Application of the ECHOMANTRA Program in the Treatment of an Adult Patient With Anorexia Nervosa: A Clinical Report With Family Involvement

Abstract

Anorexia nervosa (AN) is a severe psychiatric disorder with high mortality and frequent relapse in adulthood. Although evidence-based treatments exist, their effectiveness remains limited, and few involve caregivers despite evidence supporting their role. This single-case study explored the feasibility and preliminary effectiveness of the ECHOMANTRA program—a brief, manualized, online intervention based on the cognitive–interpersonal model—as an adjunct to treatment-as-usual (TAU) for an adult woman with AN and her mother. The eight-session intervention included MANTRA-based modules for the patient and ECHO-based modules for the caregiver, supported by manuals and personalized workbooks. Assessments were conducted at pre-treatment, post-treatment, and three-month follow-up using validated self-report measures. Patient outcomes included eating disorder symptoms (EDE-Q), emotional distress (DASS-21), functional impairment (CIA 3.0), and quality of life. Carer outcomes included symptom accommodation (AESED), perceived illness impact (EDSIS), and caregiving skills (CASK). Results showed clinically meaningful reductions in eating disorder symptoms, emotional dysregulation, and functional impairment in the patient, with gains maintained at follow-up. A transient post-treatment increase in emotional distress likely reflected greater illness insight, which subsided by follow-up. The caregiver reported decreased accommodation, lower burden, and improved caregiving competence. Both participants adhered to and were highly satisfied with the intervention. Findings offer preliminary support for ECHOMANTRA as a feasible and potentially effective adjunct to standard care, highlighting the value of integrating caregiver-focused strategies into adult AN treatment.