Can metacognitive training (MCT) improve treatment outcomes for adolescents with anorexia nervosa?

Metacognitive training (MCT) for eating disorders is a brief one-on-one training programme that encourages people to ‘think about their thinking’ (i.e., ‘meta’ means ‘about’ and ‘cognition’ means ‘thinking’). MCT targets ‘thinking errors’ underlying different forms of mental illness and is effective at reducing symptom severity in people with psychosis, depression, borderline personality disorder, and obsessive-compulsive disorder. However, the approach has not yet been applied to people with anorexia nervosa (AN), despite the high prevalence of ‘thinking errors’ in this population (e.g., belief inflexibility; weak central coherence or difficulty seeing the ‘forest for the trees’). MCT may be an particularly beneficial treatment adjunct to adolescents with AN, as it aims to improve cognitive flexibility in a non-confrontational manner by targeting the biased thinking styles that contribute to disordered eating symptoms. The MCT programme for eating disorders is therapist-led but will be conducted online (via a 'video-chat' interface) and is spread over four modules (two are approximately 30-minutes long and two are approximately 60-minutes long), which will cover some common thinking errors and strategies to reduce them (i.e., belief inflexibility, perfectionism). Each module incorporates several interactive elements, including completing brief exercises (eg, writing your name with your non-dominant hand) or watching short (1-3mins) videos. All interactive elements include the opportunity for personal reflections in the supplied MCT worksheet 'booklet' (created specifically for this study), which participants can complete both within a therapy session or between sessions. Modules conclude with a 'case study' that links the thinking style back to clinically relevant scenarios (eg, consequences of rigid thinking vs. flexible thinking when feeling 'bloated'). The first module serves as an introduction to MCT, focussing on different 'thinking styles' (eg, flexible vs. rigid thinking) and the 'pros' and 'cons' of these. The next module focusses on belief inflexibility, where participants learn about the consequences of rigid thinking and are encouraged to adopt more flexible thinking patterns by practicing short interactive exercises (eg, participants are shown images that require them to 'switch' their interpretation of the image when shown from a different perspective/angle). The next module focusses on perfectionism, where participants learn about factors that maintain perfectionism, and are encouraged to adopt a less 'perfect' approach when completing interactive exercises (eg, drawing 3 everyday objects with 2 minutes). The final module summaries the main learning outcomes of MCT, and provides strategies on relapse prevention. Modules will be completed once per week. The online MCT sessions will be delivered by a provisional psychologist, who is a psychology student in their 5th or 6th year of training to become a fully qualified psychologist. The provisional psychologist will receive supervision from two qualified psychologists who will provide regular support and guidance. Adherence to the intervention will be monitored by recording the number of sessions completed (maximum 4).