The efficacy of meaning-centered psychotherapy in women at risk for developing eating disorders

Eating disorders (EDs) such as anorexia nervosa and bulimia nervosa are severe mental disorders, marked by emotional distress, psychosocial impairment, and physical morbidity (Dakanalis et al., 2017; Stice, Marti, & Rohde, 2013). One out of every ten women is at one point in her life affected by any of the EDs mentioned in the DSM-5 (Stice et al., 2013), leading to enormous health care and burden of disease costs (Schmidt et al., 2016). Despite the great impact of EDs, current treatment options are limited in their effectiveness and recurrence rates are high (e.g., Brockmeyer, Friederich, & Schmidt, 2018; Stice et al., 2013). Therefore, there is a great need to develop new, evidence-based treatment options that focus on the maintaining factors of EDs. One of the factors that has recently been proposed to be relevant in the development and maintenance of EDs is (reduced) meaning in life (Marco, Cañabate, Pérez, & Llorca, 2017). Meaning in life can be defined as the extent to which one’s life is experienced as making sense (comprehension), as being directed by one’s valued goals (purpose), and as worth living (mattering; George & Park, 2016; Martela & Steger, 2016). Prior studies in clinical samples indicated that individuals with EDs report lower life meaning than individuals without EDs (Fox & Leung, 2009; Marco et al., 2017) and that life meaning is inversely related to ED symptoms, weight preoccupation, and body dissatisfaction (Marco et al., 2019). In the current RCT, we will investigate whether a meaning-centered psychotherapy is effective in increasing meaning in life in women at risk of developing an eating disorder. Furthermore, we will examine whether the meaning-centered psychotherapy leads to an improvement in satisfaction with normative life domains and psychological well-being, and to a reduction in eating disorder symptoms and general distress. The meaning-centered psychotherapy was originally developed by Breitbart et al. (2015), and has proven its effectiveness in multiple samples and cultures (e.g., Breitbart et al., 2015; Van der Spek et al., 2017). We adjusted the manual to be suitable for administration among individuals with a high risk of developing an eating disorder. Participants will be randomly assigned to either the waiting list or therapy condition, after they complete the first assessment. The current meaning-centered psychotherapy is a manualized 6-week intervention, with 6 weekly online individual sessions of one hour each. Each session addresses a theme related to the concepts and sources of meaning.

The meaning-centered psychotherapy leads to an improvement in experienced meaning in life

Pre-assessment (at the start), post-assessment (after 7 weeks), follow-up assessment (after 4 weeks)

Waiting list condition: After participants complete the pre-assessment (all online), they will be randomly assigned to either the therapy or waiting list condition. Participants who are assigned to the waiting list condition, won’t receive any form of therapy. After 7 weeks of waiting, they will be asked to complete the post-assessment. Finally, four weeks later, they will be invited to complete the follow-up assessment. Afterwards, their participation in the current study will be completed. After the data collection has been finished, participants from the waiting list condition will be offered the opportunity to follow the meaning-centered psychotherapy as well.

Therapy intervention: The meaning-centered psychotherapy for individuals at risk of developing an eating disorder is an adapted version of the manualized meaning-centered psychotherapy for cancer patients by van der Spek et al. (2017). The current meaning-centered psychotherapy follows a manual that contains six weekly individual online therapy sessions of one hour. The intervention’s purpose comprises reducing worries about weight and shape through enhancing a sense of meaning in life. Therefore, participants will be educated about meaning in life and actively engaged with meaning in life through experiential assignments, homework exercises, and discussions with the trainer (Breitbart et al., 2010). Four sources of meaning will be covered during the sessions, including the personal life story, dealing with life’s limitations, creating your own life, and meaningful experiences. These sources are based on work by Frankl, who established them to be universal to human existence (Breitbart & Poppito, 2014). During each session participants will receive homework assignments, to deepen their experience and reflection on meaning in life in their daily context. All sessions will be conducted by a psychologist or master-level students who will be trained in delivering this intervention. Treatment will be offered in either English, Dutch or German language. After the final session, participants will be invited to complete the post-assessment. Four weeks later, they will be asked to complete the follow-up assessment. Afterwards, their participation in the current study will be completed.