Cognitive-behavioral Orientation Research Articles

Effect of Training on Beliefs About Exposure Therapy in Experienced Therapists

Exposure therapy is an effective psychotherapeutic intervention for anxiety disorders, obsessive-compulsive disorder, and acute or posttraumatic stress disorder. Despite its effectiveness, exposure therapy is underutilized in situations in which it could be beneficial for patients. Negative beliefs about exposure therapy in therapists may partly explain this. This study therefore investigated the effect of a one-day training in exposure therapy on beliefs about exposure therapy in 81 experienced therapists with mostly cognitive behavioral orientations. In addition, anxiety sensitivity and intolerance of uncertainty were tested as predictors of this effect. Results showed that a one-day training had a significant moderate positive effect on therapist beliefs about exposure therapy. The magnitude of this effect was not predicted by anxiety sensitivity or intolerance of uncertainty in therapists. Further research is needed that includes control conditions and longer posttest intervals, investigates the effect of exposure training in therapists with different theoretical orientations, and examines if changes in beliefs about exposure therapy mediate the effect of exposure training on actual therapist behaviors.

Playful sport design: A game changer?

The aim of this paper is twofold. First, the concept Playful Sport Design (PSD) is introduced, based on play and proactivity theories. PSD is defined as a proactive cognitive-behavioral orientation that makes athletes incorporate fun and self-oriented challenges into training sessions. Second, we develop and test an instrument to assess PSD. In phase 1 (N = 562), the PSD instrument is tested on its reliability, factorial validity, and construct validity. In phase 2 (N = 131), the test-retest reliability and predictive validity of the PSD instrument is considered. Additionally, the nomological network of PSD is expanded. In phase 3 (N = 212), the predictive validity of PSD is further assessed. As hypothesized, the results of factor analyses show that PSD is best represented by two dimensions: designing fun and designing competition. The psychometric properties of the scale were shown to be satisfactory. Providing evidence for convergent validity, PSD was positively related to playfulness, competitiveness, fantasy proneness, personal initiative, openness to experience, achievement striving, and fun seeking. Specifically, designing fun showed more robust relations with fun-focused personality traits, while designing competition showed stronger relations with competition-focused traits. Providing evidence for divergent validity, PSD did not share variance with negative affect, procrastination, and perfectionism. Finally, in support of predictive validity, athletes who playfully designed their training sessions reported better subjective and objective sports performance. Lay summary: We introduce the concept Playful Sport Design (PSD), which refers to athletes’ proactive addition of play elements to their sports training. We present a scale that reliably and validly measures PSD. Further, we show that PSD is positively associated with immersion in sports training and sports performance. IMPLICATIONS FOR PRACTICE Results of this paper could result in more awareness among adult athletes that play during sports training has beneficial sports outcomes. Athletes can use PSD to increase flow experiences during training sessions and enhance sports performance. The results of this paper open the door for practitioners to develop PSD interventions, through which athletes are taught how they can approach their training sessions in a more playful manner.

Playful work design: Conceptualization, measurement, and validity

In three different studies, we challenge the traditional view that work and play are mutually exclusive phenomena. We introduce the concept of playful work design – the proactive cognitive-behavioral orientation that employees engage in to incorporate play into their work activities to promote fun and challenge. In Study 1, we utilized expert-ratings and iterative exploratory factor analyses to develop an instrument that measures (1) designing fun and (2) designing competition. Additionally, Study 1 evidences the divergent and convergent validity of the subscales as well as their distinctiveness. Specifically, playful work design was indicative of proactivity as well as play, and designing fun especially correlated with ludic traits (i.e. traits focused on deriving fun; e.g. humor), whereas designing competition particularly correlated with agonistic traits (i.e. traits focused on deriving challenge; e.g. competitiveness). Study 2 cross-validated the two-factor structure, further investigated the nomological net of playful work design, and revealed that playful work design is distinct from job crafting. Finally, Study 3 examined the predictive and incremental validity of the playful work design instrument with self- and colleague-ratings two weeks apart. Taken together, the results suggest that the instrument may advance our understanding of play initiated by employees during work.

Therapist-level moderation of within- and between-therapist process-outcome associations.

