The experience of caring for an adult loved one with an eating disorder: A meta-synthesis, and healthcare professionals’ experiences of delivering CBT-E and MANTRA to autistic individuals with an eating disorder

Setters, Chloe 2025. The experience of caring for an adult loved one with an eating disorder: A meta-synthesis, and healthcare professionals’ experiences of delivering CBT-E and MANTRA to autistic individuals with an eating disorder. ClinPsy Thesis, Cardiff University. Item availability restricted.

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Abstract

This thesis presents two projects investigating experiences of providing support to individuals with an eating disorder: a systematic review focusing on carers’ experiences of supporting a loved one with an eating disorder, and an empirical project interested in healthcare professionals’ experiences of delivering eating disorder treatments to autistic people and those with autistic traits. Paper 1: Systematic Review This paper aims to synthesise the experiences of carers who provide care or live with an adult loved one with an eating disorder. The review topic was primarily inspired by a long-standing interest in eating disorders and their impact on the wider family system, particularly the cyclical nature of perpetuating eating disorder behaviours and carers’ maladaptive coping. Working in mental health services highlighted the differences in systemic working within young peoples’ services and adult services, with the latter having significantly less family involvement. Existing research highlights the importance of carers’ wellbeing on eating disorder recovery and so it was important to consider how carers viewed their role and any challenges they may encounter to provide efficient care to an adult. There is extensive literature pertaining to caring for adolescents with eating disorders, but caring for adults may bring further challenges with navigating confidentiality, treatment involvement, carer identity and balancing the independence of their loved one. Therefore, it is important to give a voice to carers to further understand their experiences and support needs. The intention of this review was to investigate the practical, social and emotional impact of caring for or living with a loved one with an eating disorder. Previous reviews on this topic offer insights but require updating. Scientific and medical databases were searched for appropriate literature. 12 papers met the inclusion criteria, which included caregiving accounts from parents, partners and siblings. The papers were deemed of high quality and included a variety of ages and biological sexes. A thematic meta-synthesis was conducted on the data to identify themes. The findings indicated that initially carers looked for someone to blame and this led to fractured relationships and decreased emotional wellbeing. As carers learnt more about the eating disorder, they were better able to empathise, and this had a positive impact on their ability to provide care. Carers struggled with understanding their role, feeling ambiguous about their identity, and how to balance adult relationships with caregiving. Carers particularly struggled with the demand of providing care when they received little guidance and were excluded from their adult loved ones’ treatment. The review highlighted maladaptive coping and emphasised support needs for carers to be able to carry out their caring responsibilities effectively. The findings were critically discussed, and areas of future research and clinical implications were explored. Paper 2: Empirical Project The second paper is a qualitative study investigating the experiences of healthcare professionals delivering two eating disorder therapies, CBT-E and MANTRA, to autistic people and those with autistic traits. The study aimed to understand healthcare professionals’ views on the effectiveness of these treatments for autistic individuals and those with autistic traits, as well as any adaptations they may make. The researcher’s clinical experience working with autistic people and those with autistic traits, brought more awareness to a world designed for neurotypical people and the challenges this may present autistic individuals. This poses challenges within several aspects of society, but also within healthcare. The literature emphasises poorer outcomes for autistic people with eating disorders. With this in mind, it is interesting to consider that perhaps psychological therapies are also designed for neurotypical people, and the nuances that lead autistic people to developing eating disorders may not be as widely considered. It is also important to consider that healthcare professionals may feel less confident delivering effective therapy to autistic people and those with autistic traits if neurodiversity is not accounted for in the protocols. The literature has looked widely at healthcare professionals’ experiences of providing therapy to autistic people and those with autistic traits, but has not specifically investigated particular eating disorder treatments, which is what this paper aimed to do. Semi-structured interviews were conducted with 14 healthcare professionals, from numerous different professions, recruited through eating disorder services and social media. Healthcare professionals had experience of delivering CBT-E and/or MANTRA to autistic clients or those with autistic traits. The interview questions encouraged healthcare professionals to appraise the therapies, considering benefits and challenges, as well as sharing any adaptations they deemed efficacious. Reflexive thematic analysis was used to capture shared insights and recurring themes from the data. The findings highlighted the importance of considering the unique and individual presentations of autistic people and those with autistic traits when delivering therapy. This should be encouraged using a more detailed formulation to encompass autism and encouraging agency in therapy. The findings report specific treatment modifications that may be considered when delivering CBT-E or MANTRA to autistic people and those with autistic traits, and these can be used by healthcare professionals in collaboration with autistic clients and those with autistic traits. Healthcare professionals reported differing degrees of confidence when working with this client group and this could be influenced by lived experience, but also training, which healthcare professionals desired more of. The paper discussed the findings critically and highlighted important clinical implications and areas for future research.

Item Type:	Thesis (DClinPsy)
Date Type:	Completion
Status:	Unpublished
Schools:	Schools > Psychology
Subjects:	B Philosophy. Psychology. Religion > BF Psychology
Date of First Compliant Deposit:	8 July 2025
Last Modified:	10 Jul 2025 10:08
URI:	https://orca.cardiff.ac.uk/id/eprint/179634

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