Process Evaluation of the MOSAIC Trial, Part I: Therapist Experiences of Delivering Two Psychological Therapies for Treatment of Anorexia Nervosa

Waterman-Collins, Daniella; Renwick, Beth; Lose, Anna; Kenyon, Martha; Serpell, Lucy; Richards, Lorna; Boughton, Nicky; Treasure, Janet; Schmidt, Ulrike

doi:10.1002/erv.2278

Cited by 22 publications

(31 citation statements)

References 28 publications

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“…Throughout, a user-friendly easy-to-read style with text broken up by images, stories, diagrams, or checklists is used. Patients and therapists like the manual and find its content highly pertinent Waterman-Collins et al, 2014). Doing therapy with a manual to guide the approach requires considerable skill from therapists and it is certainly not "painting by numbers."…”

Section: Facets Of the Mantra Treatment Programmentioning

confidence: 99%

“…Although there is a brief window for early intervention (within about 3 years of onset), once the illness is well-established (i.e., usually in adulthood), the treatment response is poor and dropout from treatment is high Treasure & Russell, 2011). The evidence base for psychological treatment of adults with AN is extremely limited and the urgent need to develop more effective treatments for adults with AN has been highlighted (e.g., National Collaborating Centre for Mental Health, 2004;Watson & Bulik, 2012).…”

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confidence: 98%

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The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA): Development, Key Features, and Preliminary Evidence

2014

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Anorexia nervosa (AN) is a severe mental disorder that affects mainly young females. In adults with a well-established form of the illness, it is hard to treat. In 2006, we proposed a maintenance model of AN, combining intra-and interpersonal factors and we have recently refined this model. The model encompasses four main maintaining factors (a thinking style characterized by rigidity, detail focus, and a fear of making mistakes; an avoidant emotion processing and relational style; positive beliefs about the use of anorexia for the person [ pro-anorexia beliefs]; and a response of close others to the illness characterized by high expressed emotion and enabling of and accommodation to the illness). In this article, we describe how the model has been translated into a novel treatment for AN and the preliminary evidence supporting this. Implications for clinical practice and research are discussed.

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Section: Facets Of the Mantra Treatment Programmentioning

confidence: 99%

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confidence: 98%

The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA): Development, Key Features, and Preliminary Evidence

2014

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“…The qualitative components were used to either inform intervention development, 63,65 or as process evaluations of the interventions tested. [158][159][160]167,409 Both approaches have been highly valuable and have added much needed detail to inform the iterative process of intervention development and testing. The school has a responsibility to support students suffering from eating disorders…”

Section: Resultsmentioning

confidence: 99%

“…As in usual clinical practice, trial therapists were able to conduct both treatments. Through therapist interviews 159 we have been able to confirm that both treatments were experienced very differently and delivered with fidelity. Further confirmation of this will be reported separately through analysis of the therapeutic session recordings.…”

Section: Generalisabilitymentioning

confidence: 90%

“…[158][159][160] In particular, process data from therapists, who of course were able to compare and contrast these treatments, identified marked differences between these two treatments, in terms of the therapy focus, therapeutic strategies and applicability to a wide range of patients. 159 Process data from patients largely agree with these findings, and in addition strongly point to the quality of the therapeutic relationship, as the basis for a successful therapy. 158 Both treatments were perceived as having strengths and weaknesses.…”

Section: Patient and Therapist Experience Of Maudsley Model Of Anorexmentioning

confidence: 99%

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Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

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Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa

Hay

Claudino

Touyz

et al. 2015

Cochrane Database of Systematic Reviews

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There was a suggestion in one trial that focal psychodynamic therapy might be superior to TAU, but this is in the context of TAU performing poorly. An alternative control condition of dietary advice alone appeared to be unacceptable, but again this is based on just one trial. Owing to the risk of bias and limitations of studies, notably small sample sizes, we can draw no specific conclusions about the effects of specific individual psychological therapies for anorexia nervosa in adults or older adolescents. Larger RCTs of longer treatment duration and follow-up are needed.

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Process Evaluation of the MOSAIC Trial, Part I: Therapist Experiences of Delivering Two Psychological Therapies for Treatment of Anorexia Nervosa

Abstract: Findings provide testable hypotheses about what works for whom, ideas for therapist training, treatment development and delivery.

Cited by 22 publications

References 28 publications

The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA): Development, Key Features, and Preliminary Evidence

The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA): Development, Key Features, and Preliminary Evidence

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa

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