Anorexia nervosa is a severe mental illness that usually develops during adolescence. Young people with anorexia persistently restrict their energy intake to try and change their body weight or shape. Some people with anorexia have a very low body weight, while others have a standard or higher weight.
Without professional support, anorexia can cause serious and long-term damage to young people’s physical and mental health. As well as malnutrition, anorexia may lead to depression, anxiety, fatigue, social isolation, difficulties sleeping, and cognitive changes. Anorexia has the highest mortality rate of any mental health disorder.
The sooner anorexia is treated, the better the outcome. This means that seeking effective, timely treatment for anorexia during adolescence is really important. Unfortunately, there is still limited research surrounding treatment options for adolescents with anorexia and few recommended treatment approaches.
What Treatment Approaches Are Usually Recommended for Anorexia in Adolescence?
The NICE guidelines for the treatment of anorexia in young people recommend only one first-choice treatment option and two second-choice options if the first is not effective. These are:
- Family therapy for anorexia nervosa (FT-AN)
- Cognitive-behaviour therapy for eating disorders (CBT-E)
- Adolescent–focused psychotherapy for anorexia nervosa (AFT)
However, these treatments don’t work for everyone. Studies have found that less than half of young people receiving FT-AN achieved full recovery at the end of treatment. While CBT-E and AFT can lead to significant improvements in eating disorder attitudes and behaviours, many young people drop out before they finish their treatment program.
This means that many young people don’t fully recover with the recommended treatment methods, so researching, developing, and delivering alternatives is really important. MANTRa is one eating disorder treatment that has recently been adapted for adolescents, showing promising results in clinical trials.
What Is MANTRa?
MANTRa stands for the Maudsley model of anorexia nervosa treatment for adolescents and young adults. It’s adapted from MANTRA, a recommended first-line treatment for adults that was explicitly developed for anorexia.
Several studies have found that MANTRA leads to significant and lasting improvements in eating disorder attitudes, behaviours, and BMI. It’s usually well-accepted by those receiving treatment, with low drop-out rates.
MANTRA and the Cognitive-Interpersonal Maintenance Model (CIMM)
MANTRA is based on the cognitive-interpersonal maintenance model (CIMM) of anorexia nervosa, a theory that describes how the illness develops and persists. The CIMM explains how personality traits like rigid thinking and emotional avoidance, combined with interpersonal difficulties, make individuals more vulnerable to developing anorexia and help sustain symptoms.
Personality traits such as social anxiety and a tendency to compare oneself with others may make it more likely for someone to experience body dissatisfaction and internalise social norms like the ‘thin ideal’. These traits can also lead to social isolation, allowing thoughts about body shape, weight, and eating to take over someone’s life.
When someone develops anorexia, their relationships with friends and family members can become even more strained. Often, the way loved ones respond to a person’s eating disorder inadvertently sustains and worsens symptoms. Loved ones may enable disordered eating behaviours, become critical and hostile, or be emotionally over-involved.
The cognitive-interpersonal maintenance model doesn’t see weight and shape concerns as the cause of anorexia. Instead, these concerns are understood as symptoms of more profound psychological distress.
What Does MANTRA Involve?
MANTRA centres around a workbook that combines elements of cognitive behavioural therapy and writing tasks. Therapists work with each individual to select themes and exercises based on their needs.
Through MANTRA sessions, individuals develop helpful coping mechanisms that encourage positive change. This might involve addressing interpersonal issues, learning healthier thinking styles, regulating emotions, developing a positive sense of self, and forming an identity other than their eating disorder.
Tasks often involve writing alongside or instead of speaking. This can help individuals widen their perspectives, express emotions, and build problem-solving skills.
Some of the themes of MANTRA include:
- Relationships and support – exploring how relationships interact with their recovery journey, including family members and others in the treatment process
- Active change – challenging behaviours and thought patterns that maintain their eating disorder
- Finding your voice – developing more effective communication skills
- Ending and transitions – getting ready for life after treatment
How Is MANTRa Adapted for Teens?
Several aspects of MANTRA are inherently suited to adolescents. MANTRA emphasises active decision-making in the treatment process, fulfilling adolescents’ drive for independence and autonomy. Equally, it includes themes of identity formation that are especially important during adolescence when young people are developing their sense of self.
To ensure its suitability for teenagers, the MANTRa workbook also involves some practical changes. For example, some of the language is adapted to be more appropriate for teenagers and nutritional recommendations are adjusted. MANTRa also involves some additional exercises, such as ‘distress tolerance’ practices, that support adolescents who experience self-harm or suicidality. There is an extra chapter about helpful and unhelpful aspects of social media.
Like the initial MANTRA program, parents and close others are invited to participate in two to three MANTRa sessions and are also encouraged to participate in parent skills training.
How Effective is MANTRa?
MANTRa is a relatively new treatment for anorexia, so there are fewer studies available than for treatments like family therapy or cognitive behavioural therapy. However, the research conducted so far shows promising results.
For example, a 2023 cohort study found that MANTRa significantly improved eating disorder symptoms, co-occurring symptoms, and BMI. At the 18-month follow-up, the proportion of young people achieving full recovery was significantly higher than that receiving ‘treatment-as-usual’.
The Wave Clinic: Specialist Recovery Programs for Young People
The Wave Clinic provides specialist recovery programs for children, teenagers, young adults, and families, supporting them in planning and building better futures. We combine exceptional clinical care with education, social responsibility, and an international gap year experience. We work with young people to grow in self-confidence, reconnect with themselves, and develop the skills they need to follow their dreams.
The Wave Clinic is a Global Centre of Excellence for the treatment of eating disorders. Our residential and outpatient programs offer a diverse selection of the most up-to-date, evidence-based modalities. We combine our experience and expertise to deliver the highest quality treatment plans.
If you’re interested in finding out more about our programs, get in touch today. We’re here for you.
