MANTRA (Maudsley Model of Anorexia Nervosa Treatment for Adults) is based on a cognitive-interpersonal model of anorexia nervosa. It is one of three NICE-recommended first line therapy options for anorexia nervosa in adults. MANTRA was developed with support from the NIHR Maudsley Biomedical Research Centre and was designed with the needs, characteristics and illness-maintaining factors of anorexia nervosa in mind. It considers both the biology and psychology of anorexia.

“MANTRA was almost tailor made to me, brilliantly, so it was very good.”

Patient on their experience of MANTRA

MANTRA also places an emphasis on carer involvement and carer support. ‘Carers’ include any relevant close others who may be able to support someone with anorexia to change. Of course, the amount of carer involvement is flexible and dependent on individual circumstances.

The MANTRA model proposes that anorexia nervosa typically arises in people with a certain type of personality including anxious, sensitive, perfectionist and/or obsessional traits. The model suggests that anorexia is maintained by four broad factors:

  1. positive beliefs about anorexia, which may include identity becoming linked to anorexia;
  2. an inflexible, detail-focused and/or perfectionistic thinking style;
  3. difficulties with emotions and/or relationships; and
  4. responses from close others that unwittingly maintain anorexia, either due to the accommodation of eating disorder behaviours or high levels of expressed emotion and anger in response to eating disorder behaviours.

At the heart of the treatment manual is an individualised formulation depicted as a ‘vicious flower’ which maps out these maintaining factors as ‘petals’ that keep anorexia going.

MANTRA vicious flower formulation

“You can really tailor it… whatever’s going on for each patient, I think MANTRA can cover that.”

Therapist on their experience using MANTRA

MANTRA was originally developed as an individual treatment for adults to be delivered in an outpatient setting over 20 to 30 one hour sessions. It has since been adapted to be used in a group format, on inpatient wards, and for adolescents. Evaluation of MANTRA in these different formats is still ongoing but early evidence suggests positive effects.

MANTRA is structured around a workbook which empowers patients to control their own therapeutic journey. MANTRA also makes use of motivational interviewing principles and emphasises the importance of collaborative working. Generally MANTRA would be delivered by a qualified psychologist or psychotherapist with experience working with anorexia nervosa. Some people may be able to use the MANTRA workbook as a self-help resource with support from a general practitioner or other health practitioner.


“Many of the exercises that we went through in the sessions made me really think about why I felt and acted the way I did and what I really want from life.”

Patient reflecting on their use of the MANTRA workbook

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