# Mirror Exposure Training for Adolescents With Anorexia Nervosa (MIRADAN): Cognitive Mechanisms of Body Disturbance – A Study Protocol

## TL;DR

This study tests mirror exposure therapy to reduce body dissatisfaction in adolescents with anorexia nervosa and explores if changes in attention to body-related stimuli explain its effects.

## Contribution

The study is the first to test mirror exposure in adolescents with anorexia nervosa and investigate attention bias as a potential mechanism.

## Key findings

- Mirror exposure may reduce body dissatisfaction in adolescents with anorexia nervosa.
- Changes in body-related attention bias could be a mechanism of mirror exposure's effects.
- The study will assess the acceptability of mirror exposure in adolescents.

## Abstract

Anorexia Nervosa (AN) is a severe mental illness, which typically develops in adolescence and, if left untreated, often becomes chronic. Body dissatisfaction is a core characteristic of AN. Mirror exposure (ME) is an effective therapeutic technique to tackle body dissatisfaction in adult patients with eating disorders, but there is limited evidence for the effects of ME in adolescence. One potential mechanism underlying effects of ME on body dissatisfaction is change in body-related attention bias. However, this mechanism remains to be empirically tested. Accordingly, the aim of the current study is twofold: primarily, we aim to test if ME can reduce body dissatisfaction and associated symptoms in adolescent patients with AN. Additionally, we aim to investigate whether change in biased body-related attention due to ME is a possible mechanism of action.

Adolescent patients with AN are randomized to either 12 sessions of ME (3 ME-sessions/week) or wait-list within four weeks. Main outcomes include body dissatisfaction and associated symptoms of AN. Moreover, body-related attention bias is assessed at baseline and post-treatment by means of eye-tracking with two paradigms. Further, process variables are collected weekly. In addition, 12 weeks after end of the study, the acceptability of the ME is assessed.

The main aim of the study is to evaluate high-frequency and high-intense ME for treating body dissatisfaction in adolescents with AN. In addition, we would like to clarify whether change in attentional bias for body stimuli is a mechanism underlying change in body dissatisfaction due to ME.

Body dissatisfaction is a major risk factor for the development, maintenance, and relapse of AN.In this study we aim to test if mirror exposure reduces body dissatisfaction in young people with AN.A secondary aim is to test if change in body-related attention bias is a mechanism of change in body dissatisfaction.

Body dissatisfaction is a major risk factor for the development, maintenance, and relapse of AN.

In this study we aim to test if mirror exposure reduces body dissatisfaction in young people with AN.

A secondary aim is to test if change in body-related attention bias is a mechanism of change in body dissatisfaction.