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Baudinet J, Eisler I, Roddy M, Turner J, Simic M, Schmidt U. Clinician perspectives on how change occurs in multi-family therapy for adolescent anorexia nervosa: a qualitative study. J Eat Disord 2024; 12:103. [PMID: 39049063 PMCID: PMC11267764 DOI: 10.1186/s40337-024-01064-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 07/15/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Multi-family Therapy (MFT) is being increasingly used in specialist eating disorder services internationally. Despite evidence of its efficacy, little is understood about the treatment mechanisms and what specifically promotes change. This study aimed to understand clinician perspectives on how change occurs during MFT. METHODS Clinicians with (a) 5 or more years' experience facilitating MFT and (b) who had facilitated a minimum of two MFT groups were eligible for this study. Two individual interviews and four semi-structured focus groups were conducted online. Recordings were transcribed verbatim and analysed using reflexive thematic analysis. RESULTS Twelve clinicians (five systemic/family psychotherapists, five clinical psychologists, and two consultant child and adolescent psychiatrists) from six different specialist services in the UK participated. Four main inter-connected themes describing how change is perceived to occur were generated; (1) Intensity and immediacy, (2) Flexibility, (3) New ideas and channels of learning and (4) Containment. CONCLUSIONS Current data matches closely with young person and parent experiences of MFT and intensive day treatment and how they perceive change to occur. Quantitative data are now needed to evaluate the impact of these factors on outcome. Plain English Summary Multi-family Therapy (MFT) is being increasingly used in specialist eating disorder services internationally. While there is evidence that it is helpful, little is understood about how the treatment works and what specifically promotes change. This study aimed to understand how clinician believe change to occur during MFT for young people and their family members. Clinicians with (a) five or more years' experience facilitating MFT and (b) who had facilitated a minimum of two MFT groups were eligible for this study. Two individual interviews and four semi-structured focus groups were conducted online. Recordings were written out word-for-word and analysed using reflexive thematic analysis, a commonly used method for analysing this type of data. Twelve clinicians (five systemic/family psychotherapists, five clinical psychologists, and two consultant child and adolescent psychiatrists) from six different specialist services in the UK participated. Four related themes describing how change is perceived to occur were generated; (1) Intensity and immediacy, (2) Flexibility, (3) New ideas and channels of learning and (4) Containment. Current data matches closely with young person and parent experiences of MFT and intensive day treatment and how they perceive change to occur. These factors now need to be tested in future research.
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Affiliation(s)
- Julian Baudinet
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AZ, UK.
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
| | - Ivan Eisler
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AZ, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Michelle Roddy
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Jasmin Turner
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AZ, UK
- Adult Eating Disorders Service, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
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Baudinet J, Eisler I. Multi-family Therapy for Eating Disorders Across the Lifespan. Curr Psychiatry Rep 2024; 26:323-329. [PMID: 38709444 PMCID: PMC11147926 DOI: 10.1007/s11920-024-01504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE OF REVIEW This review aims to report on recent evidence for multi-family therapy for eating disorders (MFT) across the lifespan. It is a narrative update of recent systematic, scoping and meta-analytic reviews. RECENT FINDINGS There has been a recent increase in published theoretical, quantitative and qualitative reports on MFT in the past few years. Recent and emerging data continues to confirm MFT can support eating disorder symptom improvement and weight gain, for those who may need to, for people across the lifespan. It has also been associated with improved comorbid psychiatric symptoms, self-esteem and quality of life. Data are also emerging regarding possible predictors, moderators and mediators of MFT outcomes, as well as qualitative data on perceived change processes. These data suggest families with fewer positive caregiving experiences at the start of treatment may particularly benefit from the MFT context. Additionally, early change in family functioning within MFT may lead to improved outcomes at end of treatment. MFT is a useful adjunctive treatment across the lifespan for people with eating disorders. It helps to promote change in eating disorder and related difficulties. It has also been shown to support and promote broader family and caregiver functioning.
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Affiliation(s)
- Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK.
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
- Centre for Research in Eating and Weight Disorders (CREW), Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
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Funderud I, Halvorsen I, Kvakland AL, Nilsen JV, Skjønhaug J, Stedal K, Rø Ø. Multifamily therapy for adolescent eating disorders: a study of the change in eating disorder symptoms from start of treatment to follow-up. J Eat Disord 2023; 11:92. [PMID: 37287009 DOI: 10.1186/s40337-023-00814-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND This study aimed to evaluate multifamily therapy (MFT) for adolescents with eating disorders (EDs) in a clinical setting, by presenting the outcome of families participating in this treatment at a specialist ED service. MFT was an adjunct to treatment at local mental health services. In particular, the study aimed to present the change in eating disorder symptoms and psychological distress from before to after treatment and at a 6 months follow-up. METHODS Participants were 207 adolescents receiving outpatient MFT (10 or 5 months) at Oslo University Hospital in Norway between 2009 and 2022. Adolescents had heterogeneous ED presentations, with a preponderance of anorexia nervosa (AN) and atypical AN. All participants completed pre- and post-treatment questionnaires [The eating disorder examination questionnaire (EDE-Q) and the strengths and difficulties questionnaire (SDQ)]. 142 adolescents additionally completed the same questionnaires at 6 months follow-up. Weight and height were measured at all time points. RESULTS Linear mixed model analyses showed that from start of treatment to follow-up, there was a significant increase in BMI percentile (p < 0.001) and a significant decrease in EDE-Q global score (p < 0.001) and SDQ total score (p < 0.001). CONCLUSIONS The study shows that adolescents with an eating disorder who received adjunct outpatient MFT in a real world clinical setting, experienced reductions in ED symptoms comparable to that found in a randomized controlled trial. TRIAL REGISTRATION The data used in this study was collected as part of routine clinical procedures for quality assurance and trial registration is therefore not required.
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Affiliation(s)
- Ingrid Funderud
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
| | - Inger Halvorsen
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anne-Lise Kvakland
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jan-Vegard Nilsen
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Jeanette Skjønhaug
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Zinser J, O’Donnell N, Hale L, Jones CJ. Multi-family therapy for eating disorders across the lifespan: A systematic review and meta-analysis. EUROPEAN EATING DISORDERS REVIEW 2022; 30:723-745. [PMID: 35730146 PMCID: PMC9796154 DOI: 10.1002/erv.2919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/30/2022] [Accepted: 04/21/2022] [Indexed: 01/01/2023]
Abstract
Eating disorders (EDs) have an estimated prevalence rate of 1%-5% across Europe. Effective adjunct interventions are needed to support the 20%-40% of families whose recovery requires additional support to first line approaches. This systematic review and meta-analysis aimed to establish whether multi-family therapy (MFT) improves the physical and psychological health of patients and family members. Searches were conducted in PsycINFO, MEDLINE, PubMed, EMBASE, CINAHL, and the Cochrane Library in March 2021. 15 studies (850 patients) met the inclusion criteria. Meta-analysis demonstrated MFT resulted in significant benefits in weight gain, ED symptoms, patients' and parents' depression symptoms, and parents' negative experiences of caregiving. However, significant improvements were only evident when comparisons were drawn before and after the intervention; these dissipated when MFT was compared to another intervention. There was no evidence MFT improves family functioning, positive aspects of caregiving, nor patient and parental anxiety. Intervention completion rates ranged from 86% to 100% indicating a high level of acceptability. Studies varied with regard to intervention length and structure, follow-up period, and outcome measures utilised; most were rated as moderate or weak in methodological quality. More rigorous and large scale randomised controlled trials are needed to fully assess the effectiveness of MFT.
