{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T21:11:51Z","timestamp":1790111511785,"version":"4.0.1"},"reference-count":47,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Res Protoc"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study examines the effectiveness of autonomy-enhancing therapy in the last phase of a multidisciplinary day care program for anorexia and bulimia nervosa.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n 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\u2013Short (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\u2013Brief 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.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/87349","type":"journal-article","created":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T16:45:49Z","timestamp":1782837949000},"page":"e87349-e87349","source":"Crossref","is-referenced-by-count":0,"title":["The Effects of Autonomy-Enhancing Therapy for Eating Disorders: Protocol for a Single-Case Experimental Multiple Baseline Design"],"prefix":"10.2196","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3104-2575","authenticated-orcid":false,"given":"Nicky","family":"Bosman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8049-8942","authenticated-orcid":false,"given":"Joyce","family":"Maas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7517-6081","authenticated-orcid":false,"given":"Marcel","family":"van Assen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6587-5470","authenticated-orcid":false,"given":"Mladena","family":"Simeunovic-Ostojic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8552-975X","authenticated-orcid":false,"given":"Marrie","family":"Bekker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,22]]},"reference":[{"issue":"3","key":"R1","doi-asserted-by":"publisher","first-page":"215","DOI":"10.1016\/S2215-0366(20)30566-6","article-title":"Comparative efficacy and acceptability of psychological interventions for the treatment of adult outpatients with anorexia nervosa: a systematic review and network meta-analysis","volume":"8","author":"Solmi","journal-title":"Lancet Psychiatry"},{"issue":"6","key":"R2","doi-asserted-by":"publisher","first-page":"423","DOI":"10.1097\/YCO.0000000000000360","article-title":"Evidence-based clinical guidelines for eating disorders: international comparison","volume":"30","author":"Hilbert","journal-title":"Curr Opin Psychiatry"},{"key":"R3","unstructured":"Levels of evidence. 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