title: Out-patient psychological therapies for adults with anorexia nervosa: randomised controlled trial.
abstract: BACKGROUND
  Very limited evidence is available on how to treat adults with anorexia nervosa and treatment outcomes are poor. Novel treatment approaches are urgently needed.
  
  
  OBJECTIVE
  To evaluate the efficacy and acceptability of a novel psychological therapy for anorexia nervosa (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA) compared with specialist supportive clinical management (SSCM) in a randomised controlled trial.
  
  
  METHODS
  Seventy-two adult out-patients with anorexia nervosa or eating disorder not otherwise specified were recruited from a specialist eating disorder service in the UK. Participants were randomly allocated to 20 once weekly sessions of MANTRA or SSCM and optional additional sessions depending on severity and clinical need (trial registration: ISRCTN62920529). The primary outcomes were body mass index, weight and global score on the Eating Disorders Examination at end of treatment (6 months) and follow-up (12 months). Secondary outcomes included: depression, anxiety and clinical impairment; neuropsychological outcomes; recovery rates; and additional service utilisation.
  
  
  RESULTS
  At baseline, patients randomised to MANTRA were significantly less likely to be in a partner relationship than those receiving SSCM (3/34 v. 10/36; P<0.05). Patients in both treatments improved significantly in terms of eating disorder and other outcomes, with no differences between groups. Strictly defined recovery rates were low. However, MANTRA patients were significantly more likely to require additional in-patient or day-care treatment than those receiving SSCM (7/34 v. 0/37; P = 0.004).
  
  
  CONCLUSIONS
  Adults with anorexia nervosa are a difficult to treat group. The imbalance between groups in partner relationships may explain differences in service utilisation favouring SSCM. This study confirms SSCM as a useful treatment for out-patients with anorexia nervosa. The novel treatment, MANTRA, designed for this patient group may need adaptations to fully exploit its potential.
authors.affiliation: Section of Eating Disorders, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK. ulrike.schmidt@kcl.ac.uk
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schmidt
authors.forename: Anna
authors.initials: A
authors.lastname: Oldershaw
authors.forename: Fatima
authors.initials: F
authors.lastname: Jichi
authors.forename: Lot
authors.initials: L
authors.lastname: Sternheim
authors.forename: Helen
authors.initials: H
authors.lastname: Startup
authors.forename: Virginia
authors.initials: V
authors.lastname: McIntosh
authors.forename: Jennifer
authors.initials: J
authors.lastname: Jordan
authors.forename: Kate
authors.initials: K
authors.lastname: Tchanturia
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Wolff
authors.forename: Michael
authors.initials: M
authors.lastname: Rooney
authors.forename: Sabine
authors.initials: S
authors.lastname: Landau
authors.forename: Janet
authors.initials: J
authors.lastname: Treasure
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000379:methods*; D000856:Anorexia Nervosa / Q000628:therapy*; D015992:Body Mass Index; D005260:Female; D006801:Humans; D008297:Male; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome; D015430:Weight Gain / Q000502:physiology