Cover to (Re)Cover : The feasibility of a self-help workbook intervention for subthreshold Anorexia Nervosa

Abstract

Importance: Anorexia Nervosa (AN) is a debilitating illness with the highest mortality rate of all mental disorders. With protracted illness linked to declining recovery rates, evidence indicates prompt treatment in AN is a significant predictor of full recovery. Despite this, specialist treatment remains scarce and inaccessible with funding limited to those severe in presentation. Objective: The Maudsley outpatient treatment for adult anorexia nervosa (MANTRA) is an adult treatment of AN with demonstrated efficacy as a psychologist-led and guided self-help treatment in RCTs. The current study sought to evaluate the feasibility of MANTRA as a pure self-help workbook treatment for mild to subthreshold adult AN. Design: The study was an open consecutive case-series feasibility study. Eligible adults with a diagnosis of mild to subthreshold AN without specialist treatment history were recruited through G.P.s, community settings and website between 2020 and 2021. Intervention: Participants received a specialist psychological self-help workbook (MANTRA) for AN containing 10 treatment modules. A suggested reading schedule was provided, no additional guidance was given. Main outcomes and measures: Primary outcomes were 12-week change in AN case status measured by DSM-5 Structured Clinical Interview and AN symptomology measured by the EDE-Q. Secondary outcomes included 12-week and 24-week change on clinical impairment, general psychopathology and decisional balance measured using the CIA, DASS-21 and DB. Other outcomes included participant evaluation regarding treatment credibility, acceptability and perceived effectiveness. Results: A total of 8 participants completed the study and 38% of participants were reclassified to a milder AN case status at discharge. Statistically significant results were yielded using paired calculations before and after on AN symptomology (measured by EDE-Q) with large effect-sizes (d = 0.86). Significant reductions were also observed in clinical impairment at 12- weeks (z = -1.96, p = .05). No significant changes were observed on the DASS-21 or DB. The intervention was well rated for acceptability, practicality, and expansion by participants. Conclusions and Relevance: Limited findings suggest that the workbook is feasible and may improve AN case-status symptomology and clinical impairment. Less conclusive evidence was found for general psychopathology and decisional balance. Further RCTs are required to imply cause and effect.