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Affiliation(s)
| | | | - Lucy Hale
- School of PsychologyUniversity of SurreyGuildfordUK
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Van Huysse JL, Lock J, Le Grange D, Rienecke RD. Weight gain and parental self-efficacy in a family-based partial hospitalization program. J Eat Disord 2022; 10:116. [PMID: 35941708 PMCID: PMC9361508 DOI: 10.1186/s40337-022-00634-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family-based treatment (FBT) is an outpatient therapy, though FBT principles have been incorporated in higher levels of care (e.g., partial hospitalization programs, PHPs). It is unknown how participation in a family-based PHP impacts weight restoration and parental self-efficacy. METHODS Weight gain and parental self-efficacy were examined in 98 participants with anorexia nervosa or atypical anorexia nervosa during the first five weeks of participation in a family-based PHP. Maternal self-efficacy was assessed using the Parent versus Anorexia Scale. RESULTS Significant increases in weight, percent expected body weight (EBW), and maternal self-efficacy were observed, with large effect sizes. During the first five weeks of treatment, patients in the PHP gained an average of 4.5 kg, or 8.3% EBW. Maternal self-efficacy improved within two weeks of treatment. CONCLUSIONS Findings suggest that family-based PHPs may facilitate rapid weight restoration without decreasing parental self-efficacy. Randomized trials are needed to directly compare family-based PHPs to outpatient FBT and PHPs with alternate treatment approaches, including longer-term follow-up and cost-effectiveness modeling.
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Affiliation(s)
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA. .,Department of Psychiatry and Behavioral Neuroscience (Emeritus), The University of Chicago, Chicago, IL, USA.
| | - Renee D Rienecke
- Eating Recovery Center and Pathlight Mood and Anxiety Centers, Chicago, IL, USA.,Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
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6
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Family-Empowered Treatment in Higher Levels of Care for Adolescent Eating Disorders: The Role of the Dietitian. J Acad Nutr Diet 2022; 122:1825-1832. [PMID: 35738535 DOI: 10.1016/j.jand.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/27/2022] [Accepted: 06/14/2022] [Indexed: 11/21/2022]
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Bruett LD, Forsberg S, Accurso EC, Gorrell S, Hail L, Keyser J, Le Grange D, Huryk KM. Development of evidence-informed bridge programming to support an increased need for eating disorder services during the COVID-19 pandemic. J Eat Disord 2022; 10:71. [PMID: 35596216 PMCID: PMC9120343 DOI: 10.1186/s40337-022-00590-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
Over the course of the COVID-19 pandemic, rates of eating disorders have increased, further straining systems of care that were already overburdened. The current paper describes novel interventions, largely informed by Family-Based Treatment (FBT), that were implemented by a tertiary specialist adolescent eating disorders service. In response to the pandemic, programming was designed to bridge access to care while waiting for availability of evidence-based therapy. The Brief Psychology Consultation Clinic provides several sessions to patients and families, focused on psychoeducation and problem-solving informed by FBT and other evidence-based therapies. Two groups, the FBT Caregiver Workshop Series and FBT Caregiver Support Group, provide psychoeducation and support for caregivers of youth with eating disorders. Perceived strengths and benefits of these services, as well as barriers to implementation and future research directions are discussed.
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Affiliation(s)
- Lindsey D Bruett
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA.
| | - Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Lisa Hail
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Jessica Keyser
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA.,Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - Kathryn M Huryk
- Department of Psychiatry and Behavioral Sciences, UCSF Weill Institute for Neurosciences, University of California, San Francisco, 401 Parnassus Ave., San Francisco, CA, 94143, USA
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Stewart CS, Baudinet J, Munuve A, Bell A, Konstantellou A, Eisler I, Simic M. From efficacy to effectiveness: child and adolescent eating disorder treatments in the real world (Part 2): 7-year follow-up. J Eat Disord 2022; 10:14. [PMID: 35123587 PMCID: PMC8817149 DOI: 10.1186/s40337-022-00535-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 01/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Eating disorders are often characterised as disabling, chronic or relapsing conditions with high mortality rates. This study reports follow-up outcomes for patients seen at the Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), whose end of treatment outcomes are reported in a separate paper. METHODS Three-hundred-and-fifty-seven former patients, who received evidence-based treatment for an eating disorder as a child or adolescent in MCCAED between 2009 and 2014 were eligible to participate. Current contact information was available for 290, of whom 149 (51.4%) consented to follow-up. Participants were sent links to online questionnaires, with additional demographic information extracted from medical records. Descriptive analyses of key socioeconomic and health outcomes were performed on data collected. RESULTS Mean length of follow-up was 6 years 11 months. Ten (6.7%) participants reported a current diagnosis of an eating disorder at follow-up. The great majority reported no (63.8%) or minimal (26.8%) interference from eating disorder difficulties. More than half (53.6%) reported other mental health diagnoses with most reporting no (33.8%) or minimal (50.7%) interference from those difficulties. One third (33.3%) had sought help for an eating disorder and around 20% received prolonged/intensive treatment during the follow-up period. Approximately 70% had sought treatment for other mental health difficulties (mostly anxiety or depression) and 35.4% had substantial treatment. At follow-up more than half (55.5%) reported doing generally well, and around two-thirds reported general satisfaction with their social well-being (65%). The majority (62.7%) had a good outcome on the Morgan Russell criteria, which was consistent with low self-reported ratings on EDE-Q, and low impact of eating disorder or mental health symptoms on work and social engagement. Most of the former patients who had day and/or inpatient treatment as a part of their comprehensive integrated care at MCCAED did well at follow-up. CONCLUSIONS Young people seen in specialist eating disorder services do relatively well after discharge at longer-term follow-up especially regarding eating disorders but less favourably regarding other mental health difficulties. Few reported a diagnosable eating disorder, and the great majority went on to perform similarly to their peers in educational and vocational achievements.
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Affiliation(s)
- Catherine S Stewart
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Julian Baudinet
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Alfonce Munuve
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Antonia Bell
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Anna Konstantellou
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Ivan Eisler
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, Denmark Hill, London, SE5 8AF, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED), Maudsley Hospital, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
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9
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Giles EM, Cross AS, Matthews RV, Lacey JH. Disturbed families or families disturbed: a reconsideration. Eat Weight Disord 2022; 27:11-19. [PMID: 33721219 PMCID: PMC8860793 DOI: 10.1007/s40519-021-01160-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 01/25/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The relationship between anorexia nervosa (AN) and family disturbance has been a subject of debate since its first description. What began as a clear view of the pathologically disturbed family causing AN has become ever more complex over the decades. OBJECTIVE The aim of this review is to explore the literature to examine the changes and evolution of clinical opinion around family dysfunction and AN over the last 20 years. METHODS A narrative review of heterogeneous studies in peer-reviewed publications sourced from the major databases, including PubMed and ScienceDirect, to illuminate the topic of family distress and AN by highlighting the conflicting and complementary ways it has been studied. RESULTS This review has highlighted the complexity of the relationship between anorectic sufferers and their families. It has explored the literature about parental burden, emotions and cognitive mechanisms together with parental attitudes about weight and shape. It is clear that there is no consistent psycho-social pathology in families which has been shown to be causative. However, over the last twenty years, research has highlighted the distress and family dysfunction caused by having to look after an anoretic child with poor mentalisation skills, insecure attachment and emotion dysregulation. CONCLUSION The area has become clearer over the last 20 years; research suggests a bi-directional relationship between AN and family dysfunction, with difficult dynamics becoming entrenched within the family. This is best addressed, the consensus suggests, by specialist family therapy and carer skills interventions. Longitudinal research is needed to definitively answer the question with rigorous scientific certainty. EMB RATING Level V. LEVEL OF EVIDENCE Level I: Evidence obtained from: at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies. Level II: Evidence obtained from well-designed controlled trials without randomization. Level III: Evidence obtained from well-designed cohort or case-control analytic studies. Level IV: Evidence obtained from with multiple time series analysis such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence. Level V: Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
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Affiliation(s)
| | | | | | - J Hubert Lacey
- Schoen Clinic Newbridge, Birmingham, UK.
