Eating and Control Styles Axis in Mentalisation-Based Psychotherapy in Eating Disorders: A Randomised Clinical Trial

Abstract

BackgroundClinicians need an instrument that helps their patients with eating disorders (ED) to explore their agent’s inner intentions and confront negative behaviour and control styles.ObjectivesTo assess the feasibility and impact of an eating and control styles axis (ECOSA) during the first 8 months of mentalisation-based psychotherapy with a community-based sample of ED patients.MethodsSix experienced therapists and their consecutively admitted patients were randomly allocated to the intervention and control groups. A total of 94 women, Mage = 24 were recruited between June 2020 and October 2021. Ninety completed it. Both groups received mentalisation-based psychotherapy, but only the intervention group used the ECOSA repeatedly. Therapists and participants were blinded to the study aims and hypothesis. Fidelity assessment was applied to ensure that the two groups differed mainly in terms of ECOSA usage.ResultsThe use of ECOSA, although less than advised, was reported as feasible. The effect size of the improvement in reflective functioning was larger than that of the control group and correlated significantly only in the intervention group with EDE-Q score (r = 0.46; p = 0.001).ConclusionAlthough the study limitations: selective population, relatively small sample size and the lack of controlled confounder, the combined quantitative and qualitative results lend preliminary evidence for the validity and contribution of ECOSA as a possible instrument that may upgrade the clinician’s toolbox in the treatment of ED. A more rigorous study design is needed to explore the potential usage of ECOSA as a clinical tool to enhance mentalisation among people with ED.

It’s not all about control: challenging mainstream framing of eating disorders

“…Upon reflection, encountering discussions around control during ED therapy and treatment is perhaps not surprising given that control is so dominant in today’s conceptualisation of EDs [ 3 , 4 , 21 ]. However, this language may subsequently frame and shape how an individual perceives and experiences their ED.…”

“…Our aim is not to remove any mention of control but to encourage critical reflection around whether control is the most appropriate central, overarching framing when discussing EDs [ 3 , 4 , 21 ]. There are many different factors, and differences, involved in any one individual’s experience of an ED.…”

“…It is estimated that there are over 55.5 million people worldwide with eating disorders (EDs) [ 1 ], with approximately 1.25 million in the UK [ 2 ]. For many years, EDs have frequently been described using a control framing, for instance being associated with a ‘need for control’ over uncertain and potentially negative aspects of life [ 3 , 4 ]. This has dominated discourse during the COVID-19 pandemic, with researchers reporting that people with EDs turned to disordered behaviours to compensate for a perceived loss of control [ 5 , 6 ].…”

It’s not all about control: Challenging mainstream framing of Eating Disorders

“…Upon reflection, encountering discussions around control during ED therapy and treatment is perhaps not surprising given that control is so dominant in today's conceptualisation of EDs [3,4,21]. However, this language may subsequently frame and shape how an individual perceives and experiences their ED.…”

“…Our aim is not to remove any mention of control but to encourage critical reflection around whether control is the most appropriate central, overarching framing when discussing EDs [3,4,21]. There are many different factors, and differences, involved in any one individual's experience of an ED.…”