Can metacognitive training improve treatment outcomes for adolescents with anorexia nervosa? A pilot randomised controlled trial

Chief Investigator: Dr Ryan Balzan [Early Career Researcher]

Funding Amount: $31,198

Recipient: Flinders University


Anorexia nervosa is serious mental illness that has a substantial harmful effect on psychological, physical and social functioning. Adolescents are particularly vulnerable to the adverse impacts of this eating disorder, with a mortality rate that is up to 12-times higher than adult patients. However, it is very difficult to treat, and over 30% of adolescents with anorexia nervosa do not recover. This project will be the first study to investigate the effectiveness of metacognitive training, a novel psychological treatment for eating disorders. This program has the potential to improve treatment outcomes for adolescents with anorexia nervosa, and ultimately save lives.

Research Outcomes:

Researchers: Dr Ryan Balzan, Professor Tracey Wade

Research Completed: 2022

Research Findings:


Eating disorders are serious mental illnesses that have a substantial harmful effect on psychological,

physical and social functioning, with mortality rates that are almost twice as high as other psychiatric

disorders. Anorexia nervosa (AN), in particular, is a difficult disorder to treat and runs a chronic course

unless assertive early intervention is provided. Symptoms of the illness most commonly first occur in early to late adolescence. Early intervention in adolescents is critical to help mitigate the impact of AN and offers the greatest chance of improving long-term outcomes. The metacognitive training for eating disorders (MCT-ED) programme represents one such intervention.

MCT-ED encourages people with eating disorders to adopt a more flexible and less rigid ‘perfectionisticstyle’ of thinking. Specifically, the programme targets cognitive inflexibility and perfectionism, which are elevated in clinical eating disorder populations. MCT-ED may be particularly beneficial 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.

This project, the first randomised controlled trial to investigate MCT in individuals with eating disorders, aimed to:

1) determine the feasibility of the MCT programme for adolescents with anorexia nervosa (e.g.,

subjective evaluation of the programme’s effectiveness and applicability to daily life)

2) determine the therapeutic benefit of MCT for adolescents with AN, including improvements in

biased thinking styles and eating disorder symptom severity

Research findings

A total of 36 females with a diagnosis of AN aged 13-17 years (M = 15.32, SD = 1.07) were recruited for the study. The mean Body Mass Index was 19.65 (Range = 17.01 – 21.10, SD = 1.50) and the mean length of diagnosis was 0.86 years (Range = 0.10 – 2.00 years, SD = 0.63). Participants were recruited from Flinders Medical Centre Paediatric Outpatient Clinic, South Australia (n = 31), and the Women’s and Children’s Adolescent Ward, South Australia (n = 5).

Preliminary evidence suggests the programme was effective in improving cognitive flexibility (e.g.,

improved body-image flexibility) and perfectionism (e.g., lower ‘concern over making mistakes’) and

reducing the severity of eating disorder symptoms. MCT-ED was also positively evaluated, with participants enjoying its ‘non-eating-disorder’ focus and light-hearted approach to tackling biased thinking.

Key Outcomes:

This suggests that the MCT-ED was not only effective, but also highly feasible for an adolescent clinical

population. On the success of this pilot study, we further adapted MCT-ED from a therapist-led intervention into a self-guided online programme, which could be administered to non-clinical ‘at-risk’ populations. Our findings from a recent pilot study on this online version of MCT-ED showed that the programme was feasible and effective in adult females (aged 18-25 years) with elevated weight and shape concerns. MCT-ED not only improved cognitive flexibility and perfectionism, but also improved weight and shape concerns and disordered eating behaviours at one-week follow-up. Our intention is to now extend the online MCT-ED programme to adolescents who are ‘at-risk’ of developing eating disorders.

Research Papers: Given the recency in which the trial was completed, we have not yet submitted the study for publication or presented the finding at conferences as at the time of this acquittal. We intend to submit the findings for publication in the International Journal of Eating Disorders.

Related Publications:

Future Outcomes:

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