Angelo Vertti, 18 de setembro de 2022

QSR International Pty Ltd. NVivo (Version 12). By using this website, you agree to our https://doi.org/10.1002/erv.789. AnIntegrated Group Based approach for the delivery of MANTRA - The Maudsley Anorexia Nervosa Treatment forAdults -extends current NICE recommended therapy by augmenting treatment with opportunities for experientialpractice in a group context. A theoretical review of interpersonal emotion regulation in eating disorders: enhancing knowledge by bridging interpersonal and affective dysfunction. Patient BMI was recorded at each time point. We also thank Konstantin Kopp, Patrick Gollob and Helene Krauss for data processing and research assistance. Clinical assessments (BMI and the Eating Disorder Examination Questionnaire) took place before and after the group and at 6 months follow up for sites 1 and 2. Addition individual sessions were used to problem solve idiosyncratic concerns that arose as the treatment progressed that were not fully addressed in the group. Maudsley Model of Anorexia Nervosa Treatment for Adolescents and Young Adults, National Institute of Health and Care Excellence, Maudsley Model of Anorexia Nervosa Treatment for Adults, Diagnostic Interview for Mental Disorders in Children and Adolescents, Inventory for the Assessment of Quality of Life in Children and Adolescents, German Version of the Wisconsin Card Sorting Test, Rey Complex Figure Test and Recognition Trial, Frankfurter Test and Training of Facial Affect Recognition, Junior Temperament and Character Inventory, Anorexia Nervosa Stages of Change Questionnaire, German Version of the Session evaluation questionnaire. However, the freedoms and creativity of a real world case series naturally afford some limitations. Fairburn CG, Beglin SJ. government site. Treatment process and feasibility of the intervention: The Session Evaluation Questionnaire (SEQ-d [64] will be used in the MANTRa group for systematic examination of the treatment process. 2013;1:13. https://doi.org/10.1186/2050-2974-1-13. Mountford V, Waller G. Using imagery in cognitive-behavioral treatment for eating disorders: tackling the restrictive mode. This routine occurrence of co-morbid difficulties indicates an evidence-based, modularised approach to conceptualisation and treatment. Furthermore, we also adapted the design and layout of the workbook to make it more appealing for adolescents by creating each chapter in a different color and adding icons for better visual recognition of recurrent content (e.g. J Eat Disord. HS lead on the write up of the case series, along with MFS and all authors read and contributed to drafts. Westmoreland P, Krantz MJ, Mehler PS. Assessment of eating disorder psychopathology: interview or self-report questionnaire? Wittek, T., Truttmann, S., Zeiler, M. et al. Privacy J Consult Clin Psychol. Rey complex figure test and recognition trial (RCFT). Full demographics are presented in Table2. 2015;39:8395. There was a wide-range of course components that participants rated as being most useful (with no single component standing out in analysis), suggesting that the diversity of modules was important in catering to differing needs in the group. Participants had largely positive responses to the creative exercises used in group-based MANTRA, including chairwork, the value/identity box, using objects, music, movement, space, the body and literature to connect to emotions, letter-writing and pictorial cards. An Integrated Group Based approach for the delivery of MANTRA - The Maudsley Anorexia Nervosa Treatment for Adults extends current NICE recommended therapy by augmenting treatment with opportunities for experiential practice in a group context. 1994;16(4):36370. Symptoms of anorexia nervosa and bulimia nervosa have differential relationships to borderline personality disorder symptoms. Eating Disorders: Recognition and Treatment (Guideline). All participants were aware that their data could be used for evaluation purposes and that all data would be fully anonymised assuring no breaches of confidentiality. A tabular description of the differences between MANTRA for adults compared to MANTRa for adolescents according to the TIDieR framework [31] is provided as supplementary material. This paper describes MANTRA treatment delivery translated into an integrated group-based model, drawing on theories of emotion regulation in context [28], dramatherapy methods [34, 35] and experiential treatments such as schema therapy [36]. AN symptomatology and medical risk will be monitored continuously by the case manager. In total, four groups took