Dr Anna Oldershaw discusses a new guidebook for therapists to support the treatment of long-standing anorexia.  

Anorexia Nervosa remains one of the most challenging psychiatric conditions to treat, particularly when the illness becomes deeply entrenched over many years.  

Despite advances in evidence-based therapies, there remains need for improvements, and recovery rates are low, particularly for longstanding anorexia. 

Too many individuals find themselves feeling stuck, conflicted and scared about moving towards a life without anorexia.  

The recent excellent work of the All-Party Parliamentary Group (APPG) on eating disorders led by Secretariat Hope Virgo – a prominent eating disorder campaigner and founder of the #DumpTheScales movement – underscores the crisis in Eating Disorder Services and demands urgent attention. Its report, published this year, highlights how individuals with longstanding eating disorders, like anorexia nervosa, often face systemic neglect, trapped in cycles of chronic suffering and fragmented care, with some as young as 17 being placed on palliative care pathways due to a lack of effective treatment options.  

In the context of this crisis inadequate treatment options and care, Helen Startup, Tony Lavender, and I, conducted a six-year programme of detailed research to develop a new therapy for individuals with longstanding and enduring anorexia nervosa, led by learnings from those with lived experience.  

The resulting SPEAKS therapy has now been written into a guidebook for therapists – Transforming Emotional Pain and Rediscovering the Self in Anorexia Nervosa – due to be published on 12^th May. It offers an innovative approach to treatment for people with eating disorders who have become chronically unwell.  

The SPEAKS model is a structured, phase-based therapy integrating theory and practice chiefly from Emotion Focused Therapy and Schema Therapy. It comprises five stages: Engagement and Formulation, Seeing Through the Façade, Deepening to Core Pain, Resolving Core Pain, and Embracing the ‘Real Me’.  

This progression enables therapists to guide patients through a journey of self-discovery and emotional processing, seen as essential for sustainable recovery. It provides practical and detailed descriptions of therapeutic tasks to address the deep-seated emotional pain and identity struggles that often underpin anorexia nervosa. By focusing on the individual’s emotional experiences and identity, the model addresses the APPG’s call for treatments that tackle the root causes of eating disorders rather than just their manifestations.​  

A feasibility study of SPEAKS conducted across two NHS services shows the approach to be feasible, acceptable to clients and therapists, and to have clear signals of efficacy for those with longstanding anorexia nervosa. Several further studies utilising novel designs explored hypotheses pertaining to the processes of change during SPEAKS therapy, supporting the validity of the approach. SPEAKS now warrants further research through larger-scale randomized controlled trials.  

The APPG report demands systemic reform, increased research funding and development of innovative therapies, recognizing that current treatment modalities may not suffice for all individuals. The development of SPEAKS with its uniquely phased therapeutic model for longstanding eating disorders aligns with this demand. By presenting a response to this gap in eating disorder treatment, it seeks to offer chronically unwell individuals choice and hope.   

Dr Anna Oldershaw is Reader in Clinical Psychology at the Salomons Institute for Applied Psychology, CCCU.