A Guided Self-Help Approach for Outpatients

The MOPED program includes a workbook with structured activities.

Reprinted from Eating Disorders Review
March/April Volume 27, Number 2
©2016 IAEDP

As many as 73% of patients receiving outpatient care for an eating disorder drop out before treatment is completed (Clin Psychol Rev. 1998.18:391). Failure to attend outpatient appointments is a costly matter for the healthcare facility, delays treatment and exacerbates symptoms. On the other hand, patients with eating disorders who understand their condition and its treatment are more likely to comply with treatment. Since lack of motivation for recovery is also a factor in dropping out, particularly for those with anorexia nervosa, motivational interviewing techniques have been helpful for engaging patients in treatment.

Physicians at Leicestershire Adult Eating Disorders Service in the United Kingdom have recently developed a motivation and psycho-education self-help manual with structured activities (MOPED) for eating disorders outpatients. The MOPED program was developed for patients with all types of eating disorders. Dr. Nicola Brewin and coworkers compared engagement and completion of treatment rates between a group of patients on a waiting list for treatment who completed the MOPED program and those offered treatment as usual, who were given only a pamphlet describing the MOPED program (Eur Eat Disorders Rev. 20216. Published online before print. doi10.1002/erv.2431). 

The MOPED program involves a workbook with text and guided activities; it differs from other psychoeducational workbooks in that a motivational interviewing style is used throughout. All the activities are designed to increase motivation while providing psycho-education. The underlying goal is to help the patient decide whether she/he wants to change, and by doing so motivate the patient to accept help.

Dr. Brewin and colleagues’ study included 79 female patients who received MOPED after an initial assessment and who were placed on the waiting list for outpatient therapy during the study period. Because of the small numbers of male patients (n=4), no male patients were included. The 79 patients who participated in the MOPED program were then compared with 79 matched (by diagnosis) patients selected in reverse chronological order from the pool of patients assessed and placed on the waiting list for therapy before MOPED was developed. Both groups of patients were assessed by the same clinician using the Clinical Eating Disorders Rating Instrument, or CEDRI.

How well did the program work?

The MOPED manual approach significantly increased the participation of patients and reduced dropout pre-therapy while patients were on the waiting list for treatment. This was particularly true for those with anorexia nervosa. Even though the MOPED group included more students than did the second group, and students more often drop out of treatment, the self-help manual approach still significantly increased the engagement of patients and reduced dropout before therapy began.

The authors also reported that the MOPED program has been adapted for use in an online form (e-MOPED). Future studies might compare the efficacy of the paper form with the online form of the program. Future research could also involve identifying patients who may be more likely to drop out of treatment because of certain personality traits as well as tracing the efficacy of MOPED over time.