place across 3 sites with a median attendance of 7 participants per group session (Range=6 to 9). Smink FR, van Hoeken D, Hoek HW. You can also contact us with queries. MANTRA consists of seven core modules conducted over 20-40 sessions. Incidence is rising; both community service demand and inpatient admissions have increased [NHS Digital, 2017 (digital.nhs.uk)]. The UK National Health Service National Research Ethics Service guidance [43] established that this study did not require ethical approval as outcomes were collected as part of routine clinical practice. portion sizes are illustrated using the hand proportions and fists, not focusing on calories) and added information and exercises for managing binge eating and purging behavior. Some of these methods are drawn directly from the MANTRA manual and some were specific in delivery to the group format. Am J Psychiatry. Booth RDL. Craig M, Waine J, Wilson S, Waller G. Optimizing treatment outcomes in adolescents with eating disorders: the potential role of cognitive behavioral therapy. Process evaluation of the MOSAIC trial, part I: therapist experiences of delivering two psychological therapies for treatment of anorexia nervosa. US is supported by a National Institute for Health Research (NIHR) Senior Investigator Award and receives salary support from the NIHR Biomedical Research Centre (BRC) at South London and Maudsley NHS Foundation Trust and Kings College London. It is NICE recommended and used across UK services and internationally [7]. Anorexia Nervosa (AN) characterised by restricted eating, driven by intense fear, in the context of weight, shape and eating concerns [1] has the highest mortality rates of any psychiatric disorder [2, 3]. The aim of this study is to assess the feasibility, acceptability and efficacy of the manualized treatment program MANTRa compared to TAU in an adolescent sample suffering from AN. Auflage (BDI-II). Provided by the Springer Nature SharedIt content-sharing initiative. Responses are summed into a global score for eating disorder psychopathology by averaging the four EDE-Q subscales: Restraint, eating concern, shape concern and weight concern. Eat Disord. Eur Child Adolesc Psychiatry. Framework analysis methodology was used [47] to explore themes arising from semi-structured questions completed by participants at the end of treatment. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Diagnostic and statistical manual of mental disorders DSM-5. Anorexia nervosa (AN) is a severe mental illness characterized by persistent restriction of energy intake, deliberate weight loss and, in further consequence, extreme low body weight [1]. Empirical foundations for writing in prevention and psychotherapy: mental and physical health outcomes. Besier T, Goldbeck L, Keller F. Psychometric properties of the Beck depression inventory-II (BDI-II) among adolescent psychiatric patients. Adamson J, Leppanen J, Murin M, Tchanturia K. Effectiveness of emotional skills training for patients with anorexia nervosa with autistic symptoms in group and individual format. https://doi.org/10.1186/s40337-021-00387-8, DOI: https://doi.org/10.1186/s40337-021-00387-8. MANTRA, the Maudsley Model of Anorexia Nervosa Treatment in Adults, is just one of the different treatment modalities that we use here at Orri. https://doi.org/10.1080/00048670903107591. https://www.tandfonline.com/doi/abs/10.3402/ijch.v61i0.17503. Seidel M, King JA, Ritschel F, Boehm I, Geisler D, Bernardoni F, et al. Front Psychiatry. This combination of individual and group formats works well for the Emotional and Social Mind Integrated Bulimia Nervosa treatment [40] and is advocated in the broader psychotherapy literature [41]. MANTRA aims to address the cognitive, emotional, relational, and biological factors which keep individuals stuck in anorexia, and aims to uncover more productive coping mechanisms for the individual. Identifying thinking style, how thinking styles perpetuates AN, and alternative thinking styles. MANTRA (Maudsley Model of Anorexia Treatment for Adults) is a manual-based outpatient treatment for adults developed by investigators at the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre. Based on the authors' pioneering work and up-to-date research at London's Maudsley hospital, A Cognitive Interpersonal Therapy Workbook for Treating Anorexia Nervosa provides adults with anorexia nervosa and the professionals working alongside them with a practical resource to work through. This case series suggests that delivering MANTRA in an integrated group format is a feasible and effective intervention