- St Georges, University of London, London, UK.
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10
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Baudinet J, Eisler I, Dawson L, Simic M, Schmidt U. Multi-family therapy for eating disorders: A systematic scoping review of the quantitative and qualitative findings. Int J Eat Disord 2021; 54:2095-2120. [PMID: 34672007 PMCID: PMC9298280 DOI: 10.1002/eat.23616] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVE This study reviewed the quantitative and qualitative evidence-base for multi-family therapy (MFT) for eating disorders regarding change in physical and psychological symptoms, broader individual and family factors, and the experience of treatment. METHOD A systematic scoping review was conducted. Four databases (PsycInfo, Medline, Embase, CENTRAL) and five grey literature databases were searched on 24th June 2021 for relevant peer-reviewed journal articles, book chapters, and dissertations. No beginning time-point was specified. Only papers that presented quantitative or qualitative data were included. No restrictions on age or diagnosis were imposed. Studies were first mapped by study design, participant age, and treatment setting, then narratively synthesized. RESULTS Outcomes for 714 people who received MFT across 27 studies (one mixed-method, 17 quantitative and nine qualitative) were synthesized. MFT is associated with improvements in eating disorder symptomatology and weight gain for those who are underweight. It is also associated with improvements in other individual and family factors including comorbidities, self-esteem, quality of life, and some aspects of the experience of caregiving, although these findings are more mixed. MFT is generally experienced as both helpful and challenging due to the content addressed and intensive group process. DISCUSSION MFT is associated with significant improvements in eating disorder symptoms across the lifespan and improvement in broader individual and family factors. The evidence base is small and studies are generally underpowered. Larger, higher-quality studies are needed, as is research investigating the unique contribution of MFT on outcomes, given it is typically an adjunctive treatment.
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Affiliation(s)
- Julian Baudinet
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN)King's College LondonLondonUK,Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED)South London and Maudsley NHS Foundation TrustLondonUK
| | - Ivan Eisler
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN)King's College LondonLondonUK,Maudsley Centre for Child and Adolescent Eating Disorders (MCCAED)South London and Maudsley NHS Foundation TrustLondonUK
| | - Lisa Dawson
- Eating Disorder ServiceWestmead Children's Hospital, Sydney Children's Hospital NetworkSydneyNew South WalesAustralia
| | - Mima Simic
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN)King's College LondonLondonUK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN)King's College LondonLondonUK,Adult Eating Disorders ServiceSouth London and Maudsley NHS Foundation Trust, De Crespigny ParkDenmark Hill, LondonUK
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11
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Forsberg S, Gorrell S, Accurso EC, Trainor C, Garber A, Buckelew S, Le Grange D. Family-based treatment for pediatric eating disorders: Evidence and guidance for delivering integrated interdisciplinary care. CHILDRENS HEALTH CARE 2021; 52:7-22. [PMID: 36619528 PMCID: PMC9817879 DOI: 10.1080/02739615.2021.1984240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Eating disorders (EDs) are complex psychiatric diagnoses requiring specialized care. Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa and is also efficacious for other EDs. This study describes practice changes due to the implementation of an integrated interdisciplinary FBT-aligned treatment program for EDs at a large tertiary care hospital in the United States. We examined the feasibility and acceptability of implementation, barriers to implementation, and impact on providers' roles over a one-year period. Practice changes came with shifts in roles, and were largely experienced as acceptable with good suitability. Barriers identified may inform future interdisciplinary implementation efforts.
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Affiliation(s)
- Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Erin C. Accurso
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
| | - Claire Trainor
- Department of Psychology, Drexel University, Philadelphia,
PA, USA
- Center for Weight Eating and Lifestyle Science (WELL
Center), Drexel University, Philadelphia, PA, USA
| | - Andrea Garber
- Department of Pediatrics, Division of Adolescent Medicine,
University of California, San Francisco, San Francisco, CA, USA
| | - Sara Buckelew
- Department of Pediatrics, Division of Adolescent Medicine,
University of California, San Francisco, San Francisco, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, UCSF
Weill Institute for Neurosciences, University of California, San Francisco, San
Francisco, CA, USA
- Department of Psychiatry & Behavioral Neuroscience, The
University of Chicago, Chicago, IL, USA (Emeritus)
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Knatz Peck S, Towne T, Wierenga CE, Hill L, Eisler I, Brown T, Han E, Miller M, Perry T, Kaye W. Temperament-based treatment for young adults with eating disorders: acceptability and initial efficacy of an intensive, multi-family, parent-involved treatment. J Eat Disord 2021; 9:110. [PMID: 34496951 PMCID: PMC8424819 DOI: 10.1186/s40337-021-00465-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 08/23/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Adult eating disorder treatments are hampered by lack of access and limited efficacy. This open-trial study evaluated the acceptability and preliminary efficacy of a novel intervention for adults with eating disorders delivered to young adults and parent-supports in an intensive, multi-family format (Young Adult Temperament-Based Treatment with Supports; YA-TBT-S). METHODS 38 YA-TBT-S participants (m age = 19.58; SD 2.13) with anorexia nervosa (AN)-spectrum disorders, bulimia nervosa (BN)-spectrum disorders, and avoidant/restrictive food intake disorder (ARFID) completed self-report assessments at admission, discharge, and 12-month follow-up. Assessments measured program satisfaction, eating disorder psychopathology and impairment, body mass index (BMI), and trait anxiety. Outcomes were analyzed using linear mixed effects models to examine changes in outcome variables over time. RESULTS Treatment was rated as highly satisfactory. 53.33% were in partial or full remission at 12-month follow-up. 56% of participants received other treatment within the 12-month follow-up period, suggesting that YA-TBT-S may be an adjunctive treatment. Participants reported reductions in ED symptomatology (AN and BN), increases in BMI (AN and ARFID), and reductions in clinical impairment (AN and ARFID) at 12-month follow-up. CONCLUSIONS YA-TBT-S is a feasible and acceptable adjunctive treatment for young adults with a broad range of ED diagnoses and may be a method for involving parents in ED treatment in ways that are acceptable to both parents and YA. Further evaluation of efficacy is needed in larger samples, and to compare YA-TBT-S to other ED treatment approaches. Plain English summary Eating disorders are costly and dangerous psychiatric disorders that affect millions of individuals each year. Despite their risks and societal costs, currently available treatments are limited. This study examined the acceptability and efficacy of Young Adult, Temperament-Based Treatment with Supports (YA-TBT-S), a new treatment program for adults with eating disorders. YA-TBT-S was rated highly, and a significant portion of participants improved based on ratings collected 12 months after program participation. Those with anorexia nervosa (AN) and bulimia nervosa (BN) showed significant reductions in eating disorder pathology, and those with AN and avoidant/restrictive food intake disorder (ARFID) showed increases in BMI over time.
