How Do Outpatients Experience 20-Session Cognitive-Behavioral Therapy for Anorexia Nervosa (CBT-AN-20)? A Qualitative Exploration.

Objective: More efficient psychological treatments are needed to move patients with anorexia nervosa toward recovery at the earliest opportunity and reduce treatment waiting times. CBT-AN-20 is a novel, 20-session cognitive-behavioral therapy for outpatients with anorexia nervosa, emphasizing recovery from the very start of treatment. This qualitative study explored adult patients' experiences of receiving CBT-AN-20.

Method: Sixteen patients' survey data were collected (January 2023-May 2024) as part of a broader study conducted in two UK-based specialized community eating disorder services (Preregistration: https://doi.org/10.17605/OSF.IO/6RTSK). Patients were adults with anorexia nervosa assessed as suitable for outpatient therapy. Respondents included treatment completers and non-completers. Responses were analyzed using descriptives (Likert-scale questions) and thematic analysis (open-ended questions). Ethical clearance was obtained.

Results: CBT-AN-20's suitability was rated moderately high, and its helpfulness was rated positively. Thematic analysis identified three main themes: "Importance of Therapeutic Relationship", "Characteristics of Therapy" (i.e., its structure and content), and "Experiences of Therapy Over Time". While patients broadly perceived the therapeutic relationship as important, they had mixed opinions regarding its characteristics, and their experiences of therapy changed over time and at different treatment stages.

Discussion: CBT-AN-20 appears acceptable and potentially helpful for some adult outpatients with anorexia nervosa. The development of targeted psychoeducational materials to motivate patients through CBT-AN-2's challenging early stages is recommended. Future research should involve patients in the qualitative analysis and explore therapists' perspectives. Triangulating these results with patient outcome data will enable researchers to evaluate the next steps in developing and testing this novel therapy.