Abstract
Community-based clinicians who treat patients with eating disorders rarely use empirically-supported treatments, and research demonstrates that clinicians make significant modifications when implementing family-based treatment (FBT) for anorexia nervosa. This study examined clinician attitudes toward FBT and explored the extent to which attitudes predicted intent to shift practices following training in FBT. Clinicians (N = 129) completed a standardized training in FBT for AN, either a two-day introductory training (n = 99) or a one-day “advanced” training (n = 30). Linear regressions were used to examine the association between therapists’ attitudes toward FBT and their intent to use strategies consistent with FBT in the future, adjusting for pre-training use of strategies. Providers reported very positive attitudes toward evidence-based practices in general and moderately positive attitudes toward FBT. There were no significant differences between “novice” and “advanced” providers on attitudes toward evidence-based practices or FBT (ps > .10). For the subset of providers attending their first training in FBT, more positive attitudes toward FBT significantly predicted greater intent to use FBT-consistent strategies (p = .004), and more positive attitudes toward evidence-based practice significantly predicted lesser intent to use FBT-inconsistent strategies (p = .009). This study suggests that both general attitudes toward evidence-based practice and specific attitudes toward FBT may impact implementation. Future research might examine whether a brief intervention to improve attitudes toward FBT might increase the likelihood of seeking expert consultation post-training.
Highlights
Anorexia nervosa (AN) has severe medical and psychological consequences [1,2,3,4] and the highest mortality rate of any psychiatric disorder [5]
One study that coded for fidelity found that almost three-quarters of clinicians had at least considerable fidelity initially, but this decreased to about half of clinicians in the second and third phases of family-based treatment (FBT) [7]
This study found that providers who attend introductory or advanced workshops in FBT already report using various techniques that are consistent with FBT, and multiple techniques that are incompatible with FBT, some of which would require a significant shift in order to implement FBT
Summary
Anorexia nervosa (AN) has severe medical and psychological consequences [1,2,3,4] and the highest mortality rate of any psychiatric disorder [5]. Research supports family-based treatment (FBT) as an efficacious treatment for youth with AN [6], and initial studies generally support the effectiveness of FBT when disseminated to teaching hospitals [7, 8]. Community-based clinicians who treat patients with eating disorders rarely use empirically-supported treatments [9, 10], and the use of FBT in “usual care” is no exception. Clinicians who do utilize FBT often make significant modifications in its implementation [11] that may impact its effectiveness. One study that coded for fidelity found that almost three-quarters of clinicians had at least considerable fidelity initially, but this decreased to about half of clinicians in the second and third phases of FBT [7]. Understanding factors related to adoption and implementation is critical
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