Skip to main content
Article thumbnail
Location of Repository

The MOSAIC study - comparison of the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) with Specialist Supportive Clinical Management (SSCM) in outpatients with anorexia nervosa or eating disorder not otherwise specified,anorexia nervosa type: study protocol\ud for a randomized controlled trial

By Ulrike Schmidt, Beth Ulrike, Anna Lose, Martha Kenyon, Hannah DeJong, Hannah Broadbent, Rachel Loomes, Charlotte Watson, Shreena Ghelani, Lucy Serpell, Lorna Richards, Eric Johnson-Sabine, Nicky Boughton, Linette Whitehead, Jennifer Beecham, Janet Treasure and Sabine Landau


Background: Anorexia nervosa (AN) is a biologically based serious mental disorder with high levels of mortality\ud and disability, physical and psychological morbidity and impaired quality of life. AN is one of the leading causes of\ud disease burden in terms of years of life lost through death or disability in young women. Psychotherapeutic\ud interventions are the treatment of choice for AN, but the results of psychotherapy depend critically on the stage of\ud the illness. The treatment response in adults with a chronic form of the illness is poor and drop-out from treatment\ud is high. Despite the seriousness of the disorder the evidence-base for psychological treatment of adults with AN is\ud extremely limited and there is no leading treatment. There is therefore an urgent need to develop more effective\ud treatments for adults with AN. The aim of the Maudsley Outpatient Study of Treatments for Anorexia Nervosa and\ud Related Conditions (MOSAIC) is to evaluate the efficacy and cost effectiveness of two outpatient treatments for\ud adults with AN, Specialist Supportive Clinical Management (SSCM) and the Maudsley Model of Treatment for Adults\ud with Anorexia Nervosa (MANTRA).\ud Methods/Design: 138 patients meeting the inclusion criteria are randomly assigned to one of the two treatment\ud groups (MANTRA or SSCM). All participants receive 20 once-weekly individual therapy sessions (with 10 extra weekly\ud sessions for those who are severely ill) and four follow-up sessions with monthly spacing thereafter. There is also\ud optional access to a dietician and extra sessions involving a family member or a close other. Body weight, eating\ud disorder- related symptoms, neurocognitive and psychosocial measures, and service use data are measured during\ud the course of treatment and across a one year follow up period. The primary outcome measure is body mass index\ud (BMI) taken at twelve months after randomization.\ud Discussion: This multi-center study provides a large sample size, broad inclusion criteria and a follow-up period.\ud However, the study has to contend with difficulties directly related to running a large multi-center randomized\ud controlled trial and the psychopathology of AN. These issues are discussed.\ud Trial Registration: Current Controlled Trials ISRCTN67720902 - A Maudsley outpatient study of treatments for\ud anorexia nervosa and related conditions

Topics: H, RC
Publisher: BioMed Central
Year: 2013
OAI identifier:

