A Randomized Controlled Trial of Adjunctive Family Therapy and Treatment as Usual Following Inpatient Treatment for Anorexia Nervosa Adolescents

Abstract

Research on treatments in anorexia nervosa (AN) is scarce. Although most of the therapeutic programs used in ‘real world practice’ in AN treatment resort to multidisciplinary approaches, they have rarely been evaluated.ObjectiveTo compare two multidimensional post-hospitalization outpatients treatment programs for adolescents with severe AN: Treatment as Usual (TAU) versus this treatment plus family therapy (TAU+FT).MethodSixty female AN adolescents, aged 13 to 19 years, were included in a randomized parallel controlled trial conducted from 1999 to 2002 for the recruitment, and until 2004 for the 18 months follow-up. Allocation to one of the two treatment groups (30 in each arm) was randomised. The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents. The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics, but not eating disorder symptoms. The main Outcome Measure was the Morgan and Russell outcome category (Good or Intermediate versus Poor outcome). Secondary outcome indicators included AN symptoms or their consequences (eating symptoms, body mass index, amenorrhea, number of hospitalizations in the course of follow-up, social adjustment). The evaluators, but not participants, were blind to randomization.ResultsAt 18 months follow-up, we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy (Intention-to-treat: TAU+FT :12/30 (40%); TAU : 5/29 (17.2%) p = 0.05; Per Protocol analysis: respectively 12/26 (46.2%); 4/27 (14.8%), p = 0.01). Similar group effects were observed in terms of achievement of a healthy weight (i.e., BMI≥10th percentile) and menstrual status.ConclusionsAdding family therapy sessions, focusing on intra-familial dynamics rather than eating symptomatology, to a multidimensional program improves treatment effectiveness in girls with severe AN.Trial RegistrationControlled-trials.com ISRCTN71142875

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

“…The second one is a more integrative long-term systemic model which can be adapted to different contexts of care (inpatient, outpatient, day care). To the extent that FBT has demonstrated its effectiveness in several RCTs, in contrast to the systemic family therapy model for which the evidence base remains scarce and preliminary in the field of ED [73,74], it has been somewhat prematurely concluded that FBT is the best evidencebased treatment for ED children and adolescents. In a recent RCT, Agras et al [75] showed that there were no significant differences in the outcome of single FBT and single systemic family therapy (SyF) at the end of treatment and at one-year follow-up, for an adolescent ED population.…”

Bonding and Expressed Emotion: Two Interlinked Concepts?

“…Prior to inclusion in the study, all participants were hospitalized in our care unit for a life-threatening physical and/or mental state (for one or more of the following criteria: BMI below 14 and or rapid weight loss and/or compromised vital functions, severe depression, high suicide risk, chronic under-nutrition with low weight, and failure of out-patient care) according to international guidelines [7,34,35,36]. Once the patient was admitted, the objectives of hospitalization were defined by means of a weight contract establishing a discharge target weight [36,37,38].…”

“…Out of the 76 eligible participants, 16 refused to participate (21%). The patients and parents who refused to participate did not differ from those included with regard to sociodemographic variables or clinical status on entry or at discharge (data available on request) [34]. The evaluations were conducted during the second part of the hospitalization, when refeeding was partially achieved and the patient was in regular contact with the family.…”

Anorexia nervosa: diagnosis, risk factors and evidence‐based treatments

“…Results showed that focusing on the intrafamilial dynamic improves treatment effectiveness in severe AN patients even after 13 years follow up. 84 …”