Perspectives on relapse prevention following intensive treatment of anorexia nervosa: A focus group study

Abstract

Objective: Including the perspectives of individuals with lived experience of mental health issues is a critical step in research and treatment development. Focus groups with patients with a history of treatment for anorexia nervosa (AN) were conducted in anticipation of a clinical trial of Relapse Prevention and Changing Habits (REACH+).Methods: Seven female adults (23-51 years) who had previously received inpatient treatment for AN, now in remission, participated in one of two semistructured focus groups. Rapid qualitative analysis was used to examine participants' contributions and identify common topics.Results: Transcript analysis yielded three topics related to relapse prevention:(1) recovery aids, including a sense of agency in treatment decisions and finding new interests/passions, (2) recovery hindrances, such as lack of access to care, and(3) identification of members of support system. Aspects of REACH+ received positive feedback, such as continuity of care from the inpatient setting and the use of telehealth. Viewpoints differed with respect to the helpfulness of obtaining patient weights in treatment. The REACH+ online platform received positive comments regarding content and usability, as well as suggestions for additional content.Discussion: Qualitative feedback from patients with a history of AN highlighted the value of engaging patients in their own treatment decisions, as well as in treatment design and innovation. Within this small group, there were differences of opinion about treatment components, specifically weight assessment, that suggest the need for further data. User-centered design provides opportunities to improve the acceptability and, therefore, dissemination of novel treatments.Public Significance: Relapse prevention is a critical treatment need for patients with anorexia nervosa, as this illness too often follows a protracted course. There are challenges in both obtaining specialized care and in retaining patients in treatment. Here, patient perspectives on these challenges offer input to allow for optimization of relapse prevention treatment. Shared decision-making may be particularly valuable to support an individual's sense of agency and engagement in care.

Equitable access to evidence-based treatment for eating disorders for patients with low-income: identifying barriers and exploring solutions

“…Additionally, there remain times when travel costs continue to prevent attendance (Bischoff et al, 2004). For example, some patients with EDs prefer in-person sessions (Pagano et al, 2023), and some services are required to see patients in-person for evaluation sessions or prior to prescribing controlled substances. For these situations, therapists are encouraged to investigate available transportation schemes.…”

The next stages of treatment‐oriented research: Commentary on Wade et al. (2023)

“…In our current relapse prevention clinical trial (Steinglass et al, 2022), we partnered with individuals who had recovered from AN via focus groups aimed at discerning patient perspectives on the psychotherapy intervention we designed (Pagano et al, 2023). Their input was invaluable in identifying commonalities in components of care that supported health-as well as in beginning to discover individual differences.…”