Learning to connect: feasibility, acceptability and experiences in the social domain intervention for eating disorders.

OBJECTIVE: Eating disorders have been associated with neurobehavioral differences in social processing and interactions. Clinically, social support is a positive prognostic factor that protects against relapse. For these reasons, interventions that modify features in the social domain may be promising therapeutic targets to improve outcomes in eating disorders. Because groups require multiple social interactions, group therapy may be an ideal format to facilitate change. However, there is currently no standard adjunctive therapy for eating disorders that targets social domain concepts in a group setting.

METHOD: The Social Domain Intervention (SDI) is an eight-session intervention that focuses on building insight about social processing within a group. Each session includes a collaborative experiential art task followed by a psychoeducational presentation and related activity. Engagement in the SDI was measured in terms of sessions attended and assignments completed. Written participant feedback was analyzed using Braun and Clark's method for thematic analysis. Written responses were coded and then grouped into themes.

RESULTS: Eighteen female participants between the ages of 18-30 were enrolled in the group across three cohorts. Two participants withdrew after attending three sessions. On average, the remaining 16 participants attended 7 out of 8 group sessions and completed 5 out of 7 homework assignments. Qualitative analysis of feedback revealed that participants valued both the artistic component and the psychoeducation. The most highly rated sessions discussed identity, values, and connection. The main themes identified were that self-disclosure facilitates closeness, perfectionism impedes connection, shared accomplishments enhance satisfaction, and that art is a valuable grounding tool for emotional regulation. The primary challenges described by participants were related to perfectionism, social anxiety, and feelings of vulnerability.

DISCUSSION: Collaborative art therapy may be an effective modality for patients struggling with distress tolerance or avoidant behaviors, as the tasks necessitate engagement in the present moment. The concurrent psychoeducation allows participants to openly discuss the challenges, goals, and expectations present in their social interactions. Time-limited groups may be successful adjunctive treatments for outpatients with eating disorders. More work is needed to determine if these groups can facilitate long-term changes in interpersonal relationships.

TRIAL REGISTRATION: NCT06198023.