Suggested articles


  1. (2008). 0D).I nCognitive behavior therapy and eating disorders. Edited by Fairburn C.
  2. (2007). A systematic review and meta-analysis of set-shifting ability in eating disorders. Psychol Med doi
  3. (2006). Anorexia nervosa: valued and visible. A cognitiveinterpersonal maintenance model and its implications for research and practice. doi
  4. (2003). Assessing the integrity of motivational interviewing interventions: Reliability of the motivational interviewing skills code. Behav Cogn Psychother doi
  5. (1994). Beglin SJ: Assessment of eating disorders: interview or selfreport questionnaire?
  6. (2007). Bulik CM: Outcomes of eating disorders: a systematic review of the literature. doi
  7. (2008). CG: The Clinical Impairment Assessment questionnaire (CIA).I nCognitive Behavioral Therapy for Eating Disorders. Edited by Fairburn CG.
  8. (2010). Chalder T: The Beliefs about Emotions Scale: validity, reliability and sensitivity to change. doi
  9. (2010). Claudino A, Zucker N: Eating disorders. Lancet doi
  10. Costing psychiatric interventions.I nMeasuring mental health needs. Edited by Thornicroft G.
  11. Costs of eating disorders in England: economic impact of anorexia nervosa, bulimia nervosa and other disorders focusing on young people. doi
  12. (1948). EA: A behavioral analysis of degree of reinforcement and ease of shifting to new responses in a Weigl-type card-sorting problem. doi
  13. Eating disorder examination (edition doi
  14. (2003). et al: Estimating psychological treatment effects from a randomized controlled trial with both noncompliance and loss to follow-up. doi
  15. (2012). et al: Out-patient psychological therapies for adults with anorexia nervosa: randomized controlled trial. doi
  16. (2004). for Mental Health: Eating Disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. doi
  17. (2008). for the CONSORT group: Methods and Processes of the CONSORT Group: example of an extension for trials assessing nonpharmacologic treatments. Ann Intern Med doi
  18. (2007). Gowers SG: Economic evaluation of a randomized controlled trial for anorexia nervosa in adolescents. doi
  19. (2009). I: Family interventions in adolescent anorexia nervosa. doi
  20. (2009). KD: The relationship between eating disorder not otherwise specified (EDNOS) and officially recognized eating disorders: meta-analysis and implications for DSM. Psychol Bull doi
  21. (1941). L’examen psychologique dans les cas d’encephalopathie traumatique. Arch Psychol
  22. (1944). Le test de copied’une figure complexe. Arch Psychol
  23. (1995). Lovibond PF: Manual for the Depression Anxiety Stress Scales. 2nd edition. Sydney,Australia: Psychology Foundation; doi
  24. (1998). N: The validation of a new obsessive-compulsive disorder scale: the obsessive-compulsive inventory. Psychol Assess doi
  25. (2004). Nyman JA: The cost-effectiveness of anorexia nervosa treatment. doi
  26. (2003). OP: Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol doi
  27. (2004). Patterns of hospital admission for adult psychiatric illness in England: analysis of Hospital Episode Statistics data. doi
  28. (2005). PR: Measuring therapist adherence in psychotherapy for anorexia nervosa: scale adaptation, psychometric properties, and distinguishing psychotherapies. Psychother Res doi
  29. (2006). PR: Specialist supportive clinical management for anorexia nervosa. doi
  30. (2011). PR: The long-term efficacy of three psychotherapies for anorexia nervosa: a randomized, controlled trial. doi
  31. (2005). PR: Three psychotherapies for anorexia nervosa: a randomized, controlled trial. doi
  32. (2002). Preparing People for Change. 2nd edition. doi
  33. (2003). Psychological Assessment Resources: Computerized Wisconsin Card Sort Task Version 4
  34. (1995). RB: A new measure of cognitive flexibility. Psychol Rep
  35. (2000). Rosenheck RA: One-year use and cost of inpatient and outpatient services among female and male patients with an eating disorder: evidence from a national database of health insurance claims. doi
  36. (2008). S: A taxonomy of behavior change techniques used in interventions. Health Psychol doi
  37. (2004). S: Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol doi
  38. (2009). S: The ANTOP study: focal psychodynamic psychotherapy, cognitive-behavioral therapy, and treatment-as-usual in outpatients with anorexia nervosa–a randomized controlled trial. Trials doi
  39. (1996). S: The burden of mental disorders in Victoria, doi
  40. (1997). Shallice T: The Hayling and Brixton Tests.
  41. (2008). Skrondal A: Multilevel and Longitudinal Modeling Using Stata. 2nd edition. doi
  42. (2011). StataCorp: Stata Statistical Software: Release 12. College Station, TX: StataCorp LP;
  43. (2006). The ‘Reading the Mind in Films’ Task: complex emotion recognition in adults with and without autism spectrum conditions. Soc Neurosci doi
  44. (2004). The development of the P-CAN, a measure to operationalize the pros and cons of anorexia nervosa. doi
  45. (2001). The experience of caregiving for severe mental illness: a comparison between anorexia nervosa and psychosis. Soc Psychiatry Psychiatr Epidemiol doi
  46. (2005). The health service use and cost of eating disorders. Psychol Med doi
  47. (1986). The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol doi
  48. (2003). The use of the Pros and Cons of Anorexia Nervosa (P-CAN) scale with children and adolescents. doi
  49. (2011). U: A case series evaluation of the Maudsley Model for treatment of adults with anorexia nervosa. Eur Eat Disord Rev doi
  50. (2012). U: A systematic review of drop-out from treatment in outpatients with anorexia nervosa. doi
  51. (2011). U: The socio-emotional processing stream in anorexia nervosa. Neurosci Biobehav Rev doi
  52. Unit Costs of Health and Social Care.
  53. (1999). V: Anorexia nervosa: friend or foe? doi
  54. (2009). Weak central coherence in eating disorders: a step towards looking for an endophenotype of eating disorders. doi
  55. (2005). WR: Assessing competence in the use of motivational interviewing. doi

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.