for individuals with severe and enduring Anorexia Nervosa. Emotional and social mind training: a randomised controlled trial of a new group-based treatment for bulimia nervosa. Int J Eat Disord. The therapeutic alliance as possible mediating factor will be with the self-rating questionnaire Therapeutic Alliance Scale for Children (FTB-KJ) [63]. MANTRA is as effective as the other NICE recommended treatments at improving AN outcomes [812]. According to guidelines of the National Institute of Health and Care Excellence (NICE) [4] AN treatment needs to be multidisciplinary including medical care and weight monitoring as well as psychological interventions. (2) MANTRA is also conceptualized as a flexible and adaptive treatment program, in which patients are directly involved in the therapeutic process. J Eat Disord 9, 33 (2021). Routledge. This theme speaks to the value of experiential methods to lift tasks off the page when targeting the social and emotional domain within the MANTRA treatment [30, 34, 35]. Sitting on floor cushions were viewed particularly positively as they made the group feel more informal and as a result contributed to it being easier to share things with the group.. A combination of medical care and psychological interventions are recommended for the treatment of AN [4], but data on effective psychological treatment methods are limited, particularly for adolescents [10]. Primary outcome variables will be BMI and eating disorder psychopathology 12 months after baseline. However, many participants found the regular slot a helpful addition to their life which extended beyond the time spent in the group: Having a dedicated time slot in the week to think about all this, whether I wanted to or not. The reliability of the Wisconsin card sorting test in clinical practice. Enhanced cognitive behaviour therapy for adolescents with anorexia nervosa: an alternative to family therapy? But to hear X someone who has had anorexia and has recovered say I used to believe xxxxxx but now I can honestly say I dont gave me huge encouragement. Reminders will be sent if questionnaires have not been completed in time. https://doi.org/10.1159/000258901. Of those who took part in treatment, 27 (93.1%) were considered completers by attending 70% of the programme. J Adolesc Health. The inter-rater reliability ranges from .71 to .97. Neuropsychiatr. Miller WR, Rollnick S. Motivational interviewing. In contrast to CBT-E, weight and shape concerns are not considered as the central psychopathology of the disorder, but as symptoms of more profound and troubling problems [24]. MANTRA, Eating Disorder Service, Middle House, Maudsley Hospital, Denmark Hill, London SE5 8AZ. These criteria are in accordance with recommendations for starting inpatient treatment of the German guidelines for diagnosis and treatment of eating disorders [30]. Group facilitators adopt a motivational, curious stance. a diagrammatic case formulation focusing on maintaining factors) and writing tasks, supporting emotion expression and regulation, based on the seminal ideas of James Pennebaker [20]. Quality of life will be measured with the German version of the Inventory for Assessment of Quality of Life in Children and Adolescents (ILK) [48], a self-rating questionnaire with acceptable internal consistency (Cronbachs =.55.76) measured in an adolescent population. Worry and rumination in anorexia nervosa. Consecutive referrals were offered the group if they were; (a) >18yrs., and (b) had a DSM-IV diagnosis of anorexia nervosa or Other Specified Feeding Disorder (OSFED), with a body mass index (BMI) <18.5kg/m2. the contents by NLM or the National Institutes of Health. 2016;49:793800. The approach described is recommended by the National Institute of Clinical and Care Excellence . https://doi.org/10.1007/s40211-020-00330-4. Depression will be measured with the Beck Depression Inventory (BDI-2) [44], a self-rating questionnaire with excellent internal consistency (Cronbachs =.92) observed in an adolescent population [45]. Average number of group sessions attended was 15.17 (SD=3.86) alongside 7.3 individual sessions (SD=3.85). Imgart H, Plassmann R. Wirkfaktoren in der Multifamilientherapie bei Patienten mit Essstrungen. Medical complications of anorexia nervosa and bulimia. sharing sensitive information, make sure youre on a federal Participants were recruited from three specialist adult eating disorder services between September 2018 to March 2020. A study from Eisler and colleagues [13] showed significant differences of improvements in AN symptoms in favor of Multi-Family Therapy compared