1. AVATAR therapy adapted for anorexia nervosa : testing feasibility, safety and acceptability using a single case experimental design
- Author
-
Thompson, Alistair, Ward, Thomas, and Cardi, Valentina
- Abstract
Background: The eating disorder (ED) voice is a critical internal dialogue typically focused on an individual's weight, shape and eating. It has been linked to greater ED severity, more negative eating attitudes and compensatory behaviours (i.e. purging and compulsive exercise). However, there has been limited investigation into interventions targeting the ED voice (Noordenbos & Geest, 2017; Pugh, 2020; Scott et al., 2014). This study is the first to adapt and deliver AVATAR therapy, an intervention developed to target distressing voice-hearing experiences in psychosis, for those with a diagnosis of anorexia nervosa (AN). Aims: To investigate whether AVATAR for AN is feasible (assessed by recruitment and retention rates), safe (assessed by monitoring adverse experiences related to the therapy) and acceptable (assessed by participant's satisfaction rating). In addition, a preliminary analysis of efficacy was conducted focusing on voice-related distress, voice frequency and ED symptomology. Methods: A non-concurrent multiple baseline design was used. Twelve participants with a diagnosis of AN were assessed and randomised to a baseline period (two, three or four weeks), followed by one assessment session and six AVATAR sessions and a four-week follow-up period after completing the therapy. Voice-related distress and voice frequency were assessed weekly during each phase of the study (i.e. baseline, treatment and follow- up). ED symptomology, beliefs about the ED voice, self-compassion and self-criticism were assessed at pre and post-therapy as well as after the 4-week follow-up period. Results: All participants were recruited in three months with a retention rate of 90% for those who started the therapy. No therapy-related serious adverse experiences were reported. Nine of the participants rated the intervention as equal or greater to 7 on an acceptability scale ranging from complete dissatisfaction at 0 to complete satisfaction at 10. Voice-related distress showed a reduction during the treatment phase (between-case standardised mean difference= -1.02, 95% CI [-1.81, -0.24]).There was no evidence to suggest that voice frequency reduced during the treatment or follow-up phases and no clear evidence that ED symptomology reduced during either phase. Conclusions: The study indicates that AVATAR for AN was a feasible, safe and acceptable intervention. Preliminary evidence indicates the intervention is beneficial in reducing voice-related distress during the therapy. The next step in the development of AVATAR for AN is a controlled, adequately powered study to replicate the findings of the current study and determine its clinical benefit.
- Published
- 2022