A novel approach to promote motivation to change in the treatment of anorexia nervosa using visualisation and imagery

To the Editor

Patients with anorexia nervosa often display low motivation to change which is often viewed as the cause for their lack of engagement and contributes to the high dropout rate from treatment (Hötzel et al., 2013). Price-Evans and Treasure (2011) proposed motivational interview as an interventional style that is effective in those who are resistant to change.

Beck (1976) has emphasised the role of mental imagery in cognitive behavioural therapy (CBT). He contended that mental activities take the form of words, phrases and image and that modifying upsetting visual cognition can lead to cognitive and emotional shifts (Holmes et al., 2007).

Despite the recent resurgence in the interest in the use of imagery in CBT, there has been no research in its use in the treatment of anorexia nervosa. I propose a novel approach, named motivational visualisation (MV), using imagery and visualisation based on a background of motivational interview to promote motivation for recovery in the treatment of anorexia nervosa, and present two patients who responded favourably to this novel therapeutic approach.

Case 1 is a 24-year-old female patient with a history of anorexia nervosa since approximately 15 years of age. She also suffered from substance abuse including alcohol and stimulant use.

Despite many years of treatment for various conditions, she continued to suffer from relapses of her eating disorder alternating with substance abuse. She consented to a trial of the novel approach and has been 18 months free of symptoms of substance abuse. She has been maintaining at body mass index (BMI) of 20 kg/m2 for the past 12 months with ongoing motivation to remain in a healthy weight range.

Case 2 is a 27-year-old female patient who had been suffering from anorexia nervosa since 14 years of age. Despite voicing motivation to recover she would repeatedly relapse after discharge home from hospital. She required 2–3 hospital admissions per year for weight restoration and would relapse as soon as she was discharged home.

This patient consented to a trial of the novel therapeutic approach and has subsequently experienced an improvement in her motivation to recover. She has now maintained a BMI of 19 for 4 months.

It appears that this novel therapeutic approach utilising visualisation and imagery is a promising therapy in the treatment of anorexia nervosa. A formal randomised controlled trial is warranted to test its efficacy in a larger clinical population.