Although higher quality patient-therapist alliance and more positive patient outcome expectation (OE) consistently predict symptomatic/functional improvement in psychotherapy, most research has failed to capture the nuance in these process-outcome relations by parsing them into within-therapist (i.e., differences between patients treated by the same therapist) and between-therapist (i.e., differences between therapists' average process/outcome ratings across all patients in their caseloads) components. Moreover, the few studies that have done so have produced mixed results, suggesting the possibility of systematic variability in these associations (i.e., moderators). One potential source of such variability could be providers themselves; that is, different therapists could use these processes to differing therapeutic benefit. This study tested the alliance- and OE-outcome associations at both the within- and between-therapist levels and explored therapist-level moderators of them. Data derived from 212 adult outpatients treated naturalistically by 42 psychotherapists as part of a randomized trial that compared different case-assignment methods. Patients completed measures of alliance, OE, and outcome repeatedly throughout treatment. Therapist characteristics were assessed at baseline. Multilevel structural equation models revealed that, at the between-therapist level, only higher alliance quality, but not more optimistic OE, was associated with greater caseload-level improvement. At the within-therapist level, only more optimistic OE, but not higher alliance quality, was associated with patient improvement. Finally, therapists' self-perceived alliance-fostering effectiveness and cognitive-behavioral orientation moderated the within- and between-therapist alliance-outcome associations, respectively. Results indicate that different therapists use common treatment processes to differing therapeutic benefit, which can inform more personalized clinical practices and trainings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Experience of a multi-component therapy group for patients with chronic pain

IntroductionChronic pain has an impact that goes beyond the physical plane and, over the years, it ends up deteriorating the emotional, working and social life of people who suffer it.ObjectivesSince we are working with patients who suffer a chronic pathology that cannot be cured, the objective of the group is to create a safe space in which these patients can feel understood, facilitating emotional expression and promoting an active attitude. Accepting pain and its limitations allows the person to regain their ordinary life.MethodsA multicomponent group therapy with a cognitive-behavioural orientation was carried out. The group was formed by 12 patients, all of them women with chronic pain. Eleven sessions were established on a weekly basis of one and a half hours of duration.ResultsIn each session a specific aspect was worked on, favouring the learning of techniques, tools and strategies of coping. A global approach was made, including behavioural, cognitive and emotional elements. At the end of the process, the patients reported benefits in their ability to manage anxiety and depression symptomatology, and they reflected a lower impact of pain in their daily life.ConclusionsGiven the complexity of the symptomatology in chronic pain, it is important to approach the treatment from a multidimensional perspective that envisages every component of pain in order to being able to give a response to the physical and psychosocial impact that it implies, favouring a better confrontation and adaptation.DisclosureNo significant relationships.

Il disturbo autistico ad alto funzionamento: criteri per un modello integrato

The autism studies show a greater degree of scientific evidence. They derive from Applied Behavioural Analysis (Aba) and Cognitive-Behavioural orientation. Gestalt therapy deals with autism recently. The concepts of Gestalt psychotherapy, including the concept of contact boundary, the principle of creative adaptation and the phenomenological perspective of the organism-environment field, are central to the characteristics of autism. These concepts are important, in particular for autism high functioning. Gestalt therapists deal with the value of spirituality in the treatment of people with autism. This is of strong scientific significance. Health includes, in fact, the physical, social, psychological and spiritual aspects as represented by OMS in the 2004 Promoting Mental Health document. The purpose of this work is to produce a contribution in the direction of comparison and integration. The aim is to lay the foundations for the creation of an integrated model for the treatment of high functioning autistic disorder. In order to implement this integration logic, based on the study of scientific data and my clinical experience, the active ingredients present in these three approaches will be identified (Aba, Cognitive-Behavioral Psychotherapy and Gestalt Psychotherapy). The development of a mix of active ingredients allows to obtain a greater control of the possible limits and side effects present in each orientation. The next step is to conduct the assessment through these integration criteria. For this purpose, areas of intervention will be identified in which the examination of the specific characteristics will be described. Keywords Autism, intervention, integration Abstract in italiano Gli studi sull’autismo che mostrano un maggior grado di evidenza scientifica derivano dall’Applied Behavioral Analysis (Aba) e dall’orientamento Cognitivo-Comportamentale. La psicoterapia della Gestalt ha iniziato ad occuparsi di autismo recentemente. I concetti della psicoterapia della Gestalt, tra cui il concetto di confine di contatto, il principio di adattamento creativo e la prospettiva fenomenologica del campo organismo-ambiente, sono centrali per le caratteristiche dell’autismo e, in particolare, per la specificita dell’autismo ad alto funzionamento. Psicoterapeuti della Gestalt hanno, inoltre, evidenziato il valore della spiritualita nel trattamento delle persone con autismo. Cio e di forte pregnanza scientifica in quanto la salute comprende gli aspetti fisici, sociali, psicologici e spirituali come rappresentato dall’Oms nel documento Promoting Mental Health del 2004. La finalita di questo lavoro e produrre un contributo nella direzione del confronto e dell’integrazione. L’obiettivo e porre le basi per la costituzione di un modello integrato per il trattamento del disturbo autistico ad alto funzionamento. Al fine di attuare tale logica d’integrazione, sulla base dello studio dei dati scientifici e della mia esperienza clinica, saranno identificati i principi attivi presenti in questi tre approcci (Aba, psicoterapia Cognitivo-Comportamentale e psicoterapia della Gestalt). La messa a punto di un mix di principi attivi consente di ottenere un maggior controllo dei possibili limiti ed effetti collaterali presenti in ciascun orientamento. Il passo successivo e la conduzione dell’assessment mediante questi criteri d’integrazione. A tale scopo, saranno individuate delle aree d’intervento in cui sara descritto l’esame delle specifiche caratteristiche. Parole chiave: autismo, intervento, integrazione

