Abstract
Comparing evidence-based psychotherapy (EBP) to usual care typically demonstrates the superiority of EBPs, although this has not been studied for eating disorders EBPs such as family-based treatment (FBT). The current study set out to examine weight outcomes for adolescents with anorexia nervosa who received FBT through a randomized clinical research trial (RCT, n = 54) or non-research specialty care (n = 56) at the same specialist pediatric eating disorder service. Weight was recorded throughout outpatient treatment (up to 18 sessions over 6 months), as well as at 6- and 12-month follow-up. Survival curves were used to examine time to weight restoration [greater than 95% median body mass index (mBMI)] as predicted by type of care (RCT vs. non-research specialty care), baseline clinical and demographic characteristics, and their potential interaction. Results did not indicate a significant main effect for type of care, but there was a significant effect for baseline weight (p = .03), such that weight restoration was achieved faster across both treatment types for those with a higher initial %mBMI. These data suggest that weight restoration achieved in non-research specialty care FBT was largely similar to that achieved in a controlled research trial.Clinical Trial Registrationhttp://www.anzctr.org.au/, identifier ACTRN12610000216011.
Highlights
Anorexia nervosa (AN) is a pernicious psychiatric illness with significant morbidity and mortality rates [1], considerable distress and impairment [2], and high treatment costs [3]
Weight data missing at week 4 was only evident for those in Non-Research Care [n = 4 (3.6%)]; at week 12, missing weight data were comparable for both groups [n = 6 (5.5%) randomized clinical trials (RCTs) and n = 7 (6.4%) Non-Research Care]
Those with missing weight data resulting from early treatment termination were older (15.6 vs. 14.7 years, t = −2.48 p = .02), had lower initial weights (79.3 vs. 84.3%median body mass index (mBMI), t = 4.19, p < .001), and has longer duration of illness (10.1 vs. 7.5 months, t = −2.44, p = .02)
Summary
Anorexia nervosa (AN) is a pernicious psychiatric illness with significant morbidity and mortality rates [1], considerable distress and impairment [2], and high treatment costs [3]. The most efficacious EBP for adolescents with AN is family-based treatment (FBT), a manualized intervention that emphasizes the role of parental support in facilitating their child’s recovery from AN [8]. An FBT approach consists of an average of 6–12 months of therapeutic intervention; the treatment includes three phases, whereby it is initially symptom focused, with parents providing meal support and prevention of compensatory behaviors with a primary goal of weight restoration. FBT differs considerably from other approaches such as individual therapy and inpatient management, in that parents are instrumentally involved in their child’s weight restoration, and resumption of appropriate eating and exercise behavior. Research on provider attitudes towards the use of EBPs for eating disorders suggests that there are several barriers to using manualized treatments [12]. Therapists who implement FBT often make significant modifications to treatment delivery [17], and in so doing, may unintentionally compromise the effectiveness of treatment
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