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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

Published online by Cambridge University Press:  16 October 2019

Valentina Cardi Open the ORCID record for Valentina Cardi [Opens in a new window] ,
Gaia Albano ,
Suman Ambwani ,
Li Cao ,
Ross D. Crosby ,
Pamela Macdonald ,
Ulrike Schmidt  and
Janet Treasure
Valentina Cardi*
Affiliation:
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Gaia Albano
Affiliation:
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK Department of Psychology and Educational Sciences, University of Palermo, Palermo, Italy
Suman Ambwani
Affiliation:
Department of Psychology, Dickinson College, Carlisle, PA, USA
Li Cao
Affiliation:
Sanford Center for Biobehavioral Research, Fargo, ND, USA Department of Psychiatry and Behavioral Sciences, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
Ross D. Crosby
Affiliation:
Sanford Center for Biobehavioral Research, Fargo, ND, USA Department of Psychiatry and Behavioral Sciences, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
Pamela Macdonald
Affiliation:
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Ulrike Schmidt
Affiliation:
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Janet Treasure
Affiliation:
Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
*
Author for correspondence: Valentina Cardi, E-mail: valentina.cardi@kcl.ac.uk
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Abstract

Background

Outpatient 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.

Methods

Participants 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.

Results

Adherence 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.

Conclusions

Augmenting 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.

Keywords

Anorexia nervosaaugmentationearly symptom changefeasibilityguidancemotivationonlinerecoveryself-helptrial
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 15 , November 2020 , pp. 2610 - 2621
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Copyright
Copyright © Cambridge University Press 2019

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