An Italian validation of the Comparative Psychotherapy Process Scale: Reliability and validity.

The Comparative Psychotherapy Process Scale (CPPS) is an instrument designed to measure therapist interventions in a psychotherapy session. The scale includes 20 items divided into two subscales: the PI (psychodynamic-interpersonal) scale, which describes psychodynamic-interpersonal techniques; and the CB (cognitive-behavioural) scale, which includes cognitive-behavioural interventions. The aim of the study was to examine the psychometric properties of the CPPS, comparing the PI and CB subscales with the psychodynamic, cognitive and STTP prototypes, as described by the Psychotherapy Process Q-set(PQS). The sample comprised 94 sessions (N = 94) of psychodynamic and cognitive-behavioural orientation. Two groups of independent raters with excellent interrater reliability (ICC = .78) evaluated the sessions. The results suggest that the CPPS is a valid and reliable instrument that provides a clinically sensitive and psychometrically robust evaluation of a therapist's techniques. The clinical and research implications of the results are discussed.

Temporal Personality of Psychology Students According to their Preference for a Theoretical Orientation

The choice of a theoretical orientation often starts early during studies in psychology, and may guide the entire work of clinical psychologists. The aim of this study is to unveil associations between the temporal personality of university students in psychology, their personality traits and their preferences for each of the four main theoretical orientations recognized by the Ordre des Psychologues du Québec [Professional Order of Psychologists of Quebec]: psychodynamic-analytic, cognitive-behavioural, existential-humanistic and systemic-interactional. One hundred and twenty-nine students in psychology completed three online questionnaires assessing temporal personality, personality traits and theoretical orientation. Canonical correlations reveal that there are significant correlations between personality traits, temporal personality and preference for a theoretical orientation. More specifically, a preference for the existential-humanistic and systemic-interactional orientations is associated with weaker tendencies on the following temporal features: proximity of the results, consciousness of time on vacation and planning at home. Also, a preference for the cognitive-behavioural orientation is associated with stronger planning skills, time awareness and a propensity for conscientiousness. Those findings invite further investigations to better clarify the relations between time, theoretical orientation and personality.

Cognitive-Behavioural group interventions and Multifamily Psychoanalysis group in a Psychiatric Ward

This paper aims to study, evaluate and compare the effectiveness of two group interventions within a Psychiatric Intensive Care Unit (PICU). The outcome indicators of the satisfaction of patients and their families with the ward were evaluated with a Satisfaction Questionnaire on the department, and their satisfaction with the groups were evaluated with the Satisfaction Questionnaire for the groups. The two theoretical orientations examined are the cognitive-behavioural therapy, with group cognitive-behavioural intervention in the context of SPDC, and psychoanalysis, with multifamily psychoanalysis groups, according to the model of Jorge García Badaracco. The sample is composed of 83 users (42 males and 41 females) participating in the groups; 41 users (23 males and 18 females) not participating in the groups; 54 family members participating in the groups; 41 family members not participating in the groups. The results show an improvement of satisfaction with activities compared to the hospitalisation into the ward (p<.01), an improvement in the perception of the ward climate (p<.01) of the users participating in the groups, regardless of the orientation of reference, but it shows a greater effectiveness of groups with cognitive-behavioral group orientation (p<.001). The results indicate a greater effectiveness of the groups with cognitive-behavioural orientation, but confirm that psychotherapeutic groups in psychiatric contexts, even in emergency, not only seems to be well accepted and perceived positively by users and family members, but it also contributes to increasing satisfaction with the ward.

