Accepted for/Published in: JMIR Research Protocols
Date Submitted: Nov 12, 2025
Date Accepted: Jun 30, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Taking The Wheel - The Effects of Autonomy Enhancing Therapy for Eating Disorders: Protocol for a Multiple Baseline Design
ABSTRACT
Background:
Eating disorders remain challenging to treat effectively, with low recovery percentages and high relapse rates. This study protocol explores autonomy-enhancing therapy (AET) as a therapeutic adjunct, examining its effects on autonomy-connectedness and treatment outcomes in eating disorders. Autonomy-connectedness, which encompasses self-awareness, sensitivity to others, and capacity for managing new situations, has been associated with better eating disorder recovery and lower relapse rates
Objective:
Our 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=36). Participants receive weekly Autonomy Enhancing (group-)Therapy (AET) sessions, focusing on autonomy-related personal goals. Primary outcomes measured weekly include eating disorder symptoms and autonomy-connectedness levels, secondary outcomes depression, anxiety, self-esteem, and quality of life will be assessed every three months. Throughout the treatment, we expect an improvement of autonomy-connectedness and a decrease of eating disorder symptoms, with autonomy-connectedness mediating treatment success. Additionally, post-treatment improvements in self-esteem, quality of life, depression and anxiety are expected. Visual analysis of the single-case experimental design data and mixed models will be used to evaluate treatment effectiveness, with mediation analyses exploring autonomy-connectedness’ role.
Results:
As of September 2025, fourteen participants are enrolled.
Conclusions:
This study aims to demonstrate the effects of AET in improving eating disorder treatment outcomes, potentially offering a valuable addition to standard care by reducing relapse risk. Clinical Trial: Medical ethical approval for the study protocol was obtained at METC VU Amsterdam (NL83503.018.23) and the internal research ethics committee of the GGZ Oost Brabant. A brief overview of the proposed study can be found in the trial registry entry https://osf.io/fdsyw; this protocol provides a more detailed account of the proposed study’s background, design and planned analyses.
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