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Affiliation(s)
- Stephanie Knatz Peck
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA.
| | - Terra Towne
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Christina E Wierenga
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Laura Hill
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Ivan Eisler
- King's College London, London, UK.,Maudsley Centre for Child Adolescent Eating Disorders, London, UK
| | - Tiffany Brown
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Emily Han
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - McKenzie Miller
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Taylor Perry
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
| | - Walter Kaye
- Eating Disorder Treatment & Research Center, Department of Psychiatry, University of California, San Diego, 4510 Executive Drive Suite 315, San Diego, CA, 92121, USA
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Dennhag I, Henje E, Nilsson K. Parental caregiver burden and recovery of adolescent anorexia nervosa after multi-family therapy. Eat Disord 2021; 29:463-479. [PMID: 31617832 DOI: 10.1080/10640266.2019.1678980] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
This study investigated whether parental caregiving burden changed during adjunct multi-family therapy of adolescent anorexia nervosa and eating disorders not otherwise specified (EDNOS) and whether caregiver burden at baseline and changes in caregiver burden during treatment were associated with treatment outcome.Twenty-four females, 13 to 16 years old, and their parents, participated in the study. Caregiver burden was measured with the Eating Disorders Symptom Impact Scale, by mothers (n = 23) and fathers (n = 22). Treatment outcome was measured by adolescent body mass index, level of global functioning and self-rated eating disorder symptoms by the Eating Disorders Examination Questionnaire 4.0.All patient outcomes improved and overall caregiver burden decreased significantly during treatment. When broken down in aspects of caregiver burden the decrease in parental perceived isolation, was found to be associated with improvement of BMI and Children's Global Assessment Scale. When analyzing fathers and mothers separately, we found that maternal feelings of guilt and paternal perceived burden of dysregulated behaviors at base-line were correlated to treatment outcome. Future studies are needed to clarify the role of caregiver burden as a potential mediator of treatment results.
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Affiliation(s)
- Inga Dennhag
- Department of Clinical Science, Child- and Adolescent Psychiatry, Umeå University, Umeå, Sweden
| | - Eva Henje
- Department of Clinical Science, Child- and Adolescent Psychiatry, Umeå University, Umeå, Sweden
| | - Karin Nilsson
- Department of Clinical Science, Child- and Adolescent Psychiatry, Umeå University, Umeå, Sweden
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14
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Baudinet J, Eisler I, Simic M, Schmidt U. Brief early adolescent multi-family therapy (BEAM) trial for anorexia nervosa: a feasibility randomized controlled trial protocol. J Eat Disord 2021; 9:71. [PMID: 34134769 PMCID: PMC8206871 DOI: 10.1186/s40337-021-00426-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Multi-family therapy (MFT) is a recommended treatment for adolescent anorexia nervosa internationally. Despite recent significant advances in single-family therapy, the evidence base for MFT remains relatively small. Several individual and family factors have been associated with poorer outcomes in single-family therapy, many of which may be addressed or ameliorated by MFT if delivered early in treatment. This trial aims to determine the feasibility and acceptability of adding a five-day multi-family therapy group to the early stages of family therapy for anorexia nervosa. Secondary objectives are to explore effect size changes in key individual and family factors across treatment. METHODS This feasibility trial will use a randomised controlled design. Sixty adolescents (age 10-17 inclusive) with anorexia nervosa or atypical anorexia nervosa and their parents will be recruited from a community-based specialist eating disorder service in London, UK. Participants will be randomly allocated to receive six months of eating disorder focussed family therapy with a five-day MFT group (experimental group) or without (control group). Block randomisation will be conducted by the King's Clinical Trials Unit and researchers will be blind to participants' intervention allocation. Feasibility, acceptability and secondary outcomes measures will be collected at baseline, post-MFT, end of treatment, six-month and 12-month follow-up. Feasibility and acceptability will be assessed according to trial sign-up rates, retention, measure completion rates and satisfaction. Secondary outcomes include physical health improvements, changes in psychiatric symptoms, emotion regulation and reflective function capacity, expressed emotion, parental difficulties and therapeutic alliance. Descriptive data and exploration analysis of trends and effect sizes will be reported upon at trial completion. DISCUSSION The five-day MFT program developed for this study is novel, brief and more accessible than previous MFT models. The inclusion of a data collection point during treatment and follow-up will allow for an investigation of trends during and after treatment. This will allow exploration and comparison of future potential mediators and moderators of MFT and FT-AN outcomes and how these may differ between treatments. TRIAL REGISTRATION ISRCTN registry; ISRCTN93437752 , on 27 January 2021.
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Affiliation(s)
- Julian Baudinet
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AB, UK.
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK.
| | - Ivan Eisler
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AB, UK
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Mima Simic
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AB, UK
- Adult Eating Disorders Service, South London and Maudsley NHS Foundation Trust, De Crespigny Park, Denmark Hill, London, SE5 8AZ, UK
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15
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Imgart H, Plassmann R. [Effective factors in multifamily therapy in patients with eating disorders : Critical appraisal and implications for practice]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2020; 34:48-60. [PMID: 31997267 DOI: 10.1007/s40211-020-00330-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 01/08/2020] [Indexed: 10/25/2022]
Abstract
Multifamily therapy (MFT), the treatment of several families simultaneously, is an established method of psychotherapy used in a wide range of diagnoses. However, there is limited knowledge about the exact factors of action of this treatment method. The development of MFT as a separate form of therapy is presented, as are its previous applications in the treatment of patients with eating disorders. Known factors of change are critically evaluated, new factors of change are discussed and the practical application in MFT in the context of inpatient treatment of adolescents with eating disorders is demonstrated.Processes in the large group that have not yet been considered, such as emotional contagion, exaltation of emotion and subgroup formation and work with the meta-family, are described for the first time in the context of MFT and possibly represent mediators in the therapeutic process.The model of affect and process resonance in Plassmann's individual therapy can be applied well to the processes in the MFT and possibly represents its own effect factor through the production of episodes of secure attachment. Further research on the factors of change in the MFT is of practical relevance.
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Affiliation(s)
- Hartmut Imgart
- Kompetenzzentrum für Essstörungen und Adipositas, Parkland-Klinik, Im Kreuzfeld 6, 34537, Bad Wildungen, Deutschland.
