Transition Care in Anorexia Nervosa Through Guidance Online from Peer and Carer Expertise (TRIANGLE): Study Protocol for a Randomised Controlled Trial

Cardi, Valentina; Ambwani, Suman; Robinson, Emily; Albano, Gaia; Macdonald, Pamela; Aya, Viviana; Rowlands, Katie; Todd, Gillian; Schmidt, Ulrike; Landau, Sabine; Arcelus, Jon; Beecham, Jennifer; Treasure, Janet

doi:10.1002/erv.2542

Cited by 38 publications

(35 citation statements)

References 48 publications

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“…Treatment using MANTRA focuses on both inter and intrapersonal model elements [55,56]. Augmenting treatment through digital technology is showing potential [137]. Finally, we are borrowing approaches that show promise in other domains of psychiatry in which a chronic stress response has led to the illness having a life of its own.…”

Section: Resultsmentioning

confidence: 99%

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Treasure

Willmott

Ambwani

et al. 2020

JCM

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The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.

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Section: Resultsmentioning

confidence: 99%

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Treasure

Willmott

Ambwani

et al. 2020

JCM

Self Cite

135

122

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“…More extended periods of guidance and/or a greater focus on interpersonal elements might improve clinical outcomes over time. Strategies such as inviting carers to provide support and encourage the use of self-help materials (Hibbs et al ., 2015; Cardi et al ., 2017) and greater utilisation of peer support to strengthen the recovery identity (Leamy et al ., 2011) might better augment outpatient interventions for anorexia nervosa.…”

Section: Resultsmentioning

confidence: 99%

“…It is also possible that the format of our intervention failed to optimise reflection and adoption of a recovery identity through increasing social support. For example, clinical observations from a trial in progress testing online guided self-help for patients with anorexia nervosa and their carers to facilitate the transition from intensive hospital treatment into the community (Cardi et al ., 2017) indicate that strengthening social connection by improving patient-to-patient support and support from carers is highly valued by participants.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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BackgroundOutpatient 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.MethodsParticipants 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.ResultsAdherence 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.ConclusionsAugmenting 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.

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“…A current trial is investigating the use of an online, guided self-help intervention for patients with anorexia nervosa admitted for intensive treatment and their carers based on the New Maudsley approach and Recovery MANTRA [84]. The intervention is delivered on a website that includes a workbook, short video-clips, online groups with patients or carers and joint Skype sessions with parents and carers.…”

Section: Treatments Introduced or Developed To Target Social Difficulmentioning

confidence: 99%

Premorbid and Illness-related Social Difficulties in Eating Disorders: An Overview of the Literature and Treatment Developments

Cardi

Tchanturia

Treasure

2018

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Transition Care in Anorexia Nervosa Through Guidance Online from Peer and Carer Expertise (TRIANGLE): Study Protocol for a Randomised Controlled Trial

Abstract: ISRCTN registry ISRCTN14644379, 08/12/2016. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Cited by 38 publications

References 48 publications

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

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

Premorbid and Illness-related Social Difficulties in Eating Disorders: An Overview of the Literature and Treatment Developments

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