The Maudsley Anorexia Nervosa Treatment for Adults (MANTRA): a feasibility case series of an integrated group based approach

Helen Startup; Mary Franklin-Smith; William Barber; Nicola Gilbert; Yael Brown; Danielle Glennon; Akira Fukutomi; Ulrike Schmidt

doi:10.1186/s40337-021-00424-6

The Maudsley Anorexia Nervosa Treatment for Adults (MANTRA): a feasibility case series of an integrated group based approach

J Eat Disord. 2021 Jun 15;9(1):70. doi: 10.1186/s40337-021-00424-6.

Authors

Helen Startup¹, Mary Franklin-Smith², William Barber³, Nicola Gilbert³, Yael Brown⁴, Danielle Glennon⁴, Akira Fukutomi⁴, Ulrike Schmidt⁵

Affiliations

¹ Sussex Partnership NHS Foundation Trust, Sussex Eating Disorders Service, Brighton, UK. helen.startup@sussexpartnership.nhs.uk.
² Leeds Partnership NHS Foundation Trust, CONNECT: The West Yorkshire Adult Eating Disorder Service, Leeds, UK.
³ Sussex Partnership NHS Foundation Trust, Sussex Eating Disorders Service, Brighton, UK.
⁴ South London and Maudsley NHS Foundation Trust, Eating Disorders Outpatient Service, London, UK.
⁵ Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK.

Abstract

Background: Individuals with Anorexia Nervosa (AN) typically struggle in social and emotional contexts. 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. A feasibility case series, delivered across three NHS community services is presented.

Methods: The design was a case series of four Integrated Group MANTRA treatments delivered across three NHS sites (N = 29). Feasibility data of: retention, acceptability and effectiveness; alongside the qualitative capture of participant experiences of treatment is presented.

Results: Primary outcomes suggest treatment acceptability. Participants committed to treatment with only 2 dropouts. There was significant change with medium effect sizes for eating disorder cognitions and symptoms (as measured by the global score on EDEQ) and BMI. Core themes emerging from qualitative analysis captured the value of the relational aspect of the treatment, the incorporation of experiential methods, and the opportunity to draw on the support of the group members to reduce shame and stigma.

Conclusions: An Integrated Group based MANTRA approach is a feasible and effective alternative intervention for community Eating Disorder services.

Keywords: Anorexia nervosa; Eating disorders; Emotion regulation; Group treatment.

Plain language summary

Treatments for Anorexia Nervosa (AN) are somewhat effective, but there is room for improvement. A core struggle for individuals with Anorexia Nervosa is managing emotions especially in a social context. One of the leading treatments for AN - MANTRA – was adapted to be delivered in a group to provide opportunities for individuals to practice experiencing and managing emotions amongst others. We hoped that being in a group could help tackle the shame and isolation that many people with AN endure. Patients seemed to find value in this approach and there are early signs that it may support people on their journey of recovery from Anorexia Nervosa.