A Randomized Controlled Trial of Family Therapy and Cognitive Behavior Therapy Guided Self-Care for Adolescents With Bulimia Nervosa and Related Disorders

Schmidt, Ulrike; Lee, Sally; Beecham, Jennifer; Perkins, Sarah; Treasure, Janet; Yi, Irene; Winn, Suzanne; Robinson, Paul; Murphy, Rebecca; Keville, Saskia; Johnson‐Sabine, Eric; Jenkins, Mari; Frost, Susie; Dodge, Liz; Berelowitz, Mark; Eisler, Ivan

doi:10.1176/ajp.2007.164.4.591

Cited by 227 publications

(190 citation statements)

References 5 publications

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“…Schmidt et al43 compared family therapy to cognitive behavioral therapy guided self-care (CBT-GSC) for 85 adolescents. The family therapy in this study was similar to FBT-BN, but differed in that adolescents were allowed to choose “close others” other than parents in their treatment, and a quarter of patients chose this option.…”

Section: Empirical Evidence For Family-based Treatment For Bnmentioning

confidence: 99%

Family-based treatment of eating disorders in adolescents: current insights

Rienecke¹

2017

AHMT

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Eating disorders are serious illnesses associated with significant morbidity and mortality. Family-based treatment (FBT) has emerged as an effective intervention for adolescents with anorexia nervosa, and preliminary evidence suggests that it may be efficacious in the treatment of adolescents with bulimia nervosa. Multifamily therapy for anorexia nervosa provides a more intensive experience for families needing additional support. This review outlines the three phases of treatment, key tenets of family-based treatment, and empirical support for FBT. In addition, FBT in higher levels of care is described, as well as challenges in the implementation of FBT and recent adaptations to FBT, including offering additional support to eating-disorder caregivers. Future research is needed to identify families for whom FBT does not work, determine adaptations to FBT that may increase its efficacy, develop ways to improve treatment adherence among clinicians, and find ways to support caregivers better during treatment.

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Section: Empirical Evidence For Family-based Treatment For Bnmentioning

confidence: 99%

Family-based treatment of eating disorders in adolescents: current insights

Rienecke¹

2017

AHMT

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“…Results from this seminal study favored the application of this approach for patients with less than a three-year duration of AN, and the body of studies to immediately follow therefore focused exclusively on adolescent AN (Eisler, Dare, Hodes, Russell, Dodge, & Le Grange, 2000; Eisler, Simic, Russell, & Dare, 2007; Le Grange, Eisler, Dare, & Russell, 1992). Since the original collection of randomized controlled trials (RCTs) of FBT was conducted, the approach has been disseminated and tested beyond the Maudsley (Le Grange, Crosby, Rathouz, & Leventhal, 2007; Lock, Agras, Bryson, & Kraemer, 2005; Lock, Couturier, & Agras, 2006; Loeb, Walsh, Lock, Le Grange, Jones, Marcus, Weaver, & Dobrow, 2007; Robin, Siegel, Moye, Gilroy, Dennis, & Sikand, 1999; Schmidt et al, 2007), and is now being adapted for a more transdiagnostic spectrum. There are currently FBT manuals for the treatment of AN (Lock, Le Grange, Agra, & Dare, 2001) and BN (Le Grange & Lock, 2007), which have both been tested in studies that included subthreshold and atypical (i.e., EDNOS) cases (Le Grange et al, 2007; Lock et al, 2005; Lock et al, 2006; Loeb et al, 2007); for the prevention of AN in symptomatic children and adolescents at high risk for developing the full disorder (Loeb, Le Grange, & Lock, 2005); and even for the treatment of adolescent overweight and obesity (Loeb, Celio Doyle, Le Grange, Bremer, Hildebrandt, & Hirsch, 2006), which can be associated with disordered eating but are not categorized as psychiatric disorders.…”

Section: Transdiagnostic Conceptualizations Of Eating Disordersmentioning

confidence: 99%

Transdiagnostic Theory and Application of Family-Based Treatment for Youth With Eating Disorders

Loeb

Lock

Grange

et al. 2012

Cognitive and Behavioral Practice

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This paper describes the transdiagnostic theory and application of family-based treatment (FBT) for children and adolescents with eating disorders. We review the fundamentals of FBT, a transdiagnostic theoretical model of FBT and the literature supporting its clinical application, adaptations across developmental stages and the diagnostic spectrum of eating disorders, and the strengths and challenges of this approach, including its suitability for youth. Finally, we report a case study of an adolescent female with eating disorder not otherwise specified (EDNOS) for whom FBT was effective. We conclude that FBT is a promising outpatient treatment for anorexia nervosa, bulimia nervosa, and their EDNOS variants. The transdiagnostic model of FBT posits that while the etiology of an eating disorder is unknown, the pathology affects the family and home environment in ways that inadvertently allow for symptom maintenance and progression. FBT directly targets and resolves family level variables, including secrecy, blame, internalization of illness, and extreme active or passive parental responses to the eating disorder. Future research will test these mechanisms, which are currently theoretical.

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“…Individuals who engage in extreme weight loss behaviours were less likely to engage in health-promoting weight maintenance strategies such as fruit and vegetable consumption (Story, Neumark-Sztainer, Sherwood, Stang, & Murray, 1998). Several studies comparing the diagnosis of BN to subthreshold forms of this disorder found no difference in comorbid symptom severity or treatment response (Binford & le Grange, 2005; Le Grange, Crosby, Rathouz, & Leventhal, 2007; Schmidt et al, 2007). These results portend harm: Adolescents engaging in even subthreshold levels of extreme weight loss strategies are positioned on a harmful trajectory predictive of unhealthy weight management and increased eating disturbance and appear to be as ill as threshold forms of BN.…”

Section: Changes To Criteria For Inappropriate Compensatory Mechanismmentioning

confidence: 99%

Classification of eating disturbance in children and adolescents: Proposed changes for the DSM‐V

Bravender

Bryant‐Waugh

Herzog

et al. 2010

Euro Eating Disorders Rev

102

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Childhood and adolescence are critical periods of neural development and physical growth. The malnutrition and related medical complications resulting from eating disorders such as anorexia nervosa (AN), bulimia nervosa (BN) and eating disorder not otherwise specified may have more severe and potentially more protracted consequences during youth than during other age periods. The consensus opinion of an international workgroup of experts on the diagnosis and treatment of child and adolescent eating disorders is that (a) lower and more developmentally sensitive thresholds of symptom severity (e.g. lower frequency of purging behaviours, significant deviations from growth curves as indicators of clinical severity) be used as diagnostic boundaries for children and adolescents, (b) behavioural indicators of psychological features of eating disorders be considered even in the absence of direct self-report of such symptoms and (c) multiple informants (e.g. parents) be used to ascertain symptom profiles. Collectively, these recommendations will permit earlier identification and intervention to prevent the exacerbation of eating disorder symptoms.

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A Randomized Controlled Trial of Family Therapy and Cognitive Behavior Therapy Guided Self-Care for Adolescents With Bulimia Nervosa and Related Disorders

Abstract: Compared with family therapy, CBT guided self-care has the slight advantage of offering a more rapid reduction of bingeing, lower cost, and greater acceptability for adolescents with bulimia or eating disorder not otherwise specified.

Cited by 227 publications

References 5 publications

Family-based treatment of eating disorders in adolescents: current insights

Family-based treatment of eating disorders in adolescents: current insights

Transdiagnostic Theory and Application of Family-Based Treatment for Youth With Eating Disorders

Classification of eating disturbance in children and adolescents: Proposed changes for the DSM‐V

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