Exposure Therapy: Conquering Food Challenges After Years of Food Anxiety

Safely Experimenting with Cross Contamination

After receiving my negative skin + blood tests from Chicago Family Allergy and Asthma, I was given the “all clear” to food challenge tree nuts, seafood, and legumes at home for the very first time. Given my undetectable IgE levels, Dr. Katie Tanner felt confident in conducting my taste tests outside of their Lincoln Park office. But the girl with a history of severe anxiety, traumatic stress, and anaphylactic reactions was in no such hurry to suddenly pick up an almond joy on her way home. Yesterday I was avoiding tree nuts like the plague… But today you want me to eat one and just see what happens?!

In the food allergy community, we rally around our commonalities – But each of us are the experts of our own respective journeys. So as an exercise in self compassion, I have chosen to take an individualized approach to this process. With more than twenty years of associating tree nuts with danger + disaster, it has been in my best interest to move at pace that feel right for me. So, with consultation from both my allergist and therapist, I created a personalized exposure hierarchy to gradually introduce previously restricted allergens into my everyday life.

Exposure Therapy

Personalized Exposure Hierarchy

According to the American Psychological Association, exposure therapy is a “psychological treatment that was developed to help people confront their fears.” This intervention is often used to treat phobias, post traumatic stress, obsessive compulsive tendencies, and other anxiety related disorders. One variation of exposure therapy is graded exposure – A technique where psychologists help “construct an exposure fear hierarchy, in which feared objects, activities or situations are ranked according to difficulty. They begin with mildly or moderately difficult exposures, then progress to harder ones.” Graded exposure therapies minimize distress by slowly habituating clients towards their desired goal with progressive, but manageable steps.

Following these same principles, we created an exposure hierarchy to manage food anxiety in preparation for my first food challenge. We designed the hierarchy to begin with the least challenging exercise (Being near previous allergens), then move towards my most challenging feat (Incorporating previous allergens into my regular diet). We avoid labeling the inaugural tasks as “easier” because each phase presents with its own expected anxiety. In fact, the purpose of this therapeutic intervention is to gradually minimize that exact experienced arousal by steadily increasing stress tolerance.

(See Mom and Dad?! These psychology degrees are definitely paying off!)

In preparation for my upcoming food challenges, my homework assignment outside of the therapy room has been to actively engage in lower tier exposure activities. Below, I have provided examples for each prong of the exposure latter, moving from least difficult to most difficult.

1. Being Comfortable Around Foods (Least Difficult)

  • Friends + Family Order Previous Allergens at Restaurants
  • Sit by Peers in Class Eating Previous Allergens
  • Purchase Allergens at Store to Bring into Food Challenges

2. Cross Contamination

  • Consume Foods That Poses Cross Contamination Risk to Previous Allergens
    • Starbucks = Almond Milk
    • Sweetgreen = Cashews
    • Do Rite Donuts = Pistachios
    • RPM Seafood = Shellfish
    • Mezza Grill = Chickpeas
    • LINDOR Truffles = “May Contain Tree Nuts”

3. Food Challenge

  • Schedule Food Challenge @ Chicago Family Allergy and Asthma
  • Attend Brief Therapy Check-In During Food Challenge
  • Utilize Meditation, Relaxation, and Breathing Skills to Differentiate Between Anaphylaxis Symptoms and Anxiety Symptoms

4. Incorporate into Diet (Most Difficult)

  • Recommend by Allergist, Consume Previous Allergens on Regular Basis to Maintain Tolerance
  • Purposely Eat Previous Allergens Every 1-2 Weeks
  • Once Proven to be Safe, Build Up Courage to Eat these Foods Away from Home
    • Use Almond Milk in Coffee
    • Hippeas Chickpea Puffs
    • Order Pine Nut Pesto at Dinner

Allergen Hierarchy

Not all allergies are created equally; My food anxiety has seemingly associated more fear with some allergens than others. For example, almonds and hazelnuts feel more intimidating to food challenge than walnuts or pistachios – Despite there being no meaningful difference between the nuts. In fact, the thought of food challenging any tree nut produces significantly more apprehension than legumes or seafood.

Following suit, these allergens fall into a exposure hierarchy of their own. Chickpeas were purposely scheduled for my first challenge to reduce overall uneasiness about trying a previously restricted food in general. Similarly, before my in office food challenge of almonds (most difficult), I will be conducting an at home challenge of walnuts (less difficult). Taking my first bites of almond should hopefully feel less alarming if its not the first nut I have ever eaten.

Next Steps

On Saturday October 9th, I will challenge my first tree nut in the comfort of my childhood home. Just two weeks after testing walnuts, I chosen to host my almond food challenge in the safety of Chicago Family Allergy + Asthma on Friday October 22nd. Stay tuned for updates, because as always, the Hivey League will get a front row seat as I steadily move towards the peak of my exposure hierarchy.

The emotions that I have associated with previous allergens will certainly take time to unlearn, but research in the field of psychology has highlighted the effectiveness of behavioral interventions for extinguishing anxieties similar to mine. Despite close to twenty years of paralyzing food anxiety, I am hopeful – Because being scared means you are about to do something really, really brave.

DISCLAIMER: The content of this post is for educational purposes only, and should not be substituted for medical, psychological, or professional advice. Please consult with your doctor or a licensed mental health professional for more information.

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