Education Education about gut-brain dysregulation and interaction with avoidant/restrictive eating Creation of a personal formulation of behavioral, cognitive, and emotional factors that contribute to both DGBI and ARFID symptom maintenance Education about suppressed weight and importance of gaining weight Monitoring food intake and timing with food diary Regular Eating Eating by the clock, not according to hunger/fullness (e.g., every 3–4 hours) For patients who need to gain weight, increase of food intake by at least 500 calories per day to support 1–2lb weight gain/week Exposure and Response Prevention Gradual exposure to situations and/or food types that are avoided or associated with Gradual exposure to increased food amounts to habituate the GI sensations around eating (e.g., to increase fullness toleration) [For ARFID sensory sensitivity motivation] Progressive introduction of new variations of preferred foods (e.g., different brand, different preparation) and unfamiliar foods, approaching them with a non-judgmental stance Maintenance Planning Summarize progress and areas for further improvement Create a plan for continued progress

Note. ARFID=Avoidant/Restrictive Food Intake Disorder; DGBI=Disorders of Gut-Brain Interaction. Techniques are modeled from cognitive-behavioral treatment for ARFID¹⁰⁷ and exposure-based brain-gut behavioral therapies for DGBI.^44,108,109 An 8-session version of the treatment is currently being tested.