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Therapist written goodbye letters: evidence for therapeutic benefits in the treatment of anorexia nervosa

Published online by Cambridge University Press:  17 March 2020

Jess Simmonds ,
Karina L. Allen ,
Caitlin B. O’Hara ,
Savani Bartholdy ,
Beth Renwick ,
Alexandra Keyes ,
Anna Lose ,
Martha Kenyon ,
Hannah DeJong  and
Hannah Broadbent
...Show all authors
Jess Simmonds*
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Karina L. Allen
Affiliation:
Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK School of Psychology, University of Western Australia, Perth, Australia
Caitlin B. O’Hara
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Savani Bartholdy
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Beth Renwick
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Alexandra Keyes
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Anna Lose
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Martha Kenyon
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Hannah DeJong
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Hannah Broadbent
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Rachel Loomes
Affiliation:
Oxford Adult Eating Disorder Service, Warneford Hospital, Oxford, UK
Jessica McClelland
Affiliation:
Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Lucy Serpell
Affiliation:
Hope Wing, Porters Avenue Health Centre, Dagenham, Essex, UK
Lorna Richards
Affiliation:
The Phoenix Wing, St Ann’s Hospital, Tottenham, London, UK
Eric Johnson-Sabine
Affiliation:
The Phoenix Wing, St Ann’s Hospital, Tottenham, London, UK
Nicky Boughton
Affiliation:
Oxford Adult Eating Disorder Service, Warneford Hospital, Oxford, UK
Linette Whitehead
Affiliation:
Oxford Adult Eating Disorder Service, Warneford Hospital, Oxford, UK
Janet Treasure
Affiliation:
Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
Tracey Wade
Affiliation:
School of Psychology, Flinders University, Adelaide, Australia
Ulrike Schmidt
Affiliation:
Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
*
*Corresponding author. Email: Jess.c.simmonds@kcl.ac.uk
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Abstract

Background:

Despite their use in clinical practice, there is little evidence to support the use of therapist written goodbye letters as therapeutic tools. However, preliminary evidence suggests that goodbye letters may have benefits in the treatment of anorexia nervosa (AN).

Aims:

This study aimed to examine whether therapist written goodbye letters were associated with improvements in body mass index (BMI) and eating disorder symptomology in patients with AN after treatment.

Method:

Participants were adults with AN (n = 41) who received The Maudsley Model of Anorexia Treatment for Adults (MANTRA) in a clinical trial evaluating two AN out-patient treatments. As part of MANTRA, therapists wrote goodbye letters to patients. A rating scheme was developed to rate letters for structure and quality. Linear regression analyses were used to examine associations between goodbye letter scores and outcomes after treatment.

Results:

Higher quality letters and letters that adopted a more affirming stance were associated with greater improvements in BMI at 12 months. Neither the overall quality nor the style of goodbye letters were associated with improvements in BMI at 24 months or reductions in eating disorder symptomology at either 12 or 24 months.

Conclusions:

The results highlight the potential importance of paying attention to the overall quality of therapist written goodbye letters in the treatment of AN, and adopting an affirming stance.

Keywords

anorexia nervosaeating disordersgoodbye letterspsychotherapytreatment
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 4 , July 2020 , pp. 419 - 431
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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