Family-based Treatment For Anorexia Nervosa Research Articles

The use of effective treatments: The case of an adolescent girl with anorexia nervosa in the context of a conversion disorder

The use of empirically supported treatment (EST) has been shown to enhance treatment outcome. The purpose of this case study was to suggest that ESTs further encourage effective reconceptualisation and the ongoing delivery of effective treatment, especially in the case of complex or atypical presentations or response to treatment. This report describes the case of an adolescent girl who underwent Maudsley family-based treatment for anorexia nervosa (AN) for a period of 12 months. Atypical response lead to an understanding of her presentation as representing a primary conversion disorder, within which AN symptoms were conceptualised as another somatic conversion of emotional distress. The report details her clinical presentation and management over the course of her illness. The case offers an important opportunity to explore the central role of the use of ESTs in guiding effective treatment delivery.

Do the components of manualized family‐based treatment for anorexia nervosa predict weight gain?

Family-based treatment for anorexia nervosa (FBT) has demonstrated efficacy in the treatment of adolescents with anorexia nervosa (AN) in a number of randomized control trials (RCT). The aim of the current research was to determine whether adherence to the key components of the model as outlined in the treatment manual predict weight gain or dropout. The 59 participants were under 19 years and had AN for less than 3 years. Five core treatment objectives and working alliance were measured across 20 sessions of FBT. The core objectives of parents taking control, being united, not criticizing the patient and externalizing the illness predicted greater weight gain. Sibling support did not predict weight gain. The relationship between therapeutic alliance and weight gain was positive for mothers but negative for fathers. Dropout was predicted by low control and poor maternal-therapeutic alliance. The results of this study lend further support for the efficacy of the FBT, demonstrating that the principles guiding clinical practice are those which lead to weight gain. The finding that parental control is the central predictor of change can also support the development of augmentations to the model.

Family-Based Treatment for Adolescents With Anorexia Nervosa: A Dissemination Study

This open trial of Family-Based Treatment for Anorexia Nervosa was completed in order to assess the dissemination of this treatment, including effectiveness, fidelity, and acceptability. Fourteen adolescents with Anorexia Nervosa were recruited with mean age 14.0+1.5 years (range 12–17 years). Therapists were trained using a workshop, manual and weekly supervision. Sessions were videotaped and rated for treatment fidelity. Pre- and post- treatment assessments were compared. Weight was significantly increased by an average of 7.8 kg. Dietary restraint showed significant improvement, as did interoceptive deficits and maturity fears. Of the 9 participants who had secondary amenorrhea at baseline, 8 had regained menstrual function. Treatment fidelity was rated as at least considerable 72% of the time in phase I of the treatment. Adolescents and parents found the treatment to be acceptable. This preliminary investigation of the dissemination of Family-Based Treatment for adolescents with Anorexia Nervosa indicates that this treatment is effective not only for weight restoration, but also in improving some psychological symptoms including dietary restraint, interoceptive deficits, and maturity fears. In addition, this treatment was adopted with considerable fidelity and was acceptable to adolescents and parents.

The Maudsley Model of Family‐Based Treatment for Anorexia Nervosa: A Qualitative Evaluation of Parent‐to‐Parent Consultation

This article describes the qualitative analysis of a randomized control trial that explores the use of parent-to-parent consultations as an augmentation to the Maudsley model of family-based treatment for anorexia. Twenty families were randomized into two groups, 10 receiving standard treatment and 10 receiving an additional parent-to-parent consultation. Parents of all families were interviewed regarding their experience of treatment and transcripts were analyzed with the assistance of QSR N-Vivo. Parents described parent-to-parent consultations as an intense emotional experience that helped them to feel less alone, to feel empowered to progress, and to reflect on changes in family interactions. These results suggest that parent-to-parent consultations are seen as a useful augmentation to the Maudsley model of family-based treatment for anorexia nervosa.

Life-Threatening Food Refusal in Two Nine-Year-Old Girls: Re-Thinking the Maudsley Model

While there is growing evidence for the efficacy of the Maudsley model of family-based treatment for anorexia nervosa, little is known concerning the most effective treatment for pre-adolescents with Eating Disorders Not Otherwise Specified (EDNOS). The presentation of case studies of children with EDNOS is important. Large-scale studies are difficult due to low incidence and the application of homogenous manualized approaches may be unsuitable to the wide range of potential disorders. The aim of this article is to present two detailed case studies of children with food avoidant emotional disorder, both presenting with life threatening food refusal. A flexible and individualized approach to family therapy was taken, resulting in the resumption of eating in less than seven weeks and four months respectively.

‘Communities of concern’ in the family-based treatment of anorexia nervosa: towards a consensus in the Maudsley model

The Maudsley model of family-based treatment for anorexia nervosa, first developed in the mid-1980s, has been the subject of a number of randomized controlled trials over the past 20 years, each demonstrating its efficacy. In the past 5 years, the model has developed into two streams with the emergence of a multiple family therapy format in the United Kingdom and Europe and the consolidation of single family practice in the United States, including the publication of a treatment manual. While the benefits of multiple family therapy have not yet been experimentally demonstrated, its potential lies in the solidarity that can be promoted between families in their fight against the anorexia. In this paper, we will argue that the standard manualized version of the Maudsley model might also be augmented to incorporate strategies that introduce a role for a wider community, specifically by employing practices derived from a model of generic family therapy called narrative therapy. Copyright © 2005 John Wiley & Sons, Ltd and Eating Disorders Association.

Is manualized family‐based treatment for adolescent anorexia nervosa acceptable to patients? Patient satisfaction at the end of treatment

Patient satisfaction with treatment sheds light on the acceptability, disseminability and usefulness of treatments. This study aimed to assess the perspectives of families who completed treatment using a manual‐driven family‐based treatment for anorexia nervosa. We hypothesized that overall, manualized treatment would be viewed as acceptable and helpful, but that none the less, a proportion of patients would identify a wish for other types or additional therapy. A total of thirty‐four families participated in the survey. Results suggest that patients and families viewed the treatment as highly effective and acceptable. However, approximately a quarter suggested that individual therapy, more family therapy, and focusing on other issues besides anorexia nervosa would improve treatment. These data suggest that a manual‐driven family‐based treatment for adolescents with anorexia nervosa is acceptable to adolescents and their parents, though modifications to include additional therapy and individual therapy might be considered in some cases.