# Family-based treatment with metacognitive therapy for adolescents with anorexia nervosa: findings from a phase II trial

## TL;DR

A new therapy combining family-based treatment and metacognitive therapy helped most adolescents with anorexia nervosa recover and maintain progress for a year.

## Contribution

This is the first phase II trial to integrate metacognitive therapy with family-based treatment for adolescent anorexia nervosa.

## Key findings

- 13 out of 14 patients no longer met anorexia nervosa diagnostic criteria after treatment.
- Patients showed significant weight gain and reduced emotional and cognitive symptoms.
- Treatment was well tolerated with no adverse events over 12 months.

## Abstract

The incidence of anorexia nervosa (AN) has increased over the past decade, particularly among school-aged children. Family-based therapy (FBT), which focuses on parental management and control, is the recommended and standard treatment for adolescents with AN. While FBT promotes weight gain and improved parent‒child interactions, it does not directly address the adolescents’ cognitive change, which could make them vulnerable to relapse. Metacognitive therapy is scarcely studied in AN, and this trial tested its feasibility and long-term effects for adolescents with AN.

This phase II trial included 14 adolescents with AN in an A‒B design. Medical tests and diagnostic assessments were conducted before and after treatment. Assessments were conducted before treatment, by end of treatment and at 12 months after end of treatment. We integrated family-based treatment and metacognitive therapy for patient intervention and parental guidance.

At posttreatment, 13 of the 14 patients no longer met the diagnostic criteria for AN. There were significant increases in percentage expected body weight and reductions in emotional and cognitive symptoms. One patient continued to have eating disorder symptoms at posttreatment and withdrew before follow-up. No significant changes were observed in areas of family conflict or parent‒child communication. The treatment was well tolerated and deemed meaningful by both parents and patients. No adverse events or rehospitalization occurred during the 12 month follow-up period. Data collection was challenging, especially with respect to patients’ disclosure of family interactions and symptoms.

The trial revealed positive effects posttreatment at the 12 month follow-up for 13 of 14 participants with AN. The treatment was well tolerated with no adverse effects. Despite the small sample size and lack of control, the results suggest that larger-scale trials of this intervention are warranted.

The study has been approved as a clinical and quality audit of the delivered clinical service registered by the institutional research board at Levanger Hospital HF (IRB-13672).

The online version contains supplementary material available at 10.1186/s40337-025-01272-4.

Family-based therapy (FBT) is a recommended treatment for anorexia nervosa (AN) and focuses on parents managing the child’s meals and nourishment. While FBT helps with weight gain and improves parent‒child interactions, it does not directly address patients’ anorectic thinking, which can lead to relapse. Metacognitive therapy might help patients with emotional regulation and the underlying cognitive processes. We tested whether metacognitive therapy, combined with FBT, is effective, tolerable, and safe for adolescents with AN and their parents. The trial included 14 patients and parents. The patients were assessed before and by the end of treatment and again 12 months by end of treatment. After treatment, 13 out of 14 patients no longer met the criteria for AN. They gained weight and had fewer emotional and cognitive symptoms. One patient had AN posttreatment and left the study before the 12 month follow-up. There were no reported changes in family conflict or communication, but the treatment was well tolerated, with no adverse events or rehospitalizations. However, this study had a small sample size and no matched controls, and the results suggest that larger comparative trials should be conducted with this approach.

The online version contains supplementary material available at 10.1186/s40337-025-01272-4.