to Single-Family Therapy, possibly due to the fact that relationship patterns become more visible in the multi-family setting [14], but the percentage of patients having a good outcome after 1 year (measured with the Morgan-Russell scale) was limited in both groups ranging from 33 to 45% [13]. The social regulation of emotion: an integrative, cross-disciplinary model. Additional t-tests will be used to explore group differences between intervention (MANTR-a) and control group (TAU). The MANTRA treatment program is considered to be a first-line treatment method for adults suffering from AN [4], that has been found to effectively improve ED psychopathology [18, 19]. Before Self-report questionnaires were used to evaluate participants experience of group-based MANTRA. The primary statistical analysis will be based on the intention-to-treat principle, which means that participants will be analyzed in the group to which they were allocated irrespective of their compliance with the assigned treatment. Behav Res Ther. J Clin Med. Article The book carefully walks the reader down a path of recovery, richly augmenting text with exercises and illustrations to engage them in the process of achieving wellness. Differences in BMI scores had an average change of 1.4 (SD=1.13) from assessment to follow-up. Methods Paired sample t-tests were used to compare means at assessment with post-group for BMI, and because of insufficient EDEQ data at assessment, means were compared for this variable at baseline and post-group. Teufel M, Hofer E, Junne F, Sauer H, Zipfel S, Giel KE. 2020;34:4860. A core component of the group-based MANTRA programme valued by participants was the creation of a safe space where they were able to be open and vulnerable with others who shared a diagnosis of AN. Federal government websites often end in .gov or .mil. Each individual session is an hour long and practical rather than experiential in foci. The approach described is recommended by the National Institute of Clinical and Care Excellence . Instead, patients will be assigned to the group based on predefined criteria, like the presence of a recently started psychotherapy or centre of treatment (for details see 2.4.3 Assignment of intervention). 2023 BioMed Central Ltd unless otherwise stated. Comorbid psychopathology: The State-Trait Anxiety Inventory (STAI) [43] is a self-rating questionnaire assessing anxiety. 2017;26:148399. https://doi.org/10.1176/appi.ajp.159.8.1284. MFS, YB, HS, NG and AF were all involved in running the groups within this case series. Group-based MANTRA has been adapted from the standard MANTRA manual [6] with the goal of augmenting change in the social and emotional domain through the use of group processes and live experiential methods [46]. A Cognitive-Interpersonal Maintenance Model specifies 4 domains of biological and psychological predisposing and maintaining factors: 1) the emotional and social mind, 2) identity, 3) thinking styles, and 4) relationships [13, 14] which map onto intervention targets. For example, participants tended to find the duration of the group (90 mins) acceptable; longer than 90 mins was predicted to have taxed concentration. Follow up data were available for two participating sites and therefore an additional repeated measures one-way ANOVA was run comparing BMI and timepoint. Trauma and the body: a sensorimotor approach to psychotherapy (Norton series on interpersonal neurobiology). Verhaltenstherapie. It is based on a psychobiological model of anorexia nervosa, developed with support from the NIHR Maudsley Biomedical Research Centre. These comments remind us of the importance of the environment in enabling people to feel safe and valued. Schmidt U, Treasure J. Anorexia nervosa: valued and visible. Self-report questionnaires will be administered online via LimeSurvey, while interviews will be conducted face-to-face or via telephone by trained professionals. https://doi.org/10.1016/j.jaac.2014.07.014. Patients will be eligible if they: are diagnosed with full-syndrome AN, atypical AN or weight restored AN (following inpatient treatment) according to DSM-5, suffer from life-threatening AN requiring immediate inpatient treatment as defined by the German guidelines for diagnosis and treatment of eating disorders [30], have insufficient cognitive abilities or German language skills to follow the treatment content, suffer from a severe mental or physical illness that needs priority treatment (for example psychosis, acute suicidality, borderline personality disorder, substance abuse).

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