Motivation-Enhancing Psychotherapy for Inpatients With Anorexia Nervosa (MANNA): A Randomized Controlled Pilot Study

Abstract

Patients with anorexia nervosa (AN) are frequently characterized by an unstable readiness to change and high ambivalence toward treatment. Enhancing readiness to behavioral change therefore plays an essential role for adherence to treatment especially for severely ill patients treated in inpatient settings. Therefore, a novel 10 week program for the individual psychotherapy sessions was designed using elements from motivational interviewing to be applied within the multidisciplinary inpatient treatment for patients with AN. In a randomized controlled pilot trial, N = 22 patients with AN received either the new intervention or treatment as usual in one of two recruiting university hospitals. Readiness to change, eating disorder pathology, therapeutic alliance as well as acceptance and feasibility of the new intervention were measured from patients and therapists in week 1, 5, and 10 of inpatient treatment. Results confirm acceptance and feasibility of the MANNA intervention as evaluated by patients as well as therapists. Patients receiving the new intervention completed their inpatient treatment significantly more often on regular terms than patients receiving treatment as usual. No differences between the groups could be found concerning therapeutic alliance during and at the end of treatment and readiness to change. Absolute numbers of BMI increase indicate a larger increase in the intervention group albeit not significant in this pilot study sample. Limitations of the study such as the small sample size as well as possible adaptions and advancements of the intervention that need to be examined in a larger clinical trial of efficacy are discussed. This phase II study is registered with the German Clinical Trials Register (DRKS) under the trial number DRKS00015639.

Interprofessional collaboration and patient-reported outcomes in inpatient care: a systematic review

“…After the first screening, there were 338 records eligible for the second screening. Twenty-two studies (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29), five NRS [30][31][32][33][34], and one CBA [35]) were included as a result of the second screening and subject to data extraction. Studies excluded in the second screening can be found in the supplementary appendix (see Additional file 3).…”

“…Studies include between 20 [19] and 1531 [15] patients and are conducted in Australia [19,28], Denmark [14,34], France [31], GB [17,22], Germany [21,23,27,29,32,33], Italy [24], Netherlands [35], Norway [18], Switzerland [30], and the USA [15,16,20,25,26]. Five studies focus on patients with chronic pain [21,23,30,32,33], four studies on patients undergoing palliative care [16,19,20,26], and two studies on patients with neurological diseases (Parkinson's disease (PD) [24], multiple sclerosis [14]), cancer [27,31], or severe mental illness [34,35].…”

“…Cognitive impairment [17] in old age, fibromyalgia [18], general medical patients [25], patients with anorexia nervosa [29], critical care survivors [28], homeless patients [22], and patients in old age [15] are study subject in one study each. Based on the categorization by Reeves et al [9] (see above), nine studies describe an intervention that can be categorized as "interprofessional practice" intervention [15,16,19,22,25,26,[28][29][30], and one study [24] evaluates an "interprofessional organization" intervention. The remaining studies assess the effect of interventions containing elements of at least two [14,18,20,23,27,[31][32][33]35] or even all three types of interventions [17,21,34].…”

“…The PHQ-9 (Patient Health Questionnaire), BDI (Beck Depression Inventory), GHQ-20 (General Health Questionnaire), DASS-21 (Depression Anxiety Stress Scale), EDE-Q, and DIKJ (Depression Inventory for Children and Adolescents) were used for evaluating psychiatric morbidity in seven RCTs [18,20,21,23,26,28,29]. Moreover, the HADS (Hospital Anxiety and Depression Scale), ADS (General Depression Scale, "Allgemeine Depressions-Skala"), K10 (Kessler Psychological Distress Scale), and SCL-90-R (Symptom Checklist-90-R) were used in three CTs [30,32,34].…”

“…Overall, significant unstandardized MD are presented in Sidebottom et al [26] (MD = 1.42 (1.12, 1.73; p = 0.000); patients with acute heart failure within palliative care) as well as Mangels et al [23] who focused on patients with CLBP and report a significant between group difference at t1 (p < 0.01). The remaining studies do either report no [21,28,29,32] or statistically insignificant estimates [18,20,30,34] of treatment effects (see Additional file 10).…”