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16
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Wallin U, Saha S. Implementation of Key Components of Evidence-Based Family Therapy for Eating Disorders in Child and Adolescent Psychiatric Outpatient Care. Front Psychiatry 2020; 11:59. [PMID: 32153439 PMCID: PMC7044340 DOI: 10.3389/fpsyt.2020.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/23/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Restrictive eating disorders with pronounced starvation are serious psychiatric conditions that often begin during childhood or adolescence. An early and efficient intervention is crucial to minimize the risk of the illness becoming longstanding and to limit the consequences. There is good evidence that weight gain during the first month of treatment provides a better prognosis. Only a limited amount of young people suffering from severe restrictive eating disorder receive an evidence-based treatment at present in Sweden. The ROCKETLAUNCH project intends to implement key components of the evidence-based family therapy during the first month of treatment in child and adolescent psychiatric outpatient care. METHODS From the southern part of Sweden, 12 local child and adolescent psychiatric outpatient services will take part. All patients with a restrictive eating disorder and pronounced starvation together with their families will be asked to take part in the study. We expect that one hundred 50 patients will be assessed every year. The patients and their families will receive 1 month of intense manualized treatment. Body weight, days in inpatient care, eating disorder, and other psychopathology-related symptoms, will be evaluated after one month and at 12-month follow-up. Economic evaluation of ROCKETLAUNCH will also be carried out alongside the intervention. At each outpatient clinic, data from the 10 previous patients will be gathered to compare the treatment provided at ROCKETLAUNCH with the standard treatment in Sweden. DISCUSSION We expect that by implementing the key components of the evidence-based family therapy during the first month of treatment, the prognosis of young newly diagnosed patients with severe restrictive eating disorders, primarily anorexia nervosa will improve, which, in turn, will reduce the need for psychiatric inpatient care. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier NCT04060433.
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Affiliation(s)
- Ulf Wallin
- Centre of Eating Disorders, Psychiatry Skåne, Lund, Sweden
| | - Sanjib Saha
- Health Economics Unit, Department of Clinical Science (Malmo), Lund University, Lund, Sweden
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17
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Spettigue W, Aldaqqaq Z, Isserlin L, Bishop B, Norris ML, Valois D, Obeid N. A Brief Modified Family-Based Treatment Intervention for Youth With Mild Eating Disorders: A Case Series. Front Psychiatry 2020; 11:105. [PMID: 32210848 PMCID: PMC7066491 DOI: 10.3389/fpsyt.2020.00105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/07/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Family-based treatment (FBT), an outpatient treatment which is typically offered for 6-12 months by specially trained therapists, is currently the first line treatment for adolescent anorexia nervosa and bulimia nervosa. The success of FBT for adolescents with moderate to severe eating disorders indicates a potential use for a short course of modified FBT which could be offered as an early intervention by nonspecialized community mental health counselors to adolescents with mild or subsyndromal eating disorders. METHODS In 2016, seven adolescents with mild eating disorders underwent a brief intervention in the form of five FBT-inspired therapy sessions (called 'DREAMS' sessions). The DREAMS sessions consisted of five replicable family sessions given over 6 weeks, each with a specific area of focus for treatment, such as nutrition and eating disorder symptoms, mood, relationships and anxiety. Charts of these seven patients were reviewed in 2019 to determine whether this treatment might be worthy of further study. RESULTS Based on a review of the progress notes, all seven patients reported an improvement in intake, a decrease in ED symptoms and an improvement in mood by the end of the sessions. All seven families reported that the sessions had been beneficial. CONCLUSION Early intervention is recommended for adolescents who present in the early stages of an eating disorder, yet there are no guidelines to recommend which treatment should be offered to this population. Further research is required to determine whether a short course of modified FBT, such as these five FBT-inspired 'DREAMS' sessions, may be an effective intervention to offer to youth who present with mild eating disorders.
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Affiliation(s)
- Wendy Spettigue
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Zizo Aldaqqaq
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Leanna Isserlin
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Brittany Bishop
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Mark L Norris
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.,Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | - Darcie Valois
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Nicole Obeid
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
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18
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Couturier J, Isserlin L, Norris M, Spettigue W, Brouwers M, Kimber M, McVey G, Webb C, Findlay S, Bhatnagar N, Snelgrove N, Ritsma A, Preskow W, Miller C, Coelho J, Boachie A, Steinegger C, Loewen R, Loewen T, Waite E, Ford C, Bourret K, Gusella J, Geller J, LaFrance A, LeClerc A, Scarborough J, Grewal S, Jericho M, Dimitropoulos G, Pilon D. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord 2020; 8:4. [PMID: 32021688 PMCID: PMC6995106 DOI: 10.1186/s40337-020-0277-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline. METHODS Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders. RESULTS Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed. CONCLUSIONS Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Wendy Preskow
- National Initiative for Eating Disorders, Toronto, Canada
| | - Catherine Miller
- Canadian Mental Health Association - Waterloo, Wellington, Dufferin, Kitchener, Canada
| | | | | | | | | | | | | | - Catherine Ford
- 9Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Kerry Bourret
- 10St. Joseph's Care Group - Thunder Bay, Thunder Bay, Canada
| | | | - Josie Geller
- 6The Univeristy of British Columbia, Vancouver, Canada
| | | | | | - Jennifer Scarborough
- Canadian Mental Health Association - Waterloo, Wellington, Dufferin, Kitchener, Canada
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Abstract
There are few systematic studies of treatment of bulimia nervosa (BN) in adolescents. Although family-based treatment has demonstrated preliminary evidence to support involvement of caregivers in treatment, there is significant opportunity for improvement in mitigating binge-eating and purging symptoms among adolescents afflicted with BN. When caregivers are unable to participate in treatment, there is evidence that BN-specific cognitive behavioral therapy approaches are helpful for some adolescents. Further research is needed to determine for whom, and under what conditions certain types of family involvement might be most effective in adolescent treatment of BN.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; The University of Chicago, Chicago, IL, USA.
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20
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[Editorial]. Prax Kinderpsychol Kinderpsychiatr 2019; 68:355-358. [PMID: 31250719 DOI: 10.13109/prkk.2019.68.5.355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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21
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Multifamilientherapie mit anorektischen Kindern und Jugendlichen im tagesklinischen Rahmen. Prax Kinderpsychol Kinderpsychiatr 2019; 68:438-458. [DOI: 10.13109/prkk.2019.68.5.438] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Abstract
Eating disorders (EDs) are serious psychiatric illnesses that typically develop during adolescence or young adulthood, indicating that individuals with EDs may benefit from early intervention. Family-based treatment is the leading treatment of youth with anorexia nervosa, with increasing evidence of its efficacy for youth with bulimia nervosa. This review describes the role of family engagement within family-based treatment of EDs, followed by a summary of current empirically supported, family-based ED interventions. It concludes with discussion of the ways in which family interventions are expanding and adapting to improve the breadth and scope of ED treatment in adolescence and young adulthood.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Katherine L Loeb
- School of Psychology, Fairleigh Dickinson University, 1000 River Road (T-WH1-01), Teaneck, NJ 07666, USA
| | - Daniel Le Grange
- Eating Disorders Program, Department of Psychiatry, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, USA; The University of Chicago, Chicago, IL, USA.
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23
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Lock J, Le Grange D. Family-based treatment: Where are we and where should we be going to improve recovery in child and adolescent eating disorders. Int J Eat Disord 2019; 52:481-487. [PMID: 30520532 DOI: 10.1002/eat.22980] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 10/15/2018] [Accepted: 10/20/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Family therapy has long been advocated as an effective intervention for eating disorders. A specific form of family therapy, one that utilizes family resources, has proven especially effective for adolescents with anorexia or bulimia nervosa (AN and BN). First developed in London, a behaviorally focused adaptation, called family-based treatment (FBT), has been manualized and systematically studied in six randomized clinical trials for adolescent AN and two for adolescent BN. METHOD This Commentary focuses on manualized FBT; what we know, what we do not know (yet), and what we hope for. RESULTS We do know that efficacy data for FBT, especially adolescent AN, are quite robust, even though remission rates remain elusive for more than half of all cases. While preliminary, moderators of FBT for adolescent AN have been identified and could aid us in determining the most (or least) responsive patient groups. And weight gain (∼2.5kg) by week four has been confirmed as an early predictor of remission at end-of-treatment. What we do not know, yet, is whether specific adaptations to manualized FBT will confer improved remission rates. DISCUSSION Finally, and in terms of what is hoped for, we highlight the promise of improved access, dissemination, and implementation of FBT.
