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

Abstract

The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02336841.

Patient and mentor language style matching as a predictor of working alliance, engagement with treatment as usual, and eating disorders symptoms over the course of an online guided self‐help intervention for anorexia nervosa

“…The first hypothesis was tested controlling for relevant covariates (EDE‐Q, BMI and DASS‐21 at baseline), in order to take into account their relationships with working alliance with the outpatient therapist and motivation for TAU at the end of RecoveryMANTRA. This is in accordance with previous studies which supported the relationship between ED severity, depression, anxiety and motivation for treatment (Cardi et al., 2020 ; Ostiguy et al., 2017 ). Also, to test the second hypothesis, the relationship between LSM and EDs and mood symptoms was calculated controlling for baseline symptoms (EDE‐Q, BMI and DASS‐21) severity.…”

“…Patient/peer mentor dyads had higher attunement of LSM scores than patient/student mentor dyads. These findings support previous evidence that an early augmentation intervention for AN might enhance engagement with the outpatient therapist (Cardi et al, 2020). However, motivation was not improved.…”

“…The primary and secondary outcome results from this trial were that people in RecoveryMANTRA+ TAU arm of the study experienced a greater reduction of anxiety and reported a greater working alliance with their clinic therapist, at the end of the 6 weeks (Cardi et al., 2020 ). In a study in which we examined the working alliance with the mentors we found that the working alliance during the RecoveryMANTRA sessions predicted a change in symptoms in the following session (Albano et al., 2021 ).…”

Pretreatment motivation and therapy outcomes in eating disorders: A systematic review and meta‐analysis

“…The majority of included studies (38 out of 42) were based on DSM‐III, DSM‐IV, or DSM‐IV‐TR criteria. Two recent studies (Cardi et al, 2020; Pellizzer, Waller, & Wade, 2018) used DSM‐5 criteria, whereas two studies (Riesco et al, 2018; Sansfaçon et al, 2018) included individuals that were admitted using either DSM‐IV‐TR or DSM‐5 criteria (depending on the exact date of admission), and re‐assigned the DSM‐5 diagnosis retrospectively.…”

The relationship between working alliance with peer mentors and eating psychopathology in a digital 6‐week guided self‐help intervention for anorexia nervosa

“…Furthermore, patients receiving RecoveryMANTRA in addition to TAU reported greater confidence in their own ability to change (small effect size) and greater alliance with their mentor at the outpatient clinic (small‐to‐medium effect size) at 6 weeks, compared to the TAU only group (Cardi et al, 2019 ). Patients who dropped‐out early from the intervention were less satisfied with the online guidance received from the mentor delivering guidance at the end of the first week (Cardi et al, 2020 ). These results indicate that further research is needed to establish how effective mentoring strategies can be implemented in digital GSH for AN.…”