Adherence to Family-Based Treatment (FBT) in Studies of Youth with Anorexia Nervosa: A Critical Review of the Literature

Abstract

Objectives: Family-Based Treatment (FBT) is a manualised out-patient approach delivered by trained clinicians. FBT is recommended as first-line treatment for anorexia nervosa (AN) in youth. As FBT moves from specialist centers to the community setting, clinician drift may contribute to variations in delivery of the treatment and subsequently outcome. The aim of this research, in the context of the development of national FBT training in Ireland, was to systematically review FBT-effectiveness literature, and to determine based on details in articles published if the reader can ascertain the extent of FBT treatment adherence and key components of treatment success. For the purpose of this paper, reporting on FBT adherence rather than fidelity is reviewed. Methods: 320 papers were screened and 15 papers reporting on FBT outcome in AN were included in the final analysis. Results: Evidence such as shorter duration of illness, fewer hospital admissions and better cost effectiveness compared to some other therapies support FBT as an evidenced based and effective intervention in youth with AN. General principles of FBT were given in most papers as were important details on therapist expertise and supervision. However, specific details measuring therapist adherence to the core aspects of FBT treatment were absent from most of the written articles, making it impossible to establish the impact of manual deviation on outcome. Conclusion: Examining associations between treatment adherence and therapeutic outcome is essential to ensure optimal training and delivery of FBT for youth with AN, especially as treatment becomes disseminated to varied settings.