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Affiliation(s)
- James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Daniel Le Grange
- Department of Psychiatry and UCSF Weill Institute for Neurosciences, University of California, San Francisco, California.,Department of Psychiatry and Behavioral Neuroscience, Emeritus, The University of Chicago, Chicago, Illinois
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24
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Mason TB, Smith KE, Crosby RD, Wonderlich SA, Crow SJ, Engel SG, Peterson CB. Does the eating disorder examination questionnaire global subscale adequately predict eating disorder psychopathology in the daily life of obese adults? Eat Weight Disord 2018. [PMID: 28643290 PMCID: PMC5889351 DOI: 10.1007/s40519-017-0410-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The eating disorder examination questionnaire (EDE-Q) Global score is a self-report measure of global eating disorder (ED) psychopathology. This study used ecological momentary assessment (EMA) to evaluate the ecological validity of EDE-Q Global scores among obese adults. Fifty obese adults completed the EDE-Q and 2 weeks of EMA ratings prior to initiating eating episodes and subsequently after eating episodes. EMA items assessed behavioral symptoms [i.e., loss of control (LOC) eating and overeating] and cognitive symptoms (i.e., weight/shape concerns, eating concerns, and restraint). EDE-Q Global was associated with increased EMA weight/shape concerns and fear of LOC at pre-eating recordings. EDE-Q Global was associated with increased EMA post-episode weight/shape concerns, eating concerns, LOC eating, and overeating. There was no association between EDE-Q Global and EMA restraint. Results generally supported the ecological validity of EDE-Q Global scores. Future studies of ED psychopathology in obese adults may benefit from considering EDE-Q Restraint separately. Level of Evidence Level V, descriptive study.
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Affiliation(s)
- Tyler B Mason
- Department of Clinical Research, Neuropsychiatric Research Institute, 120 8th Street S, Fargo, ND, 58103, USA. .,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA.
| | - Kathryn E Smith
- Department of Clinical Research, Neuropsychiatric Research Institute, 120 8th Street S, Fargo, ND, 58103, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Ross D Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, 120 8th Street S, Fargo, ND, 58103, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Stephen A Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, 120 8th Street S, Fargo, ND, 58103, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Scott J Crow
- University of Minnesota Medical School, Minneapolis, MN, USA.,The Emily Program, St. Paul, MN, USA
| | - Scott G Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, 120 8th Street S, Fargo, ND, 58103, USA.,Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Fargo, ND, USA
| | - Carol B Peterson
- University of Minnesota Medical School, Minneapolis, MN, USA.,The Emily Program, St. Paul, MN, USA
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25
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Wierenga CE, Hill L, Knatz Peck S, McCray J, Greathouse L, Peterson D, Scott A, Eisler I, Kaye WH. The acceptability, feasibility, and possible benefits of a neurobiologically-informed 5-day multifamily treatment for adults with anorexia nervosa. Int J Eat Disord 2018; 51:863-869. [PMID: 29722047 DOI: 10.1002/eat.22876] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Novel treatments for adults with anorexia nervosa (AN) are lacking. Recent scientific advances have identified neurobiologically-driven temperament contributors to AN symptoms that may guide development of more effective treatments. This preliminary study evaluates the acceptability, feasibility and possible benefits of a multicenter open trial of an intensive 5-day neurobiologically-informed multifamily treatment for adults with AN and their supports (SU). The temperament-focused treatment combines psychoeducation of AN neurobiology and SU involvement to develop skills to manage traits contributing to disease chronicity. METHOD Fifty-four adults with AN and at least one SU (n = 73) received the 5-day treatment. Acceptability, feasibility, and attrition were measured post-treatment. Clinical outcome (BMI, eating disorder psychopathology, family function) was assessed post-treatment and at >3-month follow-up. RESULTS The treatment had low attrition, with only one drop-out. Patients and SU rated the intervention as highly acceptable, and clinicians reported good feasibility. At post-treatment, patients demonstrated significantly increased BMI, reduced eating disorder psychopathology, and improved family function. Benefits were maintained in the 39 patients who completed follow-up assessment, with 62% reporting full or partial remission. DISCUSSION Preliminary results are promising and suggest this novel treatment is feasible and acceptable. To establish treatment efficacy, fully-powered randomized controlled trials are necessary.
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Affiliation(s)
- Christina E Wierenga
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Laura Hill
- The Center for Balanced Living, Columbus, Ohio
| | - Stephanie Knatz Peck
- Department of Psychiatry, University of California San Diego, San Diego, California
| | | | - Laura Greathouse
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Danika Peterson
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Amber Scott
- The Center for Balanced Living, Columbus, Ohio
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Walter H Kaye
- Department of Psychiatry, University of California San Diego, San Diego, California
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Ganci M, Pradel M, Hughes EK. Feasibility of a parent education and skills workshop for improving response to family-based treatment of adolescent anorexia nervosa. Int J Eat Disord 2018; 51:358-362. [PMID: 29417594 DOI: 10.1002/eat.22834] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 01/14/2018] [Accepted: 01/18/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Early response to family-based treatment (FBT) is a robust predictor of positive outcomes for adolescents with anorexia nervosa (AN). We introduced a parent education and skills workshop in the first 4 weeks of treatment with the aim of improving changes in parent self-efficacy in FBT and, in turn, patient weight gain. METHOD Forty-five families who had at least one parent attend the workshop were compared to a matched control of families who did FBT before the workshop was introduced. RESULTS Among adolescents who were underweight at baseline, weight gain by Week 4 of treatment was higher for adolescents whose parents attended the workshop (M = 90.84% median BMI) than those who did not (M = 88.54% mBMI, p < .05). There was no significant difference in weight at Week 12 or at end of treatment, nor was there a difference in self-efficacy as measured by the Parent Versus Anorexia Scale. Participants reported a high level of satisfaction with the workshop and significant improvements in knowledge and confidence. DISCUSSION Overall, the workshop was a feasible adjunct for improving early response to FBT.
