Introducing CBT-AR: A New Addition to ARFID Support at Stepping Stones

Understanding eating difficulties, building confidence and supporting meaningful change.

For many children, adolescents and adults living with Avoidant/Restrictive Food Intake Disorder (ARFID), eating is far from straightforward.

What may appear to others as picky eating, stubbornness or an unwillingness to try new foods can actually reflect significant sensory discomfort, anxiety, fear or a genuine lack of interest in eating.

For individuals and their families, this can make everyday experiences such as preparing meals, eating at school, attending social events or going on holidays incredibly challenging.

At Stepping Stones with Helen Dean, I regularly work with individuals and families navigating these difficulties.

I'm pleased to share that I have recently completed additional training in Cognitive Behavioural Therapy for ARFID (CBT-AR), further strengthening the support I can offer.

Understanding ARFID: It's More Than Picky Eating

ARFID is an eating disorder characterised by avoidant or restrictive eating that can significantly affect nutritional intake, growth, physical health or psychosocial functioning.

Unlike anorexia nervosa, ARFID is not driven by concerns about weight or body shape.

People experiencing ARFID may struggle with eating for several different reasons.

Sensory sensitivities

Certain tastes, smells, textures, temperatures or appearances may feel overwhelming or intolerable. Even small changes to familiar foods can cause significant distress.

Fear of aversive consequences

Eating may be associated with fears of choking, vomiting, allergic reactions or becoming unwell. Sometimes these fears develop following a frightening experience involving food.

Limited appetite or interest in eating

Some individuals experience little hunger, find eating a chore or struggle to recognise their body's signals that they need nourishment.

These experiences can overlap, and every person's presentation of ARFID is different.

For some, food variety becomes increasingly limited. For others, eating enough food throughout the day is the primary challenge.

What Is CBT-AR?

Cognitive Behavioural Therapy for ARFID (CBT-AR) is a structured, evidence-informed treatment designed to address the factors contributing to avoidant or restrictive eating.

It has been developed primarily for individuals aged 10 years and older, including adolescents and adults, and is generally delivered in an outpatient setting when medically appropriate.

Rather than simply encouraging someone to eat unfamiliar foods, CBT-AR seeks to understand why eating has become difficult and what may be maintaining those difficulties.

Treatment may involve:

• Developing a clearer understanding of current eating patterns

• Establishing regular and nutritionally adequate eating

• Exploring how thoughts, emotions, sensory experiences and physical sensations influence eating

• Gradually building confidence with unfamiliar foods

• Addressing fears associated with eating

• Developing practical strategies to support change between sessions

Treatment is tailored to the individual's needs, with family involvement where appropriate.

Importantly, nutritional rehabilitation and medical safety remain priorities, particularly where growth, weight or nutritional adequacy have been affected.

CBT-AR Meets Responsive Feeding: My Clinical Approach

While CBT-AR provides a valuable therapeutic framework, I also believe that how we support someone to make changes is just as important as the changes themselves.

My clinical approach draws on both CBT-AR and responsive feeding principles.

This means recognising that eating difficulties are not simply behaviours to be corrected. They are often connected to sensory experiences, anxiety, past experiences, emotional regulation and the individual's relationship with food.

I aim to balance structured therapeutic goals with:

Respect for sensory differences

Recognising that sensory experiences are real and that some foods may genuinely feel overwhelming.

Autonomy and meaningful choice

Working collaboratively so individuals have an active role in identifying goals and participating in decisions about their treatment.

Emotional safety and trust

Creating a supportive environment where eating difficulties can be explored without judgement or shame.

Gradual, manageable challenges

Supporting individuals to build confidence through carefully planned experiences, rather than overwhelming them with expectations.

Family understanding and support

Helping parents and carers understand the reasons behind eating difficulties and develop supportive, practical responses.

This does not mean avoiding all challenges. Meaningful change often involves approaching situations that feel uncomfortable or unfamiliar.

However, those challenges should be purposeful, collaborative and responsive to the individual's needs.

Progress matters, but so does how we get there.

Why Parents and Families Matter

ARFID rarely affects just one person.

Parents may spend hours planning meals, preparing different foods, managing distress or worrying about whether their child is eating enough.

Family meals can become stressful, and parents may feel caught between wanting to encourage change and fearing that additional pressure will make eating more difficult.

Parents may also receive conflicting advice about how best to respond.

In my work, supporting parents and carers is often an essential part of treatment.

This may involve understanding a child's eating profile, establishing predictable opportunities to eat, supporting adequate nutrition, reducing unhelpful mealtime pressure and finding realistic ways to encourage food exploration.

For younger children, parent-focused intervention and responsive feeding strategies can be particularly important.

Families deserve support, understanding and practical guidance rather than blame.

Looking Beyond Food: An Integrated Approach

One of the benefits of my work at Stepping Stones is the ability to combine my experience as an Accredited Practising Dietitian and Registered Counsellor.

ARFID involves both nutritional and psychological considerations, and these are often closely connected.

For example, inadequate nutritional intake can affect concentration, energy, mood and the capacity to manage anxiety.

At the same time, anxiety, sensory distress or negative eating experiences can make it increasingly difficult to meet nutritional needs.

Addressing one without considering the other may limit progress.

My approach therefore considers the whole person, including their nutritional needs, emotional wellbeing, sensory experiences, family relationships and everyday environment.

Where needed, I also work collaboratively with other health professionals to support coordinated care.

What Does Progress Look Like?

Progress in ARFID treatment is not always measured by the number of new foods someone can eat.

It may look like:

• Eating breakfast more consistently

• Feeling less anxious when an unfamiliar food is nearby

• Managing a meal away from home

• Becoming more comfortable exploring different textures

• Having enough food available during the school or workday

• Feeling more confident in social eating situations

• Reducing family stress around meals

• Developing greater flexibility with familiar foods

Sometimes the first goal is simply ensuring someone is eating enough of the foods they already feel comfortable with.

For others, the focus may be on gradually increasing variety or reducing fear.

There is no single pathway that works for everyone.

ARFID Support at Stepping Stones with Helen Dean

I provide individualised ARFID and feeding support for children, adolescents, adults and their families.

My work combines nutritional care, counselling approaches, CBT-AR informed treatment where appropriate, responsive feeding principles and parent/carer support.

I recognise that eating difficulties can be complex and that change often takes time.

My aim is to create a supportive, collaborative space where individuals and families can develop greater understanding, confidence and flexibility around eating.

If you or someone in your family is experiencing difficulties with eating, support is available.

Stepping Stones with Helen DeanAccredited Practising Dietitian | Registered Counsellor

Ivanhoe East, Melbourne | Telehealth available