Open Trial of Family-Based Treatment for Full and Partial Anorexia Nervosa in Adolescence: Evidence of Successful Dissemination

Mount Sinai School of Medicine, New York, NY 10029, USA.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 6.35). 08/2007; 46(7):792-800. DOI: 10.1097/chi.0b013e318058a98e
Source: PubMed

ABSTRACT There is a paucity of evidence-based interventions for anorexia nervosa (AN). An innovative family-based treatment (FBT), developed at the Maudsley Hospital and recently put in manual form, has shown great promise for adolescents with AN. Unlike traditional treatment approaches, which promote sustained autonomy around food, FBT temporarily places the parents in charge of weight restoration. This aim of this open trial was to investigate the feasibility and effectiveness of delivering FBT at a site beyond the treatment's origin and manualization.
Twenty adolescents (ages 12-17) with AN or subthreshold AN were treated with up to 1 year of FBT using the published treatment manual. Outcome indices included the percentage of ideal body weight, menstrual status, the Eating Disorder Examination (EDE) subscales scores, and the Children's Depression Rating Scale-Revised score.
Of the 20 patients recruited, 15 (75%) completed a full course of treatment. Intent-to-treat analyses showed significant improvement over time in the percentage of ideal body weight (t = -4.46, p =.000), menstrual status (p =.002), EDE Restraint (z = -3.02, p =.003), EDE Eating Concern (z = -2.10, p =.04), but not in EDE Shape Concern or Weight Concern subscales or Children's Depression Rating Scale-Revised score.
This open trial provides evidence that FBT can be successfully disseminated, replicating the high retention rates and significant improvement in the psychopathology of adolescent AN seen at the original sites.

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    • "Finally, manualized MFBT appears to be effective and acceptable to 78% of patients and families (Krautter & Lock, 2004), and completion rates over 80% were reported in the large studies (Lock & Gowers, 2005; Lock et al., 2010). In addition to the trials mentioned earlier, dissemination of MFBT beyond the treatment development sites in the United States and the United Kingdom appears to be successful (Couturier, Isserlin, & Lock, 2010; Loeb et al., 2007; Paulson-Karlsson, Engstrom, & Nevonen, 2009; Wallis, Rhodes, Kohn, & Madden , 2007). "
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    ABSTRACT: Anorexia nervosa is a serious psychiatric disorder that usually occurs in adolescence. The course of the illness can be protracted. Current empirical evidence suggests that the Maudsley Family-Based Treatment (MFBT) is efficacious for adolescents. MFBT empowers parents as a crucial treatment resource to assist in their child's recovery. The authors review the diagnostic criteria and course of anorexia in adolescence, present empirical evidence and key theoretical concepts of MFBT, and provide a case study.
    Journal of counseling and development: JCD 07/2012; 90(3):339. DOI:10.1002/j.1556-6676.2012.00042.x · 0.62 Impact Factor
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    • "After an unfortunate history of blaming families and excluding families from the treatment of AN, there has been a 180 degree reversal in the role of family members in the treatment and recovery process. Family-based treatment (FBT) has shown considerable promise in treating younger AN patients (Couturier, Isserlin, & Lock, 2010; Doyle, Le Grange, Loeb, Doyle, & Crosby, 2010; Eisler et al., 2000; Eisler et al., 1997; I. Eisler, Simic, Russell, & Dare, 2007; Lock, 2002; Lock, Agras, Bryson, & Kraemer, 2005; Lock, Couturier, & Agras, 2006; Lock, Couturier, Bryson, & Agras, 2006; Lock, Le Grange, Agras, & Dare, 2001; Loeb et al., 2007; Paulson-Karlsson, Engström, & Nevonen, 2009; Russell, Szmukler, Dare, & Eisler, 1987), is acceptable by both patients and parents (Couturier, et al., 2010; Krautter & Lock, 2004), and therapeutic alliance is commonly rated as strong (Pereira, Lock, & Oggins, 2006). Family therapy techniques have been applied to samples of both adolescents and adults with AN (Crisp et al., 1991; Dare, Eisler, Russell, Treasure, & Dodge, 2001; Eisler, et al., 2000; Eisler, et al., 1997; Geist, Heinmaa, Stephens, Davis, & Katzman, 2000; Gowers, Norton, Halek, & Crisp, 1994; Robin, Siegel, Koepke, Moye, & Tice, 1994; Robin, Siegel, & Moye, 1995; Russell, et al., 1987). "
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    ABSTRACT: Anorexia nervosa is a serious mental illness that affects women and men of all ages. Despite the gravity of its chronic morbidity, risk of premature death, and societal burden, the evidence base for its treatment-especially in adults-is weak. Guided by the finding that family-based interventions confer benefit in the treatment of anorexia nervosa in adolescents, we developed a cognitive-behavioral couple-based intervention for adults with anorexia nervosa who are in committed relationships that engages both the patient and her/his partner in the treatment process. This article describes the theoretical rationale behind the development of Uniting Couples in the treatment of Anorexia nervosa (UCAN), practical considerations in delivering the intervention, and includes reflections from the developers on the challenges of working with couples in which one member suffers from anorexia nervosa. Finally, we discuss future applications of a couple-based approach to the treatment of adults with eating disorders.
    Journal of Cognitive Psychotherapy 02/2012; 26(1):19-33. DOI:10.1891/0889-8391.26.1.19
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    • "Data from RCTs of family therapy for eating disorders in adolescents reveal support for those with AN (Cottrell & Boston, 2002). The Maudsley approach (Eisler et al., 2000) has received the largest amount of empirical attention, including successful dissemination beyond the original investigators (Loeb et al., 2007) and reduced hospital readmission rates (Rhodes & Madden, 2005). It combines strategic and structural family therapy techniques along with practical guidance toward improving eating behaviors and promoting weight gain (Lock & Le Grange, 2005). "
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    ABSTRACT: Emotional and behavioral symptoms and disorders are prevalent in children and adolescents. There has been a burgeoning literature supporting evidence-based treatments for these disorders. Increasingly, family-based interventions have been gaining prominence and demonstrating effectiveness for myriad childhood and adolescent disorders. This article presents the current evidence in support of family-based interventions for mood, anxiety, attention-deficit hyperactivity, disruptive behavior, pervasive developmental particularly autism spectrum, and eating disorders. This review details recent data from randomized controlled trials (RCTs) and promising interventions not yet examined using a randomized controlled methodology. It highlights the evidence base supporting various specific family-based interventions, some of which are disorder dependent. A practitioner perspective is then offered with regard to recommendations for future practice and training. The article closes with a summary and directions for future research.
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