Transforming anorexia nervosa treatment for adults

Anorexia nervosa is a serious mental disorder characterized by weight loss or lack of weight gain, difficulties maintaining an appropriate weight and distorted body image.

It is one of the most common chronic disorders in adolescence. In women, the median duration of anorexia is five to seven years with 30 per cent of women experiencing illness for more than 15 years. Less than half of people affected recover, but early treatment can massively improve recovery rates. A such, there is a great need for better, earlier and more scalable treatments.

Maudsley Model of Anorexia Treatment for Adults (MANTRA)

MANTRA (Maudsley Model of Anorexia Treatment for Adults) is a manual-based outpatient treatment for adults developed by investigators at the National Institute for Health and Care Research (NIHR) Maudsley Biomedical Research Centre. MANTRA consists of seven core modules conducted over 20-40 sessions. Following Medical Research Council guidance, it is:

  1. Based on psychological and neurobiological research
  2. Includes both intra- and interpersonal maintaining factors, and strategies for addressing these.

As a cognitive-interpersonal treatment it uses a motivational interviewing therapeutic style which is tailored to the specific needs and characteristics of people with anorexia. The treatment was co-produced with patients and carers and all studies had extensive patient and carer involvement, for example the NIHR Programme Grant for Applied Research (PGfAR) had the CEO of the eating disorder charity Beat as a co-applicant.

MANTRA has a strong evidence base from an independent multi-centre replication study in Australia and three randomised controlled trials in the UK. 

Proven effectiveness

The MANTRA model is a proven effective therapy for adults, even more acceptable than gold standard control treatment. Not only has it recorded fewer adverse effects, for example there have been no deaths of participants, but 83 per cent of service users completing the therapy needed no additional treatment.

Furthermore, service users who take part in MANTRA also have greatly improved recovery rates. In more severe cases, MANTRA doubles recovery rates compared to gold standard control from 12 per cent to 27 per cent and from those with a 1st illness episode it increased from 14 to 50 per cent.

Patient and therapist views on MANTRA are positive, particularly the motivational therapeutic style and tools such as written case formulations and goodbye letters which have contributed to efficacy and retention rates.

  • For patients, MANTRA provides an effective and user-friendly form of outpatient treatment.
  • For carers, a key part of MANTRA involves understanding how they may inadvertently keep anorexia going and MANTRA provides support both to patient and carer to find better ways of interacting to facilitate recovery.
  • For clinicians, MANTRA is easy to learn and deliver, given its manual-based approach.

Additionally, investigators have also developed skills training interventions for carers, such as groups, self-help and online interventions, which can give people with anorexia multiple sources of support.

Diagram of the MANTRA 'vicious flower' of anorexia nervosa.MANTRA 'vicious flower' of anorexia nervosa.
 No two people are exactly the same. This is also true of people with anorexia. However, there are some common factors that we know tend to maintain anorexia. These are highlighted in the ‘vicious flower’ model of anorexia (Schmidt et al., 2011). This can be a useful way of understanding what is maintaining your eating disorder, which is a crucial step in recovery.

NICE recommendation

In 2017 MANTRA was recommended as a first line treatment for anorexia in adults by the NICE guidelines which generated an enormous demand from clinicians for training and supervision. The team have since trained about 500 UK eating disorder therapists and several hundred therapists internationally. Furthermore, the manual is accessible to purchase online to support distribution.

In the future, the team hopes that the improvement in outcomes MANTRA has brought to adults with anorexia could be extended to adolescents and that these can provide a credible alternative to existing family-based treatments and they are working with international collaborators to develop the testing of this.  



National and International Collaboration | Improving Access and Uptake