The Feasibility of Using Guided Self-Help in Anorexia Nervosa: An Analysis of Drop-Out From the Study Protocol and Intervention Adherence

Valentina Cardi, Gaia Albano, Laura Salerno, Gianluca Lo Coco, Suman Ambwani, Ulrike Schmidt, Pamela Macdonald, Janet Treasure, Valentina Cardi, Gaia Albano, Laura Salerno, Gianluca Lo Coco, Suman Ambwani, Ulrike Schmidt, Pamela Macdonald, Janet Treasure

Abstract

The implementation of online technologies to promote wellbeing is increasingly becoming a worldwide priority. This study includes secondary analyses of data and examined drop-out rates in an online guided self-help intervention for patients with anorexia nervosa. Specifically, rates of drop-out at end of treatment (i.e., 6 weeks assessment), as well as intervention adherence (minimum of four of six online guided sessions) and differences between completers and drop-outs were examined. Motivation to change and associated patient variables were assessed as predictors of drop-out using structural equation modeling. Ninety-nine patients were randomized to the intervention arm of the trial. Data were available for 82 individuals, 67 of whom completed the 6 weeks assessment and attended a minimum of four online sessions. No significant differences were found between completers and drop-outs at baseline. At the end of the first week of participation, drop-outs from the 6 weeks assessment or the intervention reported less satisfaction with their work with the mentor delivering online guidance. Greater confidence in own ability to change and higher controlled motivation (willingness to change due to pressure from others) predicted lower drop-out rates from the 6 weeks assessment. Stronger alliance with the therapist at the treatment center and lower psychological distress were associated with greater autonomous motivation (self-directed motivation) and importance and ability to change. Data demonstrate that a novel online guided self-help intervention for patients with anorexia nervosa is feasible. Early satisfaction with the program and external pressure to change have a protective role against drop-out rates. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02336841.

Keywords: anorexia nervosa; drop-out; intervention; motivation; online; trial.

Copyright © 2020 Cardi, Albano, Salerno, Lo Coco, Ambwani, Schmidt, Macdonald and Treasure.

Figures

FIGURE 1
FIGURE 1
Theoretical model. This figure describes hypothesized relationships between the variables investigated.
FIGURE 2
FIGURE 2
Study flow-chart. This figure describes the process of assessing, randomizing and assessing participants and includes number of participants who completed the 6 weeks assessments and the RecoveryMANTRA intervention sessions.
FIGURE 3
FIGURE 3
Structural equation model. This model describes the relationships between patient demographic and clinical variables, self-reported motivation and drop-out from the 6 weeks assessments and RecoveryMANTRA intervention. Errors are omitted from the diagram. Significant positive parameters are represented by black solid lines. Significant negative parameters are represented by gray solid lines. Non-significant parameters are represented by gray dashed lines. For clarity, correlations between variables are omitted from the diagram: autonomus motivation is not significantly correlated to controlled motivation (p < 0.001), importance to change (p < 0.01) and confidence in ability to change (p < 0.01); moreover, importance to change is correlated to confidence in ability to change (p < 0.01) and drop-out from the assessment is correlated to drop-out from the treatment (p < 0.001).

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