A comparison of short- and long-term family therapy for adolescent anorexia nervosa.
ABSTRACT 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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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.Behaviour Research and Therapy 05/2014; 56. DOI:10.1016/j.brat.2014.02.006
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ABSTRACT: Adolescent eating disorder symptoms, depression and anxiety, the impact of their symptoms on their parents, and parental self-efficacy were assessed before beginning family-based day hospital treatment, and at 3 and 6 months post-assessment. Parents' self-efficacy increased during the first 3 months of treatment, and their knowledge and confidence in their effectiveness against the eating disorder continued to increase between 3 and 6 months post-assessment. Adolescent eating disorder symptoms, depression and anxiety, and the impact of the symptoms on their parents decreased between 3 and 6 months post-assessment. The results suggest that family-based treatment can be adapted to day hospital programmes for adolescents. The results also provide preliminary support for a treatment duration of at least 6 months.Journal of Family Therapy 04/2013; 35:102. DOI:10.1111/j.1467-6427.2012.00618.x