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Affiliation(s)
- Maria Ganci
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Martin Pradel
- Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, Australia
| | - Elizabeth K Hughes
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Parkville, Australia.,Royal Children's Hospital, Centre for Adolescent Health, Melbourne, Australia
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Hughes EK. Multifamily therapy may add to the effectiveness of single-family therapy for adolescents with anorexia nervosa. EVIDENCE-BASED MENTAL HEALTH 2018; 21:e4. [PMID: 28851703 PMCID: PMC10270373 DOI: 10.1136/eb-2017-102732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 08/10/2017] [Accepted: 08/11/2017] [Indexed: 11/03/2022]
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Richards IL, Subar A, Touyz S, Rhodes P. Augmentative Approaches in Family-Based Treatment for Adolescents with Restrictive Eating Disorders: A Systematic Review. EUROPEAN EATING DISORDERS REVIEW 2017; 26:92-111. [PMID: 29282801 DOI: 10.1002/erv.2577] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 11/29/2017] [Accepted: 12/04/2017] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To systematically review the literature reporting outcomes of augmentative family-based treatment (FBT) interventions for adolescents with restrictive eating disorders (EDs). METHOD Articles were identified through a systematic search of five electronic databases (PsycINFO, MEDLINE, EMBASE, CINAHL, Cochrane Database). RESULTS Thirty articles were included, reporting on FBT augmentations featuring adjunctive treatment components, modified treatment structure and/or content with adherence to FBT principles, and adaptations allowing FBT delivery in different settings. All reported significant improvements in weight and/or ED symptoms at end-of-treatment, although few compared augmentative and standard FBT interventions and good quality follow-up data was generally lacking. CONCLUSIONS There is early evidence for the effectiveness of augmentative FBT-based approaches in facilitating weight and/or ED symptom improvements for adolescents with restrictive EDs. There remains a lack of robust evidence demonstrating superior effects of such approaches over standard FBT, and further controlled studies are required to expand on the current evidence. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Imogen Lim Richards
- Clinical Psychology Unit, School of Psychology, The University of Sydney, NSW, Australia
| | - Anni Subar
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen Touyz
- Clinical Psychology Unit, School of Psychology, The University of Sydney, NSW, Australia
| | - Paul Rhodes
- Clinical Psychology Unit, School of Psychology, The University of Sydney, NSW, Australia
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29
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Hamilton MP, Hetrick SE, Mihalopoulos C, Baker D, Browne V, Chanen AM, Pennell K, Purcell R, Stavely H, McGorry PD. Identifying attributes of care that may improve cost‐effectiveness in the youth mental health service system. Med J Aust 2017; 207:S27-S37. [DOI: 10.5694/mja17.00972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 10/17/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Matthew P Hamilton
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Sarah E Hetrick
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | | | - David Baker
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Vivienne Browne
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Andrew M Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Kerryn Pennell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Rosemary Purcell
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
| | - Heather Stavely
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
| | - Patrick D McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC
- Centre of Youth Mental Health, University of Melbourne, Melbourne, VIC
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30
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Depestele L, Claes L, Dierckx E, Colman R, Schoevaerts K, Lemmens GMD. An Adjunctive Multi-family Group Intervention with or without Patient Participation during an Inpatient Treatment for Adolescents with an Eating Disorder: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2017; 25:570-578. [PMID: 28960604 DOI: 10.1002/erv.2556] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 08/18/2017] [Accepted: 08/25/2017] [Indexed: 11/07/2022]
Abstract
This study reports on a pilot study of a family group intervention with or without patient participation adjunctive to a specialized inpatient treatment for eating disorders (EDs). Participants were 112 female adolescent ED inpatients and one or both of their parents. The parents were invited to participate in an adjunctive multi-family group with patient (MFT) or in a similar multi-parent group without patient participation (MPT). Questionnaires assessing ED symptoms, family functioning and caregiving experiences were administered before and after intervention. Post-intervention results obtained from both patient and parent(s) indicated that improvement in ED symptoms and parental burden occurred after both types of interventions. Family functioning improved differently according to the informant: fathers reported an improvement of general family functioning, patients reported an improvement of problem solving and mothers reported a decrease in problem solving across both formats. This study emphasized the importance of including a multi-informant approach in family interventions. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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Affiliation(s)
- Lies Depestele
- Eating Disorders Unit, Psychiatric Hospital Alexianen Tienen, Belgium.,Faculty of Psychology and Educational Sciences, University of Leuven, Belgium.,Department of Psychiatry and Medical Psychology, Ghent University, Belgium
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Belgium.,Faculty of Medicine and Health Sciences (CAPRI), University of Antwerp, Belgium
| | - Eva Dierckx
- Eating Disorders Unit, Psychiatric Hospital Alexianen Tienen, Belgium.,Department of Clinical and Life Span Psychology, Vrije Universiteit Brussel, Belgium
| | - Roos Colman
- Biostatistics Unit, Department of Public Health, Ghent University, Belgium
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Abbate-Daga G, Marzola E, Amianto F, Fassino S. A comprehensive review of psychodynamic treatments for eating disorders. Eat Weight Disord 2016; 21:553-580. [PMID: 26980319 DOI: 10.1007/s40519-016-0265-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 02/17/2016] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To comprehensively review the existing literature on the effectiveness of psychodynamic psychotherapies in eating disorders (EDs) and to stimulate both debate and research on this topic. METHODS Online and hand searches were conducted to identify papers published between 1980 and 2015 on psychodynamic treatments delivered to adults with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). RESULTS A total of 47 studies were finally included in this review. Fifteen studies were available for AN, 9 for BN, 12 for BED, and 11 for samples with mixed diagnoses. Several methodological flaws emerged, but overall psychodynamic interventions showed promising results at the end of treatment and follow-up, when available. CONCLUSIONS The body of literature on psychodynamic treatments is sparse and sometimes methodologically questionable; nevertheless, current data provide support to the effectiveness of these interventions, particularly for AN. However, both a defined approach (focus, themes, and techniques) and randomized controlled trials (RCTs) are warranted to clarify the effectiveness of psychodynamic psychotherapies.
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Affiliation(s)
- Giovanni Abbate-Daga
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Enrica Marzola
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Federico Amianto
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Secondo Fassino
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy
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32
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Eisler I, Simic M, Hodsoll J, Asen E, Berelowitz M, Connan F, Ellis G, Hugo P, Schmidt U, Treasure J, Yi I, Landau S. A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa. BMC Psychiatry 2016; 16:422. [PMID: 27881106 PMCID: PMC5122159 DOI: 10.1186/s12888-016-1129-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 11/15/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa, with a general consensus in the field that eating disorders focussed family therapy (often referred to as Maudsley Family Therapy or Family Based Treatment) currently offers the most promising outcomes. Nevertheless, a significant number do not respond well and additional treatment developments are needed to improve outcomes. Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first randomised controlled trial of multifamily therapy for adolescent anorexia nervosa. METHODS The study was a pragmatic multicentre randomised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy (MFT-AN) and single family therapy (FT-AN). A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified (restricting type) were randomised to the two treatments using computer generated blocks of random sizes to ensure balanced numbers in the trial arms. Independent assessors, blind to the allocation, completed evaluations at baseline, 3 months, 12 months (end of treatment) and 18 months. RESULTS Both treatment groups showed clinically significant improvements with just under 60% achieving a good or intermediate outcome (on the Morgan-Russell scales) at the end of treatment in the FT-AN group and more than 75% in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention (OR = 2.55 95%; CI 1.17, 5.52; p = 0.019). At follow-up (18 months post baseline) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant. Clinically significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology. Approximately half the patients in FT-AN and nearly 60% of those in MFT-AN had started menstruating. CONCLUSIONS This study confirms previous research findings demonstrating the effectiveness of eating disorder focused family therapy and highlights the additional benefits of bringing together groups of families that maximises the use of family resources and mutual support leading to improved outcomes. TRIAL REGISTRATION Current Controlled Trials ISRCTN11275465 ; Registered 29 January 2007 (retrospectively registered).
