REACH+ Trial Targets the High-Risk Months After Weight Restoration in Anorexia Nervosa
The next phase of anorexia nervosa care is often where relapse risk quietly rises. REACH+ 2.0 is designed around that vulnerable period, testing whether a structured, telehealth-based relapse-prevention package can better sustain remission after acute weight restoration in people with anorexia nervosa or atypical anorexia nervosa.
This is not a conventional efficacy trial built around a single fixed therapy. Investigators are using the Multiphase Optimization Strategy, or MOST, to identify which parts of the treatment package actually contribute to better outcomes after structured treatment. The study is framed as a treatment optimization effort rather than a simple yes-or-no comparison, which matters in a disorder where patients may benefit from some ingredients of care more than others.
Why the Post-Discharge Window Is the Focus
REACH+ centers on the six months after acute treatment, when patients have already reached weight restoration but remain medically and psychologically vulnerable. In anorexia nervosa, stabilization of weight does not erase the habits, fears, and reinforcement patterns that helped maintain starvation in the first place. A relapse-prevention approach aimed at habits makes mechanistic sense here: if maladaptive behaviors have become automatic, then recovery work must interrupt those routines before they harden again.
The study’s primary clinical emphasis is on maintenance of remission, measured by rate of weight loss and end-of-trial status. Those outcomes are practical because they speak directly to whether patients can hold on to the gains made during intensive treatment. In this setting, even modest deterioration can carry outsized clinical consequences.
A Telehealth Package Built to Fit Real-World Recovery
The intervention is behavioral and delivered over telehealth, with online psychoeducation and skill building layered onto the sessions. The plan calls for six months of REACH+ for 120 individuals, and participants will be randomly assigned to different versions of the treatment components. The study is open label and uses a factorial design, allowing investigators to examine how individual elements contribute to remission status.
A quiet but important feature of the design is its attention to access. Telehealth delivery lowers the logistical burden of ongoing psychotherapy after discharge, when travel, nutrition monitoring, and school or work demands can complicate care. The protocol also requires an internet-connected device with videoconferencing capability and residence in a state where the study therapist is licensed, conditions that are basic for remote treatment but still narrow the eligible pool.
The Components Being Tested Separately
REACH+ 2.0 is built around three core psychological elements and one food-monitoring variable. The therapy includes in-session eating experiments under the label Do, a component that directly tests feared behaviors rather than only discussing them. It also includes Accept, which teaches participants to mindfully accept unhelpful thoughts as passing mental phenomena rather than commands to obey.
The motivational component is split into two versions. One uses Values, in which patients identify personal motivators for recovery and explore aspects of identity beyond the eating disorder. The other uses Narrative, drawing on stories from people with lived experience through writing or podcasts to emphasize the long-term dangers of anorexia nervosa and the possibility of sustained recovery.
The fourth variable is food monitoring. Participants will be assigned to Long-Term Food Logs, Short-Term Food Logs, or No Food Logs. Long-term logging runs for the duration of treatment, while short-term logging is limited to the first six weeks. Food records are a familiar clinical tool, but they can also become burdensome or provoke resistance. Testing whether shorter monitoring is enough, or whether logs should be omitted entirely, gets at a core question in relapse prevention: how much self-monitoring is useful before it becomes noise.
The factorial design allows the research team to evaluate multiple combinations of these components across the same cohort. That structure is efficient, and in a disorder with complex maintenance mechanisms, efficiency matters because it can isolate which ingredients actually deserve a place in a final treatment package.
Eligibility Narrows to a Medically Stable Post-Treatment Group
The inclusion criteria are deliberately specific. Participants must have a DSM-5 diagnosis of anorexia nervosa or atypical anorexia nervosa, must have completed acute treatment with weight restoration, and must be medically stable. They also need a medical treatment provider who can be informed about their study participation.
Several exclusions reflect the realities of relapse-risk management. People with current substance use disorder or other co-occurring psychiatric diagnoses requiring specialized treatment are excluded, as are pregnant individuals, those at high risk of suicide, those with current serious medical illness, and anyone taking daily medications that affect weight. Participants cannot be seeking or engaging in additional psychotherapy outside the study, although support groups are allowed.
Adults from 18 to 65 years of age are eligible, and all sexes are accepted. Healthy volunteers are not included, which is expected in a treatment study focused on a defined psychiatric illness rather than prevention in the general population.
What the Optimization Approach Tries to Answer
The study is designed to do more than measure whether relapse prevention helps. It will evaluate which treatment components contribute to remission status as a main effect, while also considering effect sizes, treatment adherence, and end-of-treatment status. In practical terms, that means the investigators are trying to assemble a package that is not only effective but also usable.
The plan to obtain input from key end-users before future effectiveness research is a sensible bridge between trial design and clinical deployment. Patients and clinicians can judge whether a therapy is tolerable, understandable, and realistic in the weeks after discharge, when motivation may fluctuate and routine care is fragmented.
The estimated study start is December 2026, with primary completion and study completion both projected for June 30, 2030. REACH+ 2.0 is listed as interventional, randomized, and not applicable to phase-based drug development because it is a psychotherapy optimization study. The trial is sponsored by the New York State Psychiatric Institute and is linked to a National Institutes of Health grant.
One practical tension sits at the center of the protocol: the field still needs to learn which relapse-prevention ingredients are indispensable, and which are simply tradition. This study is built to sort them apart with enough precision to matter at the bedside, where the question is rarely whether recovery is possible and almost always how to keep it from unraveling after discharge.