An online treatment program has the capacity to help adolescents with anorexia nervosa, focusing on shifting thinking styles that reduce barriers to effective treatment.
Flinders University Senior Lecturer in Psychology and clinical psychologist Dr Ryan Balzan has overseen trials which demonstrate that metacognitive training for eating disorders (MCT-ED) can be a feasible adjunct intervention for adolescents with anorexia nervosa.
MCT works by targeting the cognitive biases, or irregular thinking and reasoning strategies, that are linked to disordered eating symptoms. Originally developed as a therapy for people with psychosis, this trial is the first time MCT has been adapted to suit adolescents with an eating disorder.
The MCT intervention, which is delivered online by a therapist, received positive feedback from the trial participants, had high treatment retention and led to reductions in perfectionism by the end of treatment compared to wait-list controls.
Although these gains were not sustained long-term, the MCT program is a suitable adjunct intervention for young people with eating disorders.
"The nice thing about an intervention like MCT-ED is that it does not need to directly address eating disorder symptoms, but instead focuses on problematic 'thinking styles', which is a less confrontational approach and makes therapy more accessible", says Dr Balzan.
"The brief, four-session online intervention seemed to help teenagers with anorexia nervosa improve how they address perfectionism, which is a key risk factor for the development and maintenance of anorexia nervosa and other eating disorders.
"It's a crucial area to focus on. Eating disorders are serious mental illnesses, resulting in mortality rates that are almost twice as high as other psychiatric disorders - especially among young people.
"Anorexia nervosa is a particularly difficult disorder to treat and runs a chronic course unless assertive early intervention is provided. Symptoms of the illness most commonly first occur in early to late adolescence; 3.9% of adolescent females meet a diagnosis for anorexia nervosa by the age of 19.
"Early intervention in adolescents is critical to help mitigate the impact of anorexia nervosa and offers the greatest chance of improving long-term outcomes. However, treatment outcomes for existing interventions remain sub-optimal, with more than two-thirds of adolescents with anorexia nervosa failing to fully recover within two years after receiving inpatient or outpatient treatment."
The MCT-ED intervention also offers participants alternative thinking strategies, which encourages critical reflection and may help people to avoid repeatedly falling for the same "cognitive traps".
The MCT-ED program - which features youth-friendly audio-visual treatment modules with interactive exercises - is a complement to existing treatments.
To maximise the intervention's reach and impact, the Flinders researchers have since adapted it to a purely self-guided online intervention. Dr Balzan says that early results of this self-paced version have good efficacy in 'at-risk' groups.
"The self-help resource is still in testing mode, but our intention is to eventually make it freely available online. This has the potential to improve access to evidence-based interventions, as no therapist is required to deliver the content."
The research - "A randomized controlled feasibility trial of metacognitive training with adolescents receiving treatment for anorexia nervosa" by Ryan Balzan, Madeline Gilder, Matthew Thompson and Tracey Wade - has been published in The International Journal of Eating Disorders.