Cognitive Behavioral Orientation Group Intervention of Primary and Secondary School Teachers' Job Burnout Based on the perspective of Psychological Capital Development

Cognitive Behavioral Orientation Group Intervention of Primary and Secondary School Teachers' Job Burnout Based on the perspective of Psychological Capital Development

How do personal and professional characteristics influence the development of psychotherapists in training: Results from a longitudinal study.

This study examined the professional development of psychotherapy trainees over three years of training. The first objective was to investigate the long-term change of work involvement (Healing and Stressful Involvement) during psychotherapy training. The second objective was to investigate possible predictors of professional development from the areas of training context as well as professional and personal attributes of trainees. A total of 184 psychotherapy trainees with psychodynamic, psychoanalytic and cognitive behavioral orientation participated in the study. The development of work involvement was assessed over three years of training using the Work Involvement Scales. The set of possible predictors for work involvement included training context variables (training orientation, supervision), professional attributes of trainees (theoretical breadth, work satisfaction), and personal attributes of trainees (introject affiliation, attachment strategies, personality traits). Hierarchical Linear Modeling was conducted to investigate the change over time and the individual predictors of work involvement. Over three years of training Healing Involvement improved whereas Stressful Involvement did not change over time. Healing Involvement was mostly predicted by training context variables and professional attributes (therapeutic orientation, job satisfaction) as well as extraversion. Stressful Involvement was only predicted by personal attributes of trainees (age, neuroticism, conscientiousness, introject affiliation). The results imply two distinct sets of predictors for Healing and Stressful Involvement that will be discussed with regard to their implications for psychotherapy training and trainee selection.

Barriers to and Facilitators of Delivering Brief Tobacco and Alcohol Interventions in Integrated Primary Care Settings.

Tobacco and excessive alcohol use are 2 of the top 3 preventable causes of death in the United States, yet most patients using these substances do not pursue treatment. Most patients do visit their primary care provider (PCP) annually, but PCPs report that they are not very effective in addressing behavior change with patients. Brief interventions for alcohol and tobacco use are effective and can be delivered by behavioral health providers (BHPs) embedded in the primary care setting. However, BHPs do not report frequent use of these interventions. The aim of the current study was to conduct the first examination of barriers to and facilitators of implementing brief interventions for at-risk drinking and tobacco use among integrated BHPs. BHPs (N = 285) working in a primary care setting for at least 6 months with at least 10% effort allocated to clinical activities were recruited through professional listservs (August-September 2016) and completed an online survey that assessed barriers to and facilitators of delivering brief tobacco and alcohol interventions in routine clinical practice. BHPs were primarily psychologists (48%) and social workers (33%) with cognitive-behavioral orientation (51%). The primary barriers to addressing tobacco use and at-risk drinking reported by BHPs was the perception that patients did not want to discuss or did not want to change these behaviors. The primary facilitators of addressing tobacco use and at-risk drinking were patients identifying cessation or reduction as a treatment goal, positive provider-patient relationship, and receiving referrals specifically for tobacco or alcohol use. Clinicians, researchers, and administrators should focus on strategies to increase the regularity with which BHPs assess and provide intervention for smoking and alcohol use in the context of other primary presenting concerns.

Military cultural competence in the context of cognitive behavioural therapy

AbstractCurrent work in multicultural competency has emphasized factors such as race and ethnicity, age, disability status, socioeconomic status, sexual orientation and gender. For those clinicians who work with military and veteran populations, grounding in military cultural competence is also critical as a prerequisite for providing quality care. We believe that engaging these populations from a specifically cognitive behavioural orientation allows bridging of cultural gaps and that there is a natural alignment between cognitive behavioural therapy (CBT) and many aspects of warrior culture. This paper outlines several factors related to the values of military culture and strategies of the CBT therapist to better understand and use these values effectively in clinical practice, including lessons learned from an intensive outpatient program providing speciality care to veterans and military service members.

The Advantages and Disadvantages of Online and Blended Therapy: Survey Study Amongst Licensed Psychotherapists in Austria.

