ReAttach is a transdiagnostic intervention for adults and children with mental health problems [1]. Eating Disorders involve overlapping symptomatology; therefore, a network approach influencing the underlying transdiagnostic factors would be appropriate [2]. ReAttach Affect Coaches strategically apply a network approach to treat multiple transdiagnostic factors. ReAttach, W.A.R.A. (Wiring Affect with ReAttach), and the New Mind Creation, key components of the Affect Coach intervention, are deployed in treating chronic and complex problems. This article discusses how Affect Coaches can use these techniques by describing the ReAttach Protocol for Eating Disorders.

Eating disorders are complex psychiatric conditions where severe disturbances in eating behavior, body image, and the regulation of weight are present. Eating disorders have different clinical presentations, such as anorexia nervosa or bulimia nervosa, and often overlap with other psychiatric symptoms, pathology such as anxiety, depression, trauma, and obsessive-compulsive disorders [3][4]. The transdiagnostic nature of eating disorders suggests that they share common underlying factors, such as negative affect, maladaptive coping strategies, and insecure attachment styles, which contribute to their development and persistence [2][1].

Recent research highlights the role of negative affect as a central transdiagnostic factor in eating disorders. Negative affect, which includes emotions such as guilt, shame, and body dissatisfaction, is strongly correlated with disordered eating behaviors [5][6]. For instance, individuals with anorexia nervosa often experience intense fear of weight gain and loss of control, leading to restrictive eating patterns. In contrast, those with bulimia nervosa may engage in binge-eating episodes followed by purging behaviors to alleviate feelings of guilt and shame [7]. Similarly, individuals with binge-eating disorder often report distress and loss of control during eating episodes, which can exacerbate feelings of shame and perpetuate the disorder [8].

Anxiety and stress-related behaviors are also prominent transdiagnostic factors in eating disorders. Studies have shown that anxiety is often present at the onset of eating disorders and is a significant predictor of disordered eating behaviors [9][8]. For example, adolescents with anorexia nervosa frequently exhibit heightened anxiety about their body shape and weight. This anxiety might lead to weight control and dieting [9]. Additionally, stress-related behaviors, such as emotional eating, are common in individuals with binge-eating disorder, where food is used as comfort food, managing negative emotions [8].

Maladaptive coping strategies, particularly early maladaptive schemas (EMS), play a crucial role in the development and maintenance of eating disorders. These maladaptive schemas are cognitive survival patterns often leading to dysfunctional behaviors such as food restriction, binge eating, and purging [10].

For example, individuals with eating disorders may use food-related behaviors to suppress or compensate for feelings of inadequacy, shame, or worthlessness, which are often rooted in early life experiences [11].

Insecure attachment styles are another critical transdiagnostic factor interfering in eating disorder complexity. Previous research suggests that patients with eating disorders often exhibit insecure attachment patterns, such as anxious or avoidant attachment, which can contribute to difficulties in emotional regulation and interpersonal relationships [12][13]. For instance, individuals with anorexia nervosa are more likely to exhibit anxious attachment styles, while those with bulimia nervosa tend to display preoccupied attachment patterns [12]. These attachment styles can exacerbate feelings of insecurity and contribute to disordered eating behaviors in a way to regain control or cope with emotional distress.

The systemic approach to treating eating disorders has gained increasing recognition in recent years. Family dynamics, particularly parental distress and involvement, significantly evoke the development and hinder the treatment of eating disorders [14][15]. Multi-family therapy, which involves both parents and the affected individual, is an effective adjunctive treatment for eating disorders, promoting positive changes in eating behaviors and family functioning [5]. Isserlin et al. (2024) reported the importance of a family-centered approach, including fathers' involvement, as crucial in achieving positive treatment outcomes [16].

Eating disorders are complex. Thus, a transdiagnostic intervention that addresses the underlying factors across these conditions is essential. The ReAttach Protocol integrates systemic and strategic interventions and offers a comprehensive framework for treating eating disorders. By targeting transdiagnostic factors such as negative affect, anxiety, maladaptive coping, and insecure attachment, the ReAttach Protocol provides a unified treatment approach that can be tailored to individual needs [1][17]. The ReAttach Protocol emphasizes the importance of family involvement, cognitive restructuring, and sensory integration, aligning with contemporary research highlighting the need for a holistic approach to treating eating disorders [14][5].

The ReAttach Protocol for Eating Disorders presents a new transdiagnostic approach addressing the complex and multifaceted nature of eating disorders. By integrating systemic and strategic interventions, the ReAttach Protocol offers a framework that targets the underlying transdiagnostic factors. The protocol’s emphasis on family involvement, cognitive restructuring, and sensory integration aligns with contemporary studies, highlighting the need for holistic approaches to treating eating disorders [14][5].

