with scary body-image cues until anxiety drops.

Both ideas aim to stop the relapse loop that often follows standard cognitive-behavioral packages.

Austin et al. (2015) later showed why relapse happens even after perfect exposure. They proved that returning to the old reinforcing context renews the behavior. Their data extend the 1987 warning: exposure works only if you also plan for context shifts.

Craig et al. (2019) sharpen the point. They found that hopping back and forth between reinforcement and extinction contexts causes more relapse than the classic ABA sequence. This lab result supports TERP’s real-world need for tight response-prevention rules.

Storch et al. (2012) offer a fix. They trained pigeons on an alternative response in a separate room before extinction. Relapse dropped. The study extends TERP by showing that teaching a new skill away from binge cues can protect gains.

If your client stops purging in clinic but binges again at home, you are seeing renewal. Add TERP steps: bring binge foods into session, block purging, and rehearse the new context. Schedule booster visits in multiple settings so the skill travels.