BackgroundWeb-based and blended (face-to-face plus Web-based) interventions for mental health disorders are gaining significance. However, many licensed psychotherapists still have guarded attitudes toward computer-assisted therapy, hindering dissemination efforts.ObjectiveThe objective of this study was to provide a therapist-oriented evaluation of Web-based and blended therapies and identify commonalities and differences in attitudes toward both formats. Furthermore, it aimed to test the impact of an information clip on expressed attitudes.MethodsIn total, 95 Austrian psychotherapists were contacted and surveyed via their listed occupational email address. An 8-minute information video was shown to half of the therapists before 19 advantages and 13 disadvantages had to be rated on a 6-point Likert scale.ResultsThe sample resembled all assessed properties of Austrian psychotherapists (age, theoretical orientation, and region). Therapists did not hold a uniform overall preference. Instead, perceived advantages of both interventions were rated as neutral (t94=1.89, P=.06; d=0.11), whereas Web-based interventions were associated with more disadvantages and risks (t94=9.86, P<.001; d=0.81). The information clip did not excerpt any detectable effect on therapists’ attitudes (r95=−.109, P=.30). The application of modern technologies in the own therapeutic practice and cognitive behavioral orientation were positively related to the given ratings.ConclusionsThis study is the first to directly compare therapists’ attitudes toward Web-based and blended therapies. Positive attitudes play a pivotal role in the dissemination of new technologies, but unexperienced therapists seem to lack knowledge on how to benefit from technology-aided treatments. To speed up implementation, these aspects need to be addressed in the development of new interventions. Furthermore, the preference of blended treatments over Web-based interventions seems to relate to avoidance of risks. Although this study is likely to represent therapists’ attitudes in countries with less advanced electronic health services, therapists’ attitudes in more advanced countries might present differently.

Psychotherapy from the Margins: How the Pressure to Adopt Evidence-Based-Treatments Conflicts with Social Justice-Oriented Practice

This article posits that the current interest in Empirically-Validated-Treatment (EVT) leads to a culture within psychology and counseling that presents cognitive-behavioral orientation (CBT) as the only legitimate approach to psychotherapy. This can be problematic not only because it narrows the scope of what is considered legitimate evidence of effectiveness, but also because CBT, like most Western approaches to psychotherapy, locates the origin of, and solution to, mental illness within the individual. On the other hand, social justice-oriented practice addresses how inequality, discrimination, oppression, and other societal-level forces contribute to mental illness at the individual level. Using a case example as an anchor for the ideas presented, I discuss how narrow definitions of empirical evidence have been used to justify the marginalization of multiple theoretical orientations, which in turn has led to therapies that can reinforce the marginalization of disadvantaged clients. I argue that this trend within the fields of clinical and counseling psychology reflects a wider trend in the United States and other Western cultures of xenophobia and fear of globalization. Those privileged by hierarchies of power are motivated to find uniformity and the appearance of a superior, more “correct” way of being, and to then attempt to control the lives of people who do not fit this way of being. Complexity and diversity, on the other hand, are experienced as threatening and alienating. Within psychotherapy too, CBT provides an appearance of universality in treatment that can be very appealing, yet social justice advocates have been very skeptical of claims of universality. I conclude with a discussion of how the narrowing of theoretical approaches may harm the fields of clinical and counseling psychology, and psychotherapy clients. I discuss what psychologists and counselors can do to counter this trend by taking action in professional organizations, academia, and in the therapy room.

Effectiveness of Psychological and Educational Interventions to Prevent Depression in Primary Care: A Systematic Review and Meta-Analysis.

Although evidence exists for the efficacy of psychosocial interventions to prevent the onset of depression, little is known about its prevention in primary care. We aimed to evaluate the effectiveness of psychological and educational interventions to prevent depression in primary care. We conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs) examining the effect of psychological and educational interventions to prevent depression in nondepressed primary care attendees. We searched MEDLINE, PsycINFO, Web of Science, OpenGrey Repository, Cochrane Central Register of Controlled Trials, and other sources up to May 2016. At least 2 reviewers independently evaluated the eligibility criteria, extracted data, and assessed the risk of bias. We calculated standardized mean differences (SMD) using random-effects models. We selected 14 studies (7,365 patients) that met the inclusion criteria, 13 of which were valid to perform a meta-analysis. Most of the interventions had a cognitive-behavioral orientation, and in only 4 RCTs were the intervention clinicians primary care staff. The pooled SMD was -0.163 (95%CI, -0.256 to -0.070; P = .001). The risk of bias and the heterogeneity (I2 = 20.6%) were low, and there was no evidence of publication bias. Meta-regression detected no association between SMD and follow-up times or SMD and risk of bias. Subgroup analysis suggested greater effectiveness when the RCTs used care as usual as the comparator compared with those using placebo. Psychological and educational interventions to prevent depression had a modest though statistically significant preventive effect in primary care. Further RCTs using placebo or active comparators are needed.

