A randomised clinical trial to evaluate the acceptability and efficacy of an early phase, online, guided augmentation of outpatient care for adults with anorexia nervosa

Abstract

BackgroundOutpatient interventions for adult anorexia nervosa typically have a modest impact on weight and eating disorder symptomatology. This study examined whether adding a brief online intervention focused on enhancing motivation to change and the development of a recovery identity (RecoveryMANTRA) would improve outcomes in adults with anorexia nervosa.MethodsParticipants with anorexia nervosa (n = 187) were recruited from 22 eating disorder outpatient services throughout the UK. They were randomised to receiving RecoveryMANTRA in addition to treatment as usual (TAU) (n = 99; experimental group) or TAU only (n = 88; control group). Outcomes were measured at end-of-intervention (6 weeks), 6 and 12 months.ResultsAdherence rates to RecoveryMANTRA were 83% for the online guidance sessions and 77% for the use of self-help materials (workbook and/or short video clips). Group differences in body mass index at 6 weeks (primary outcome) were not significant. Group differences in eating disorder symptoms, psychological wellbeing and work and social adjustment (at 6 weeks and at follow-up) were not significant, except for a trend-level greater reduction in anxiety at 6 weeks in the RecoveryMANTRA group (p = 0.06). However, the RecoveryMANTRA group had significantly higher levels of confidence in own ability to change (p = 0.02) and alliance with the therapist at the outpatient service (p = 0.005) compared to the control group at 6 weeks.ConclusionsAugmenting outpatient treatment for adult anorexia nervosa with a focus on recovery and motivation produced short-term reductions in anxiety and increased confidence to change and therapeutic alliance.

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

“…In this latest iteration of the cognitive interpersonal model, we have described treatments targeting modifiable elements. Increasing social connection through encouraging a collaborative inclusive approach towards recovery, by increasing the knowledge and skills of family members, decreases the need for high-intensity care (day or inpatient) and reduces carer burden and patient isolation [49][50][51]136]. Treatment using MANTRA focuses on both inter and intrapersonal model elements [55,56].…”

Review of Randomized Controlled Trials Using e-Health Interventions for Patients With Eating Disorders

“…Cardi et al examined the RecoveryMANTRA online intervention during the early (motivational) phase of AN treatment (47). Adults and adolescents with DSM-5 diagnosis of AN (n = 187), out of which 181 were women, were randomized to receiving either RecoveryMANTRA + treatment as usual (n = 99) or treatment as usual (TAU) only (n = 88).…”

“…However, patients in the RecoveryMANTRA group exhibited significantly higher confidence in their ability to change and a higher ability to build rapport with their therapist at 6 weeks. No acceptability ratings were reported (47).…”

The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

“…This study conducted secondary analyses of data from the SHARED trial (as published in Cardi et al, 2015Cardi et al, , 2019 and examined drop-out rates (i.e., non-completion of end-ofintervention assessment measures) and intervention adherence rates (adherence defined as attendance of a minimum of four of six sessions) to establish the acceptability of delivering RecoveryMANTRA to patients. The drop-out and completer groups were compared in terms of baseline socio-demographic and clinical variables and eating behaviors, usage of the selfhelp materials and perceived quality of the relationship with the online mentor at the end of the first week of project participation.…”