title: Written case formulations in the treatment of anorexia nervosa: Evidence for therapeutic benefits.
abstract: OBJECTIVE
  Case formulation is a core component of many psychotherapies and formulation letters may provide an opportunity to enhance the therapeutic alliance and improve treatment outcomes. This study aimed to determine if formulation letters predict treatment satisfaction, session attendance, and symptom reductions in anorexia nervosa (AN). It was hypothesized that higher quality formulation letters would predict greater treatment satisfaction, a greater number of attended sessions, and greater improvement in eating disorder symptoms.
  
  
  METHODS
  Patients were adult outpatients with AN (n = 46) who received Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) in the context of a clinical trial. A Case Formulation Rating Scheme was used to rate letters for adherence to the MANTRA model and use of a collaborative, reflective, affirming stance. Analyses included linear regression and mixed models.
  
  
  RESULTS
  Formulation letters that paid attention to the development of the AN predicted greater treatment acceptability ratings (p = 0.002). More reflective and respectful letters predicted greater reductions in Eating Disorder Examination scores (p = 0.003).
  
  
  CONCLUSIONS
  Results highlight the potential significance of a particular style of written formulation as part of treatment for AN. Future research should examine applicability to other psychiatric disorders. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:874-882).
authors.affiliation: Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom. Karina.allen@slam.nhs.uk.|Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom. Karina.allen@slam.nhs.uk.|School of Psychology, the University of Western Australia, Perth, Australia. Karina.allen@slam.nhs.uk.
authors.forename: Karina L
authors.initials: KL
authors.lastname: Allen
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Caitlin B
authors.initials: CB
authors.lastname: O'Hara
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Savani
authors.initials: S
authors.lastname: Bartholdy
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Beth
authors.initials: B
authors.lastname: Renwick
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Keyes
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Anna
authors.initials: A
authors.lastname: Lose
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Martha
authors.initials: M
authors.lastname: Kenyon
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Hannah
authors.initials: H
authors.lastname: DeJong
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Hannah
authors.initials: H
authors.lastname: Broadbent
authors.affiliation: Oxford Adult Eating Disorder Service, Warneford Hospital, Oxford, United Kingdom.
authors.forename: Rachel
authors.initials: R
authors.lastname: Loomes
authors.affiliation: Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Jessica
authors.initials: J
authors.lastname: McClelland
authors.affiliation: Hope Wing, Porters Avenue Health Centre, Dagenham, Essex, United Kingdom.
authors.forename: Lucy
authors.initials: L
authors.lastname: Serpell
authors.affiliation: The Phoenix Wing, St Ann's Hospital, Tottenham, London, United Kingdom.
authors.forename: Lorna
authors.initials: L
authors.lastname: Richards
authors.affiliation: The Phoenix Wing, St Ann's Hospital, Tottenham, London, United Kingdom.
authors.forename: Eric
authors.initials: E
authors.lastname: Johnson-Sabine
authors.affiliation: Oxford Adult Eating Disorder Service, Warneford Hospital, Oxford, United Kingdom.
authors.forename: Nicky
authors.initials: N
authors.lastname: Boughton
authors.affiliation: Oxford Adult Eating Disorder Service, Warneford Hospital, Oxford, United Kingdom.
authors.forename: Linette
authors.initials: L
authors.lastname: Whitehead
authors.affiliation: Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom.|Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Janet
authors.initials: J
authors.lastname: Treasure
authors.affiliation: School of Psychology, Flinders University, Adelaide, Australia.
authors.forename: Tracey
authors.initials: T
authors.lastname: Wade
authors.affiliation: Eating Disorders Service, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom.|Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, United Kingdom.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schmidt
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000379:methods; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy*; D015992:Body Mass Index; D003142:Communication; D005260:Female; D006801:Humans; D008297:Male; D066209:Medical Writing; D008875:Middle Aged; D009042:Motivation; D010045:Outpatients; D017060:Patient Satisfaction; D011613:Psychotherapy / Q000379:methods*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
keywords: anorexia nervosa; case formulation; eating disorders; psychotherapy