Abstract
Family-based treatment (FBT) for anorexia nervosa (AN) is an empirically supported treatment for this disorder. Derived from several different schools of family therapy, it is a highly focused approach that initially targets weight restoration under parental management at home. However, the view that manualized FBT is solely a behavioral therapy directing parents to refeed their children AN with the single purpose of weight gain is a common but misleading over simplification of the therapy. Indeed, weight restoration is the main goal only in phase 1 of this 3-phase treatment. When practiced with fidelity and skill, FBT's broadest aim is to promote adolescent development without AN thoughts and behaviors interfering and disrupting these normal processes. Although weight restoration is a key starting point in FBT, the entire course of treatment takes into consideration the ongoing impact of starvation, cognitions, emotions, and behaviors on adolescent development. These factors associated with maintaining low weight are viewed in FBT as interfering with the adolescent being able to take up the tasks of adolescence and thus must be overcome before fully turning to those broader adolescent tasks. In addition, FBT recognizes that adolescence takes place in the context of family and community and respects the importance of learning in a home environment both for weight gain as well as related developmental tasks to have a lasting effect. Specifically, in this article we describe how the current FBT manualized approach addresses temperament/personality traits, emotional processing, cognitive content and process, social communication and connections, psychiatric comorbidity, and family factors. This report makes no claim to superiority of FBT compared to other therapies in addressing these broader concerns nor does it add interventions to augment the current manual to improve FBT.
Highlights
The view that manualized family-based treatment (FBT) is solely a behavioral therapy directing parents to refeed their children with anorexia nervosa (AN) with the single goal of weight gain is a common but misleading over simplification of the therapy [1]
Careful reading, accredited training, adequate supervision, and experience using manualized FBT would likely decrease concerns about how FBT helps with the full range of problems associated with adolescent AN
Future studies are needed to compare the relative benefits of FBT to other approaches [e.g., cognitive behavioral treatment (CBT)-E [50], Family Therapy-Anorexia Nervosa [84], Multi-Family Group Therapy [85], and Adolescent Focused Therapy [13]] on the broader psychopathology of AN
Summary
The view that manualized family-based treatment (FBT) is solely a behavioral therapy directing parents to refeed their children with anorexia nervosa (AN) with the single goal of weight gain is a common but misleading over simplification of the therapy [1]. Parents are not viewed as a necessary evil but rather the natural and best resource for helping their children with their problems as they navigate them during treatment In this sense, the other problems that are common in AN such as social anxieties, mood lability, and family conflicts are seen as part of the family work in FBT. Studies suggest that therapeutic alliance is good in FBT, despite the often difficult beginnings [18, 19] This increased rapport built carefully over phase 1 typically improves in phases 2 and 3 as trust develops that issues will be respectfully addressed with the family. Material gathered in these brief sessions are essential for addressing cognitive, emotional, social, and family processes more broadly as FBT proceeds
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