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Affiliation(s)
- Ivan Eisler
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London, UK. .,Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Mima Simic
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - John Hodsoll
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, London, UK
| | - Eia Asen
- University College London, London, UK ,Marlborough Family Service, Central and North West London NHS Foundation Trust, London, UK
| | - Mark Berelowitz
- Child and Adolescent Eating Disorders Service, Royal Free Hospital London, NHS Foundation Trust, London, UK
| | - Frances Connan
- Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, University of London, London, UK
| | - Gladys Ellis
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Pippa Hugo
- St George’s, University of London, London, UK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, London, UK ,Adult Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, London, UK ,Adult Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Irene Yi
- Child and Adolescent Mental Health Service, Surrey and Borders Partnership NHS Foundation Trust, Frimley, UK
| | - Sabine Landau
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, London, UK
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Cook-Darzens S. The role of family meals in the treatment of eating disorders: a scoping review of the literature and implications. Eat Weight Disord 2016; 21:383-393. [PMID: 26932829 DOI: 10.1007/s40519-016-0263-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/11/2016] [Indexed: 11/30/2022] Open
Abstract
Family meal research is a fast growing field that has significant implications for the prevention and treatment of eating disorders (ED). Using a scoping review procedure, this article overviewed major historical and clinical trends that have guided the use of family meals or lunch sessions in adolescent ED family therapy over the past 40 years, and synthesized essential findings from current therapeutic family meal research. The relevant body of literature is reported within the framework of three models of family therapy (Maudsley model, family-based treatment, multi-family therapy), with a focus on their specific use of family lunch sessions and related empirical evidence. Although promising, current evidence remains contradictory, tentative and colored by therapists' convictions, resistance and fears. Future research priorities are discussed, including the need for a more direct examination of the impact of the family meal practice on therapeutic change, as well as a better understanding of its active ingredients and of the characteristics of patients/families that may benefit most from it. This review of the literature may help clinicians and family therapists (1) adhere more reliably and confidently to ED-focused treatment protocols that include a strong family meal component, and (2) make more informed decisions regarding the inclusion or exclusion of family meals in their practice. When feasibility or acceptability issues preclude their use, alternatives to family meals are also discussed, including family meal role-plays and drawings, coaching of home-based family meals and manual/DVD-based guidance.
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Affiliation(s)
- Solange Cook-Darzens
- Department of Child and Adolescent Psychiatry, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019, Paris, France. .,, 10 Grande Rue, 60460, Blaincourt, France.
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Jewell T, Blessitt E, Stewart C, Simic M, Eisler I. Family Therapy for Child and Adolescent Eating Disorders: A Critical Review. FAMILY PROCESS 2016; 55:577-594. [PMID: 27543373 DOI: 10.1111/famp.12242] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Eating disorder-focused family therapy has emerged as the strongest evidence-based treatment for adolescent anorexia nervosa, supported by evidence from nine RCTs, and there is increasing evidence of its efficacy in treating adolescent bulimia nervosa (three RCTs). There is also emerging evidence for the efficacy of multifamily therapy formats of this treatment, with a recent RCT demonstrating the benefits of this approach in the treatment of adolescent anorexia nervosa. In this article, we critically review the evidence for eating disorder-focused family therapy through the lens of a moderate common factors paradigm. From this perspective, this treatment is likely to be effective as it provides a supportive and nonblaming context that: one, creates a safe, predictable environment that helps to contain anxiety generated by the eating disorder; two, promotes specific change early on in treatment in eating disorder-related behaviors; and three, provides a vehicle for the mobilization of common factors such as hope and expectancy reinforced by the eating disorder expertise of the multidisciplinary team. In order to improve outcomes for young people, there is a need to develop an improved understanding of the moderators and mediators involved in this treatment approach. Such an understanding could lead to the refining of the therapy, and inform adaptations for those families who do not currently benefit from treatment.
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Affiliation(s)
- Tom Jewell
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | | | - Catherine Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, UK
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Knatz S, Wierenga CE, Murray SB, Hill L, Kaye WH. Neurobiologically informed treatment for adults with anorexia nervosa: a novel approach to a chronic disorder. DIALOGUES IN CLINICAL NEUROSCIENCE 2016. [PMID: 26246796 PMCID: PMC4518705 DOI: 10.31887/dcns.2015.17.2/sknatz] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Anorexia nervosa (AN) is a severe and debilitating disorder with significant medical and psychological sequelae. To date, there are no effective treatments for adults, resulting in high rates of chronicity, morbidity, and mortality. Recent advances in brain imaging research have led to an improved understanding of etiology and specific neurobiological mechanisms underlying symptoms. Despite this, there are no treatments focused on targeting symptoms using this empirically supported mechanistic understanding of the illness. Updated treatment approaches focused on targeting neurobiological mechanisms underlying core AN symptomatology are necessary to improve treatment out-comes for this population. Neurobiologically Enhanced With Family Eating Disorder Trait Response Treatment (NEW FED TR) is a neurobiologically informed treatment targeting key temperament constructs associated with the illness through the delivery of psychoeducation and skills training to patients and nominated carers.
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Affiliation(s)
- Stephanie Knatz
- University of California San Diego, Department of Psychiatry, San Diego, California, USA
| | - Christina E Wierenga
- University of California San Diego, Department of Psychiatry, San Diego, California, USA
| | - Stuart B Murray
- University of California San Diego, Department of Psychiatry, San Diego, California, USA
| | - Laura Hill
- Ohio State University, Department of Psychiatry, Columbus, Ohio, USA
| | - Walter H Kaye
- University of California San Diego, Department of Psychiatry, San Diego, California, USA
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Abstract
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.
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Abstract
PURPOSE OF REVIEW Research into the efficacy and practice of family therapy for the treatment of adolescent anorexia nervosa has been ongoing for the past 4 decades. Research results continue to highlight the effective role of family therapy for the treatment of anorexia in adolescents. This review aims to present findings and opinions from relevant articles published over the past 12 months, related to the treatment of adolescent anorexia, utilizing family therapy and multi-family therapy. RECENT FINDINGS A number of recent articles continue to explore family therapy for adolescent anorexia, with particular emphasis being placed on attempting to pinpoint those elements of the approaches that may hold significance in relation to recovery from this dangerous illness and the development of new interventions that draw on the evidence to date for a family approach to the treatment of anorexia. SUMMARY Ongoing research is needed to identify the active ingredients of family therapy for anorexia.
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Knatz S, Murray SB, Matheson B, Boutelle KN, Rockwell R, Eisler I, Kaye WH. A Brief, Intensive Application of Multi-Family-Based Treatment for Eating Disorders. Eat Disord 2015; 23:315-24. [PMID: 25984656 DOI: 10.1080/10640266.2015.1042318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is a continued need to improve upon the efficacy and availability of treatments for anorexia nervosa. Family-based therapy for anorexia nervosa demonstrates strong empirical evidence; however, trained treatment providers are limited and a subsample of participants receiving the treatment fail to respond. The intensive family treatment program is a brief, time-limited, multi-family program that trains families of adolescents with eating disorders to oversee their adolescents' recovery at home by providing psychoeducation, skills training, and immersive practice over the course of a 5-day period. This article provide a description of the program by summarizing underlying theoretical principles and key therapeutic components.
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Affiliation(s)
- Stephanie Knatz
- a Department of Psychiatry , University of California, San Diego , San Diego , California , USA
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