ArticleJMIR research protocols2026
The Effects of Autonomy-Enhancing Therapy for Eating Disorders: Protocol for a Single-Case Experimental Multiple Baseline Design.
Article in JMIR research protocols, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Eating disorders (EDs) remain challenging to treat effectively, with low recovery percentages and high relapse rates. This study protocol explores autonomy-enhancing therapy as a therapeutic adjunct to existing day care treatment in the last phase of treatment. Autonomy-enhancing therapy is aimed at improving autonomy-connectedness: the capacity for self-steering while connected to others, which encompasses self-awareness, sensitivity to others, and the capacity for managing new situations. Higher autonomy-connectedness has been associated with improved ED recovery and lower relapse rates, yet little is known about the effectiveness of autonomy-enhancing therapy in ED populations. Objective: This study examines the effectiveness of autonomy-enhancing therapy in the last phase of a multidisciplinary day care program for anorexia and bulimia nervosa. Methods: A combined single-case experimental design and repeated measures design will be used, involving participants who are in the last phase of day care treatment for anorexia or bulimia nervosa (n=22-30). Participants will receive weekly autonomy-enhancing therapy sessions focused on personal autonomy-related goals and themed group discussions. The primary outcomes (ED symptoms and autonomy-connectedness) will be assessed weekly using the Eating Disorder Examination Questionnaire-Short (EDE-QS) and a short-term version of the Autonomy-Connectedness Scale (ACS-30-ST). Secondary outcomes (depression, anxiety, self-esteem, and quality of life) will be assessed every 3 months using the Symptom Checklist (SCL-90), Rosenberg Self-Esteem Scale (RSES), and World Health Organization Quality of Life-Brief Version (WHOQOL-BREF). Throughout the treatment, we expect improvements in autonomy-connectedness and a decrease in ED symptoms, with autonomy-connectedness mediating treatment success. Additionally, increased self-esteem and quality of life and reduced depression and anxiety are expected after treatment. Visual analysis of the single-case experimental design data and mixed models will be used to evaluate treatment effectiveness, with mediation analyses exploring the role of autonomy-connectedness. Results: Data collection started in March 2024. As of September 2026, 18 participants have completed the study, and 6 are enrolled. An additional 7 participants have been recruited. Data collection is expected to be finalized in February 2027; results are expected to be published in the second half of 2027. Conclusions: This study addresses the need for improved ED treatments by investigating autonomy-enhancing therapy as a potentially valuable adjunct to existing care. Targeting autonomy-connectedness may contribute to reductions in ED symptoms, as well as to broader psychological recovery. Strengths of this study include its practice-based design and the use of a single-case experimental design, allowing a detailed examination of treatment processes. Limitations include the absence of a control condition and the limited follow-up period, which may not fully capture relapse during the period of highest relapse risk. If promising, this study may provide a foundation for future larger-scale controlled studies on autonomy-enhancing therapy in ED treatment.
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