Relating Therapy for the anorexic voice: exploring the feasibility of evaluating an extended version of the therapy

BACKGROUND: The experience of hearing an 'anorexic voice' is common amongst those diagnosed with anorexia nervosa and can act as a barrier to recovery. The relationship with the anorexic voice can become coercive and hostile. Relating Therapy promotes assertive responding to the anorexic voice and was previously evaluated over 16 sessions. Consultation with people with lived experience suggested that Relating Therapy should be offered over an extended duration to facilitate the guided application of learning to eating behaviours. AIMS: The primary aim of this study was to inform the design of a future trial by exploring the feasibility of evaluating an extended course of Relating Therapy over 24 sessions. A secondary aim focused on the preliminary exploration of signals of change. METHOD: A mixed-methods feasibility study used a case series with repeated within-person measures to explore signals of change. RESULTS: Seven of nine participants completed a course of Relating Therapy. Feasibility outcomes were positively confirmed. Signals of change were evident in relation to a greater ability to engage with important and meaningful aspects of life, a re-defined relationship with the anorexic voice, and reduced distress around eating and body image. CONCLUSION: The study generated evidence of the feasibility of evaluating an extended version of Relating Therapy for those who are distressed by an anorexic voice. Qualitative and quantitative data were suggestive of positive changes for some participants. A larger trial is warranted to evaluate the efficacy of Relating Therapy for the anorexic voice.