Anorexia nervosa (AN) can have poor prognosis and high mortality. Whilst significant gains have been made in treating AN, space exists for further innovative therapies. Improvements in treating other complex disorders were generated from clearly defined models of a core putative maintaining process. Improvements are also attained by modelling and testing psychotherapeutic change processes underpinning interventions. The SPEAKS research programme aimed to develop a psychotherapeutic intervention for adults with AN, targeting a maintaining emotions process.
Development followed an empirical research review of emotions and AN, integrating new data collected via qualitative design and patient and public involvement. This culminated in an evidence-based hypothesis and formulation of AN arising from ‘a lost sense of emotional self’. It proposed the primary therapy goal be integration of ‘emotional self’ to flexibly and adaptively direct needs. Psychotherapeutic approaches targeting similar goals were considered and integrated.
SPEAKS intervention draws primarily on theory and practice from schema therapy (ST), integrating emotion-focused therapy theory and tasks. Both apply principles of self-multiplicity (self comprised of interacting ‘parts’). SPEAKS focuses on underdeveloped ‘Healthy Adult’ (HA) and dissociated emotional self (Vulnerable Child; VC). Unhelpful drivers and blocks are considered (critical voice; coping modes).
SPEAKS is an application of ST with key focus on emotional change, drawing from emotion-focused therapy. SPEAKS is currently being assessed in a multi-site feasibility trial, which includes change process analysis. SPEAKS rapidly adapted to the COVID-19 pandemic; trial design and intervention offer new ways of working as we now move forward together.
Dr Anna Oldershaw is a Senior Clinical Psychologist working in Kent and Medway All Age Eating Disorder Service (North East London NHS Foundation Trust) and Visiting Fellow at the Salomons Institute for Applied Psychology. Prior to her clinical training, Anna completed a PhD at the Institute of Psychiatry, Psychology and Neuroscience focusing on Anorexia Nervosa, social cognition and emotion and has published extensively on the topic. In 2016, Anna received a National Institute of Health Research fellowship to fund the development and testing of an emotion focused psychological intervention for adults with Anorexia Nervosa (the SPEAKS study), working alongside Dr Helen Startup and Professor Tony Lavender.
Anna has further training in Emotion Focused Therapy (EFT) and Schema Therapy. She delivers ST, EFT and EFT supervision and is a member of the International Society for Emotion Focused Therapy (isEFT). Alongside Les Greenberg and Robert Elliott, she cofacilitates EFT training at the Emotion Focused Therapy Institute at Salomons Institute for Applied Psychology, in Southeast England.
Helen trained as a Clinical Psychologist at the Institute of Psychiatry, London, after completing a PhD in Anxiety and Worry at the University of Sussex, UK. She has worked for the Maudsley Eating Disorders service for the past 20 years as a senior clinician and researcher. She is also a Senior Research Fellow with Sussex Partnership NHS Foundation Trust. She is a BABCP accredited Cognitive Behavioural Therapist and Supervisor and an International Society of Schema Therapy (ISST) Advanced Accredited Schema Therapist, Supervisor and Trainer. She Co-Directs Schema Therapy School, UK, LTD: www.schematherapyschool.co.uk