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Research suggests that difficulties with identity negotiations may present as a barrier to treatment. This study sought to explore individuals\u2019 identity negotiations during therapy sessions using Compulsive Exercise Activity Therapy (LEAP) combined with Cognitive Behaviour Therapy for Anorexia Nervosa (CBT-AN). Analysis focused on moments in therapy where individuals\u2019 identities were dominated or defined by AN and where alternative identities could be generated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>40 in-session transcripts from sessions at early, mid and end points of the CBT-AN (with LEAP) treatment were qualitatively analysed for nine of the 78 participants in the original randomised control trial. Through a constructivist framework, thematic analysis was used to identify surface and latent meanings and discursive material participants used to negotiate their identities in the context of therapy sessions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Analysis of in-therapy transcripts generated two themes pertaining to identity negotiations: (1) troubled identities and (2) rebuilding identities and lives outside of AN. Early therapy sessions explored fragmented and AN dominated identities, including how AN was troubling to participants\u2019 sense of self, contributed to conflicted identities, positioned them outside of normality, and was associated with isolated and othering identities. Within therapy sessions, participants engaged in a recursive process of shifting relationships with AN and themselves and building identities and lives outside of the AN identity. This included generating hopes for recovery and the future more frequently in mid- to late- therapy sessions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Identity negotiations evident in the therapeutic conversations aligned with the key components of the CBT-AN intervention, including addressing (1) the characterisation of oneself as \u2018an anorexic\u2019 and (2) the diversification of roles and activities to broaden and enhance self-concepts. Future developments of therapeutic interventions for AN would benefit from greater consideration of ways to assist individuals to more comprehensively address problematic identities, including uncovering identities hidden by the AN identity and generating preferred identities.<\/jats:p>\n                    <jats:p>\n                      <jats:italic>Trial Registration<\/jats:italic>\n                      : Ethics approval was obtained at the time of the initial study and for this embedded research by the HREC at the Western Sydney University (HR777332).\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40337-024-00979-0","type":"journal-article","created":{"date-parts":[[2024,1,31]],"date-time":"2024-01-31T09:03:16Z","timestamp":1706691796000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Key-in-session identity negotiations in a first line treatment for adult anorexia nervosa"],"prefix":"10.1186","volume":"12","author":[{"given":"Lauren","family":"Heywood","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Conti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Touyz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sloan","family":"Madden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phillipa","family":"Hay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,1,31]]},"reference":[{"key":"979_CR1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and statistical manual of mental disorders","author":"D American Psychiatric Association","year":"2013","unstructured":"American Psychiatric Association D, Association AP. 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Author PH has received sessional fees from the Therapeutic Guidelines publication and the Health Education and Training Institute (HETI, NSW), and royalties\/honoraria from Hogrefe and Huber, McGraw Hill Education, Blackwell Scientific Publications, BioMed Central, and PLOS Medicine. She has prepared a report under contract for Takeda (formerly Shire) Pharmaceuticals regarding binge eating disorder (July 2017) and is a consultant to Takeda Pharmaceuticals. Author ST has chaired the Takeda Australian Clinical Advisory Board for Binge Eating Disorders. He has also been a recipient of travel grants, investigator-initiated research grants as well as commissioned reports. He is a member of the Commonwealth Government\u2019s Technical Advisory Group on Eating Disorders and is an inaugural member of the National Eating Disorders Consortium. He receives royalties from Hogrefe and Huber, Taylor and Francis and McGraw Hill for published books\/book chapters. He is conjoint Editor in Chief of the Journal of Eating Disorders.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"20"}}