A randomized controlled feasibility trial of metacognitive training with adolescents receiving treatment for anorexia nervosa

Abstract

ObjectiveThis pilot study investigated the feasibility and preliminary efficacy of the metacognitive training for eating disorders (MCT‐ED) program in adolescents with anorexia nervosa (AN). We report attrition and subjective evaluation as well as changes to cognitive flexibility, perfectionism and eating disorder pathology relative to waitlist controls.MethodFemale (n = 35, aged 13–17 years) outpatients with a diagnosis of AN (n = 20) or atypical AN (n = 15) completed baseline measures of cognitive flexibility, perfectionism, and eating disorder pathology (May 2020–May 2022). Participants were randomly allocated to either treatment‐as‐usual (TAU) plus MCT‐ED or TAU waitlist condition. All participants completed post‐intervention and 3‐month follow‐up questionnaires.ResultsThe MCT‐ED condition had a treatment attrition rate <15%. Participants provided positive evaluation of the program. There were large between groups differences favoring MCT‐ED at post‐intervention and 3‐month follow‐up for concern over mistakes perfectionism (respective ds = −1.25, 95% CI [−2.06, −.45]; −.83, 95% CI [−1.60, .06]) with a significant group difference post‐intervention but not 3‐month follow‐up.DiscussionFindings provide tentative support for the feasibility of MCT‐ED as an adjunct intervention for young people with AN, however replication is needed with a larger sample size to further explore its efficacy.Public significanceMetacognitive training for eating disorders (MCT‐ED) is a feasible adjunct intervention for adolescents with anorexia nervosa. The intervention, which targets thinking styles and is delivered online by a therapist, received positive feedback, had high treatment retention, and led to reductions in perfectionism by the end of treatment compared to wait‐list controls. Although these gains were not sustained long‐term, the program is suitable adjunct intervention for young people with eating disorders.

Efficacy of educational interventions in adolescent population with feeding and eating disorders: a systematic review

“…Van Noort et al [ 27 ] performed a pre–post test evaluation in which an intervention group was compared with a healthy control. In the case of recent studies [ 28 , 29 ], two different interventions were compared in order to analyze which was more effective.…”

“…The studies analyzed different types of pathologies included within feeding and eating disorders. In several of them, subtypes were specified, such as unspecified AN [ 26 – 29 , 32 ], or both AN and BN [ 25 , 30 , 33 ].…”

“…Regarding the variables analyzed, as seen in Table 3 , knowledge acquired was assessed in all the selected studies using different knowledge tests[ 26 ] or indirectly by assessing changes in behavior or participants’ dietary patterns[ 31 ]. In addition, variables such as cognitive flexibility [ 27 – 29 ], learning social skills [ 31 ], perfectionism [ 29 ] attitudes and thoughts towards food [ 34 ], the quality of the choice of diet and the time it took to prepare it [ 33 ], or tolerance of uncertainty [ 32 ] were studied. Other variables evaluated in several studies highlighted the improvement in symptoms, a decrease in anxiety, and improvement in depression or changes in anthropometric parameters, self-esteem, family functioning, and average stay of admission.…”

“…Although the interventions evaluated and implemented in the selected studies were heterogeneous in several aspects, in all of them, the theoretical basis, the place where the intervention was developed and its content were described. The interventions were carried out both in the hospital setting [ 25 , 26 , 28 , 32 ] and in outpatient [ 29 , 30 , 34 ] or mixed [ 27 ] settings, such as Day Hospital in FEDs [ 31 , 33 ].…”

“…The educational activity was conducted in groups in six of the studies [ 26 – 28 , 30 , 32 , 33 ] and one-on-one in four studies [ 25 , 29 , 31 , 34 ]. The educational intervention was developed simultaneously with the usual care in most of the studies.…”