Effectiveness of a Group Intervention Program for Female Victims of Intimate Partner Violence

Group intervention has been widely used with female victims of intimate partner violence (IPV). However, efficacy studies are scarce due to several research limitations. This study evaluates the effectiveness of an 8-week group intervention program, with a cognitive-behavioral orientation and attended by 23 female victims of IPV. Self-report psychological assessment was conducted at pre-test, post-test, and follow-up. Results revealed that the group intervention had a positive impact on participants, showing a decrease in re-victimization and in beliefs toward legitimizing IPV. A decrease in levels of depression and a significant improvement in general clinical symptoms were also evident. Self-esteem and social support were enhanced throughout group intervention. The changes were confirmed through follow-up after 3 months, suggesting that this group intervention has important effects on female victims. The implications of the findings for practice are also discussed.

Expanding My Perspective on the Case of Daniel

I appreciate the reflections on the case of Daniel from Dr. Jill Bresler (2016) and from Dr. Stephen Holland (2016) —two experienced clinicians well versed in moving between psychodynamic and cognitive-behavioral orientations to more comprehensively meet the needs of their patients. Dr. Bresler’s response led me to think more about my development as a therapist and the process through which a psychoanalyst struggles to become more integrative. Dr. Holland’s response provided a helpful overview of additional cognitive techniques I might have used, but it also suggested that there may be limits to integrating certain aspects of different theories because of fundamental discrepancies.

Factor structure, reliability, and validity of the Therapist Response Questionnaire.

The aim of this study was to examine the stability of the factor structure and psychometric properties of the Therapist Response Questionnaire (Betan, Heim, Zittel Conklin, & Westen, 2005; Zittel Conklin & Westen, 2003), a clinician report instrument able to measure the clinician's emotional reactions to the patient in psychotherapy. A national sample of psychiatrists and clinical psychologists (N = 332) of psychodynamic and cognitive-behavioral orientation completed the Therapist Response Questionnaire, as well as the Shedler-Westen Assessment Procedure-200 (Westen & Shedler, 1999a, 1999b), to assess personality disorders and level of psychological functioning, regarding a patient currently in their care. They also administered the Symptom Checklist-90-Revised (Derogatis, 1994) to the patients. Exploratory and confirmatory factor analyses revealed 9 distinct countertransference factors that were similar to 8 dimensions identified in the original version of the measure: (a) helpless/inadequate, (b) overwhelmed/disorganized, (c) positive/satisfying, (d) hostile/angry, (e) criticized/devalued, (f) parental/protective, (g) special/overinvolved, (h) sexualized, and (i) disengaged. These scales showed excellent internal consistencies and good validity. They were especially able to capture the quality and intensity of emotional states that therapists experience while treating personality-disordered patients, as well as to better differentiate them; additionally, they tapped into the complexity of clinicians' reactions toward patients experiencing severe psychiatric symptomatology. Results seem to confirm that Therapist Response Questionnaire is a valid and reliable instrument that allows to evaluate patterns of countertransference responses in clinically sensitive and psychometrically robust ways, regardless of therapists' orientations. The clinical and research implications of these findings are addressed.

Two models of multiple family therapy in the treatment of adolescent anorexia nervosa: a systematic review.

Multiple family therapy (MFT) is a therapeutic method that brings together several families affected by the same pathology. Although from an ideological and conceptual point of view, MFT is often linked to family therapy and group therapy, it is difficult to define it with precision, a weakness which may in turn hinder research on therapeutic effectiveness. This is most notable in the field of eating disorders (ED) where, in spite of MFT's great popularity, research evidence remains limited. Within the context of a systematic review of the literature on MFT in the treatment of anorexia nervosa, the purpose of this article is to provide a theoretical and clinical framework for describing two MFT models, in an attempt to explore their common and distinct concepts, principles, techniques, and factors of change. The first program is a day treatment adaptation of the Maudsley family-based MFT approach, developed in Belgium at the Therapeutic Centre for Adolescents suffering from Eating Disorders: it focuses on the management of ED symptoms, using a strong cognitive behavioral orientation. The second is an integrated systemic MFT outpatient and inpatient program carried out on the ED unit of a pediatric hospital in Paris, France: it emphasizes intra- and inter-family relationships within a systemic framework. Our effort to describe and compare these two models constitutes a first step toward determining the relative value of different models of MFT. Indeed, each model presents specific characteristics that may make it best suited for specific ED populations and/or types of families.