Eating disorders are usually assumed to centre around food, eating, and beauty ideals about body shape and weight. Fears of gaining weight, body dissatisfaction, and harmful eating behaviours are often presented as the core of the disorders.
However, these traits and behaviours are not the cause of eating disorders. They develop because of other emotional and social problems that affect young people’s relationships, identity, and self-worth.
This means that treatment for eating disorders shouldn’t focus on eating or body image either. Instead, it should address the relationship difficulties and harmful ways of thinking that lie beneath.
What Does the Cognitive Interpersonal Maintenance Model Tell Us About Anorexia Nervosa?
The cognitive interpersonal maintenance model is a theory about the development and maintenance of anorexia nervosa. It describes the way that personality traits, ways of thinking, and difficulties forming relationships with others make people vulnerable to developing the disorder.
Personality traits like social anxiety, sensitivity to other’s opinions, or comparing oneself with others can make it more likely for a young person to experience body dissatisfaction or become preoccupied with society’s beauty ‘ideals’. They can also lead to social withdrawal, allowing thoughts about eating and body shape to dominate a young person’s life.
Living with anorexia, in turn, often makes interpersonal relationships even more strained, sustaining or worsening symptoms. The responses of other people towards a person with anorexia also play a role, sometimes enabling disordered eating behaviours, creating hostility, or becoming over-involved.
Cognitive interpersonal maintenance therapy doesn’t see weight and shape as central to the disorder. Instead, weight and shape concerns are symptoms caused by deeper patterns of distress.
Why Are Relationships So Important?
Just as social isolation, hostile relationships, and other interpersonal difficulties can maintain anorexia, supportive relationships with family and friends hold the key to recovery. Warm and supportive relationships can help young people develop a holistic sense of self, valuing their many strengths and positive attributes. Relationships are a chance for young people to express their characters, develop an identity, and recognise their self-worth.
At the same time, social interactions can help young people to adopt different perspectives and take their focus away from food and eating. Friends and family members can also reinforce positive changes in thinking and behaviour, supporting their recovery journey.
What Is MANTRa?
MANTRa stands for the Maudsley Model of Anorexia Nervosa Treatment for Adolescents or Young Adults. MANTRa was initially developed for adults (MANTRA) but has since been offered to young people. It’s a treatment approach based on the cognitive interpersonal maintenance model of anorexia nervosa.
MANTRa is a specialised treatment for anorexia nervosa, particuarly chronic anorexia (when the illness has persisted for a long time). Some of its key features are:
- focusing on the personality traits that contribute to the development and maintenance of anorexia
- addressing issues by improving both interpersonal relationships and individual perspectives and behaviours
- adaptability and flexibility to fit the needs of each individual
MANTRa addresses the different factors that maintain anorexia, including emotional traits, interpersonal relationships, and ways of thinking. These include:
- rigid, detail-focused thinking with a fear of mistakes
- avoiding emotions
- false beliefs about the ‘benefits’ of anorexia
- responses from family members and friends that may enable the illness
In therapy sessions, young people learn helpful coping mechanisms that promote positive change. This might involve improving nutrition, addressing interpersonal difficulties, developing healthier thinking styles, managing emotions, and forming a holistic, positive sense of self and identity that’s separate from their eating disorder.
Many tasks involve writing rather than just speaking, helping young people broaden their perspectives, reducing emotional avoidance, and enhancing problem-solving.
Some of the MANTRA modules include:
- Engagement and psychoeducation – understanding the illness and how it impacts a young person’s life
- Shared formulation – the therapist and young person work together to form a shared understanding of how their eating disorder developed and is maintained
- Making sense of illness – supporting the young person to understand their experience of anorexia as part of their life story and belief system
- Finding your voice – supporting the young person to communicate their needs and wishes more effectively
- Active change – identifying and challenging attitudes and behaviours that sustain their eating disorder
- Relationships and support – looking at the way relationships affect their recovery journey and emphasising the importance of including family members and other close figures in the treatment process
- Ending and transitions – preparing for independent living after treatment
MANTRa emphasises active decision-making during the treatment process. Young people are encouraged to select the topics they want to work on, taking responsibility in their recovery program. This process can help to motivate adolescents and improve their self-esteem, underpinned by a desire for autonomy and independence.
How Effective Is MANTRa?
MANTRA is a relatively new treatment approach, so there is less supporting evidence available than for modalities like CBT-e. However, research so far shows positive results.
A 2023 review of nine studies found that among adults, MANTRA leads to improvements in body mass index (BMI), eating symptomatology and emotional state. The same year, a study that compared MANTRa (among adolescents and emerging adults) to the usual treatment programs found that MANTRa effectively treated eating disorder symptoms and symptoms of co-occurring disorders. MANTRa was significantly more effective than the usual treatment.
The Wave Clinic: Transformative Recovery Programs for Young People
The Wave Clinic offers specialist mental health support for teenagers and young adults. Our programs combine exceptional clinical care with education, enriching experiences, and community projects.
By collectively creating new memories and experiences, we support young people in building lasting, close friendships alongside a supportive and caring family system that nurtures recovery.
As a Global Centre of Excellence in the treatment of eating disorders, we plan and deliver our programs with unequalled expertise and knowledge. We offer a diverse selection of evidence-based treatment modalities tailored to match each young person’s needs. Our programs are created collaboratively, involving family members from the very start of treatment and inviting them to our centre for a week of family therapy.
If you’re interested in finding out more about our programs, get in touch today. We’re here to make a difference.
Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).
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