Background: There is mounting evidence on the effectiveness of guided self-help (GSH) interventions to augment, shorten or replace standard care for eating disorders (EDs). However, only few studies have tested the use of GSH for people with anorexia nervosa (AN). Aims: 1) to conduct a systematic review and meta-analysis of GSH in AN, with a focus on clinical outcomes and feasibility; 2) to evaluate the feasibility, acceptability and efficacy of a novel digital GSH intervention for AN (RecoveryMANTRA) tested in addition to treatment as usual (TAU) in the outpatient setting, 3) to assess predictors of drop-out from the RecoveryMANTRA + TAU condition; 4) to establish the role of working alliance (WA) with mentors guiding the use of RecoveryMANTRA on patient’s symptom change over time and 5) to measure how language style matching between mentors and patients predicts clinical outcomes in the RecoveryMANTRA + TAU condition.
Method: 187 patients accessing outpatient services for AN across different sites in England were randomized to receive TAU only (n= 88; control group) or TAU plus RecoveryMANTRA (n= 99; experimental group). The primary outcome included change in body mass index (BMI) at the end of six weeks of intervention and changes in eating disorder symptoms at 6 and 12 months follow-up. Process measures, such as motivation for treatment, confidence to change, and working alliance with the therapist at the outpatient service were longitudinally investigated. The GSH intervention was delivered by peer mentors (recovered individuals or carers, n=12) or mentors (psychology graduates, n=14) over six weekly synchronous chat-based sessions. The impact of type of mentorship and of linguistic style matching between patients and mentors on clinical outcomes and treatment adherence was measured.
Results: Findings showed that: 1) GSH in AN was associated with significantly lower drop-out rates from the end of treatment assessments compared to a control condition; 2) those in the RecoveryMANTRA + TAU condition reported a trend level reduction in anxiety, higher levels of confidence in own ability to change, and a better alliance with the therapist at the outpatient service; 3) patient’s clinical outcomes were in part associated with the characteristics of the mentor delivering guidance 4) peer mentors working alliance in the previous session was significantly associated with eating psychopathology ratings in the next session, and 5) greater linguistic style matching between patients and mentors was associated to patient’s engagement with clinical treatment.
Conclusions:
Findings provided empirical support for the feasibility and effectiveness of online GSH for adults with AN. Strengths, weaknesses and clinical implications have been discussed
