Open Trial of Family-Based Treatment for Full and Partial Anorexia Nervosa in Adolescence: Evidence of Successful Dissemination
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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- "However, several preliminary studies are published that suggest that FT-B can be utilized in settings beyond those of the primary research (Couturier, Isserlin, & Lock, 2010; Le Grange, Binford, & Loeb, 2005; Loeb et al., 2007; Tukiewicz, Pinzon, Lock, & Fleitlich-Bilyk, 2010; Wallis, Rhodes, Kohn, & Madden, 2007). For example, Loeb et al. (2007) reported on a clinical case series of 20 patients treated in a university clinic finding low dropout (25%), end-oftreatment weight gain (from a mean of 82% ideal body weight at baseline to 94% at the end of treatment), two thirds achieving normal menstruation, and significantly improved scores on the EDE. Similarly, a study in Brazil of 11 adolescents who were treated in a teaching hospital by therapists who received a 2-day training using the FT-B manual (Tukiewicz et al., 2010) found that patients and families accepted FT-B (82%) and that most patients normalized their BMI and normalized their eating-related psychopathology during treatment. "
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ABSTRACT: Eating disorders are relatively common and serious disorders in adolescents. However, there are few controlled psychosocial intervention studies with this younger population. This review updates a previous Journal of Clinical Child and Adolescent Psychology review published in 2008. The recommendations in this review were developed after searching the literature including PubMed/Medline and employing the relevant medical subject headings. In addition, the bibliographies of book chapters and treatment guideline articles were reviewed; last, colleagues were asked for suggested additional source materials. Psychosocial treatments examined include family therapy, individual therapy, cognitive behavioral therapy, interpersonal psychotherapy, cognitive training, and dialectical behavior therapy. Using the most recent Journal of Clinical Child and Adolescent Psychology methodological review criteria, family treatment-behavior (FT-B) is the only well-established treatment for adolescents with anorexia nervosa. Family treatment-systemic and insight oriented individual psychotherapy are probably efficacious treatments for adolescents with anorexia nervosa. There are no well-established treatments for adolescents with bulimia nervosa, binge eating disorder, or avoidant restrictive food intake disorder. Possibly efficacious psychosocial treatments for adolescent bulimia nervosa include FT-B and supportive individual therapy. Internet-delivered cognitive behavioral therapy is a possibly efficacious treatment for binge eating disorder. Experimental treatments for adolescent eating disorders include enhanced cognitive behavioral therapy, dialectical behavioral therapy, cognitive training, and interpersonal psychotherapy. FT-B is the only well-established treatment for adolescent eating disorders. Additional research examining treatment for eating disorders in youth is warranted.
Available from: Andrew Wallis
- "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.
Available from: Cynthia Bulik
- "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.
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