A Comparison of Short- and Long-Term Family Therapy for Adolescent Anorexia Nervosa

Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA 94305, USA.
Journal of the American Academy of Child & Adolescent Psychiatry (Impact Factor: 7.26). 08/2005; 44(7):632-9. DOI: 10.1097/01.chi.0000161647.82775.0a
Source: PubMed


Research suggests that family treatment for adolescents with anorexia nervosa may be effective. This study was designed to determine the optimal length of such family therapy.
Eighty-six adolescents (12-18 years of age) diagnosed with anorexia nervosa were allocated at random to either a short-term (10 sessions over 6 months) or long-term treatment (20 sessions over 12 months) and evaluated at the end of 1 year using the Eating Disorder Examination (EDE) between 1999 and 2002.
Although adequately powered to detect differences between treatment groups, an intent-to-treat analysis found no significant differences between the short-term and long-term treatment groups. Although a nonsignificant finding does not prove the null hypothesis, in no instance does the confidence interval on the effect size on the difference between the groups approach a moderate .5 level. However, post hoc analyses suggest that subjects with severe eating-related obsessive-compulsive features or who come from nonintact families respond better to long-term treatment.
A short-term course of family therapy appears to be as effective as a long-term course for adolescents with short-duration anorexia nervosa. However, there is a suggestion that those with more severe eating-related obsessive-compulsive thinking and nonintact families benefit from longer treatment.

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    • "However, this also means that half of the adolescents treated with FBT achieve a suboptimal outcome. Given the medical complications, potential long-ranging effects of starvation on development, and the impact of AN on the family (Le Grange & Lock, 2005), it is critical that alternative treatments be developed so that families have options should FBT not be available or not be well-matched to a particular child or family. Newer conceptualizations of eating disorders have proposed that treatment may be expedited by focusing on maintaining factors of AN symptomatology, such as negative and positive reinforcement of restrictive eating (Corstorphine, 2006; Fairburn, Cooper, & Shafran, 2003; Schmidt & Treasure, 2006; Treasure & Schmidt, 2013; Treasure, Tchanturia, & Schmidt, 2005). "
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    ABSTRACT: Family based-treatments have the most empirical support in the treatment of adolescent anorexia nervosa; yet, a significant percentage of adolescents and their families do not respond to manualized family based treatment (FBT). The aim of this open trial was to conduct a preliminary evaluation of an innovative family-based approach to the treatment of anorexia: Acceptance-based Separated Family Treatment (ASFT). Treatment was grounded in Acceptance and Commitment Therapy (ACT), delivered in a separated format, and included an ACT-informed skills program. Adolescents (ages 12-18) with anorexia or sub-threshold anorexia and their families received 20 treatment sessions over 24 weeks. Outcome indices included eating disorder symptomatology reported by the parent and adolescent, percentage of expected body weight achieved, and changes in psychological acceptance/avoidance. Half of the adolescents (48.0%) met criteria for full remission at the end of treatment, 29.8% met criteria for partial remission, and 21.3% did not improve. Overall, adolescents had a significant reduction in eating disorder symptoms and reached expected body weight. Treatment resulted in changes in psychological acceptance in the expected direction for both parents and adolescents. This open trial provides preliminary evidence for the feasibility, acceptability, and efficacy of ASFT for adolescents with anorexia. Directions for future research are discussed. Copyright © 2015. Published by Elsevier Ltd.
    Behaviour Research and Therapy 03/2015; 69. DOI:10.1016/j.brat.2015.03.011 · 3.85 Impact Factor
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    • "d more diverse diet would be beneficial is illustrated by figures on fruit and vegetable consumption in sub - Saharan Africa , where consumption is on average low with mean daily intake , respectively , of between 36 g and 123 g in surveyed East African countries ; 70 g and 130 g in Southern Africa ; and 90 g and 110 g in West and Central Africa ( Lock et al . , 2005 ; Ruel et al . , 2005 ) . These figures add up to considerably less than the international recommendation of 400 g in total per day to reduce micronutrient deficiencies and chronic disease ( Boeing et al . , 2012 ; FAO , 2012 ; WHO , 2004 ; see also Siegel et al . , 2014 ) . In response , initiatives are underway to bring " wild " foods"

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    • "Another study that compared two types of treatments found that family treatment was superior to individual treatment with respect to weight restoration, but both treatments were equivalent with respect to improvements in eating attitudes, depressive symptoms, ego functioning, and family conflict around eating (Robin et al., 1999). Finally, although some studies report mean improvements in psychological symptoms, a statistical comparison of the two means is not provided (Lock et al., 2005). This leaves some doubts as to the efficacy of current treatments to impact psychological recovery, and to understand whether such recovery is secondary to weight gain. "
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    ABSTRACT: The main aims of this study were to describe change in psychological outcomes for adolescents with anorexia nervosa across two treatments, and to explore predictors of change, including baseline demographic and clinical characteristics, as well as weight gain over time. Participants were 121 adolescents with anorexia nervosa from a two-site (Chicago and Stanford) randomized controlled trial who received either family-based treatment or individual adolescent supportive psychotherapy. Psychological symptoms (i.e., eating disorder psychopathology, depressive symptoms, and self-esteem) were assessed at baseline, end of treatment, 6-month, and 12-month follow-up. Conditional multilevel growth models were used to test for predictors of slope for each outcome. Most psychological symptoms improved significantly from baseline to 12 month follow-up, regardless of treatment type. Depressive symptoms and dietary restraint were most improved, weight and shape concerns were least improved, and self-esteem was not at all improved. Weight gain emerged as a significant predictor of improved eating disorder pathology, with earlier weight gain having a greater impact on symptom improvement than later weight gain. Adolescents who presented with more severe, complex, and enduring clinical presentations (i.e., longer duration of illness, greater eating disorder pathology, binge-eating/purging subtype) also appeared to benefit more psychologically from treatment.
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