A case series evaluation of a schema therapy-coaching programme for carers of patients with moderate to severe anorexia nervosa: the CAREFREE programme

<title>Abstract</title> <bold>Background</bold> Anorexia Nervosa is a complex condition to treat, often complicated by high chronicity, complexity and comorbidity (MS-AN). Treatments for MS-AN are limited, with carers having to take a large role in supporting these individuals. Carer burden and distress is high, impacting carer wellbeing and contributing to familial dynamics which can perpetuate AN behaviours as a way of coping. This study evaluated the effectiveness of a novel carers group for the specific needs of carers of MS-AN using schema therapy-focused coaching, the CAREFREE programme, for improving carer distress and family functioning. <bold>Methods</bold> A Non-Concurrent group case series design was employed. Outcome measures included carer distress, expressed emotion, family functioning and communication, mood, and attachment-related anxiety and avoidance. Outcomes were analysed at 4-timepoints, pre-intervention, mid-point (6 weeks), post-intervention (12-weeks) and 3-month follow-up, using multi-level modelling. <bold>Results</bold> 53 carers commenced treatment in the study across 5 groups. Carers distress, expressed emotion, family functioning, mood and attachment-related avoidance improved after the end of the group and remained improved at follow-up. Attachment-anxiety did not lead to significant changes, although a trend for improvement was seen. <bold>Conclusions</bold> Preliminary evidence suggests the CAREFREE programme is effective at improving carer wellbeing and family functioning for carers of MS-AN. Attachment outcome measures which did not significantly change may be related to the typical resistance to change for these measures. Future research is required to explore what impact this has on patient outcomes. <bold>Trial registration:</bold> This study was registered with clinicaltrials.gov (ClinicalTrials.gov ID: NCT06624397).