A case series evaluation of the Maudsley Model for treatment of adults with anorexia nervosa

Abstract

Objective: Outpatient psychotherapy has been largely unsuccessful in assisting adults with anorexia nervosa (AN) to achieve weight restoration. The aim of the current study was to evaluate change and attainment of good and moderate outcome at 12-month follow-up using the Maudsley Model for Treatment of Adults with AN (MANTRA).

Methods: Of 33 people assessed, 28 people commenced therapy, and 23 completed it (82%).

Results: At post-treatment, seven people (30%) met the criteria for good outcome and one person met the criteria for moderate outcome. At 12-month follow-up, six people (26%) achieved good outcome, a further five achieved a moderate outcome, and there were significant improvements in body mass index, eating psychopathology and motivation, with large intention to treat effect sizes (ES) of 0.85, 1.19 and 1.57, respectively. Those people who dropped out of therapy were significantly more likely to binge or purge, and this behaviour was also associated with a moderate effect size (0.71) when examining differences between people who obtained good/moderate outcome versus poor outcome. Also predicting poor outcome status was lower baseline self-esteem and ineffectiveness.

Conclusion: Further evaluation of the use of MANTRA as an outpatient therapy for AN appears justified. Improvements to this therapy could include an early focus on binge and purge behaviour, as well as modules addressing low self-esteem and ineffectiveness.

Keywords: anorexia nervosa; motivational interviewing; outcome; treatment.