One of the key strengths of the ReAttach Protocol is its focus on transdiagnostic factors such as negative affect, anxiety, maladaptive coping, and insecure attachment. These factors are consistently identified across various eating disorders, including anorexia nervosa, bulimia nervosa, and binge-eating disorder [3][4]. By targeting these transdiagnostic factors, ReAttach Protocol provides a unified multi-family treatment strategy, which can be tailored to individual needs, making it a useful tool for clinicians.

The protocol’s use of W.A.R.A. (Wiring Affect with ReAttach) is particularly noteworthy. This technique rapidly reduces negative affect and has shown promise in helping patients manage food cravings, and adverse feelings of guilt or shame [17]. However, the authors acknowledge that W.A.R.A. alone is insufficient for long-term recovery [33]. Integrating cognitive bias modification and social cognitive training addresses this limitation by helping patients develop adaptive coping strategies and improve their self-awareness and executive functioning [11][20].

Another significant aspect of the ReAttach Protocol is its systemic approach, which involves the family in the treatment process. Research has consistently shown that family dynamics play a crucial role in the development and maintenance of eating disorders [28][15]. By empowering parents as co-regulators and by involving them in ReAttach sessions, the protocol addresses the patient’s symptoms and strengthens family functioning, which is critical for sustained recovery [16].

Another innovative aspect of the protocol is its focus on body identification rather than body positivity. By helping patients reconnect with their bodies and reduce the sense of alienation, the protocol addresses the core issue of body image distortion, which is a common feature across eating disorders [34].

ReAttach's hypothesis on body-identification aligns with recent research emphasizing the importance of body neutrality and self-compassion in eating disorder recovery [35][36].

While the ReAttach Protocol offers a promising framework, some areas need further study. For instance, the protocol’s reliance on mirror neuron system activation and mentalizing system activation is based on emerging research, and more empirical studies are needed to validate its efficacy in the context of eating disorders [31]. Additionally, it is important to further thoroughly assess the protocol’s applicability to diverse populations, including neurodiverse individuals and those with comorbid psychiatric conditions [23].

In conclusion, the ReAttach Protocol for Eating Disorders is of clinical importance as a guideline for ReAttach Specialists and Affect Coaches, working with patients with these complex conditions. By addressing main transdiagnostic factors, while involving families, and integrating innovative techniques such as W.A.R.A., the M.I.S.T. and Cognitive Bias Modification, and New Mind Creation, the protocol offers a comprehensive and adaptable brief therapy to eating disorders.

Future research should focus on validating the efficacy of this ReAttach Protocol across diverse populations and exploring its long-term outcomes.

Eating disorders are among the most complex and challenging psychiatric conditions, characterized by a profound disruption in eating behaviors, body image, and emotional regulation. The transdiagnostic nature of these disorders—rooted in shared factors such as negative affect, anxiety, maladaptive coping, and insecure attachment—underscores the need for a comprehensive and flexible treatment approach. The ReAttach Protocol emerges as a promising intervention, offering a holistic framework that addresses these underlying mechanisms while integrating systemic, cognitive, and sensory-based strategies.

One of the most compelling aspects of the ReAttach Protocol is its systemic approach, which recognizes the critical role of family dynamics in developing and treating eating disorders. By involving parents as co-regulators and empowering them to support their loved ones, the protocol not only addresses the individual’s symptoms but also strengthens family functioning—a key factor in achieving sustained recovery [14][5]. This emphasis on family involvement is particularly relevant given the growing evidence that parental distress and attachment styles significantly influence the course of these disorders [16][12].

The protocol’s innovative techniques, such as W.A.R.A. and Cognitive Bias Modification, provide patients with practical tools to manage negative emotions, reframe distorted thought patterns, and rebuild a healthier relationship with food and their bodies. These interventions are particularly effective in addressing the core issues of body image distortion and emotional dysregulation, which are central to eating disorders [17][34]. Moreover, the focus on body identification rather than body positivity offers a nuanced approach to helping patients reconnect with their bodies and reduce feelings of alienation—a critical step in the recovery process.

However, while the ReAttach Protocol shows great promise, some areas warrant further exploration. For instance, more research is needed to validate its efficacy across diverse populations, including neurodiverse individuals and those with comorbid psychiatric conditions [23]. Additionally, long-term studies are essential to assess the sustainability of outcomes and their impact on patients' and their families' quality of life. As the field of eating disorder treatment continues to evolve, interventions like ReAttach remind us of the importance of addressing not just the symptoms, but the whole person—mind, body, and environment.

In conclusion, the ReAttach Protocol represents a significant advancement in the treatment of eating disorders. By combining cutting-edge techniques with a compassionate, systemic approach, it offers hope to those struggling with these debilitating conditions. As clinicians, researchers, and caregivers, we must continue to innovate and collaborate, ensuring that each individual has access to the care they need to heal and thrive. The journey to recovery is not easy, but with interventions like ReAtach, we are one step closer to understanding and overcoming the complexities of eating disorders.