Reclaiming Agency and Retuning Reward: Protocol for a Mixed-Methods Study on an Integrated Model of Empowered Recovery in Eating Disorders

Background: Eating disorder (ED) recovery is challenging, with high relapse rates and frequent treatment dissatisfaction. While standard treatments address symptoms, they may not adequately target underlying issues like diminished psychological agency, reward dysfunction (anhedonia), trauma impacts, and cultural influences. There is a need for integrated models that address these multifaceted components. This study protocol outlines research designed to investigate a novel "Empowered Recovery" framework, positing that fostering agency, particularly in dietary and physical activity choices within a trauma-informed and culturally sensitive context, is linked to reduced anhedonia and improved, sustainable well-being. Methods: This study will employ a cross-sectional, mixed-methods design. Adults (18+) currently in or within 5 years postED treatment will be recruited internationally via online platforms and advocacy organizations. Data collection will involve secure online surveys assessing demographics, ED/treatment history, trauma history (e.g., PC-PTSD-5), perceived agency in diet/activity, ED symptoms (e.g., EDE-Q 12), depression (PHQ-9), anxiety (GAD-7), anhedonia (e.g., SHAPS), well-being (e.g., WHO-5), interoceptive awareness (e.g., MAIA subscale), and perceived empowerment (e.g., HES). Semi-structured qualitative interviews (~15-20 participants) will explore experiences of agency, reward, trauma, and culture in depth. Quantitative data will be analyzed using descriptive statistics, correlations, and regression analyses. Qualitative data will undergo thematic analysis. Findings will be integrated to provide a comprehensive understanding of the relationships between agency, reward, context, and recovery. Discussion: This study is expected to provide empirical support for the "Empowered Recovery" framework, potentially identifying agency as a key mechanism influencing motivation and reward-related experiences in ED recovery. Findings could inform clinical practice by highlighting the therapeutic potential of prioritizing patient autonomy, trauma-informed care, and cultural sensitivity. It may also encourage a broader definition of recovery beyond symptom reduction. Potential challenges include online recruitment biases and reliance on self-report measures. Registration: This study protocol was preregistered on OSF Registries (DOI: https://doi.org/10.17605/OSF.IO/VZCNF) on May 1, 2025, registration pending final approval.