Can adaptive treatment improve outcomes in family-based therapy for adolescents with anorexia nervosa? Feasibility and treatment effects of a multi-site treatment study

Abstract

Objective Adolescents with Anorexia Nervosa (AN), treated with family-based treatment (FBT) who fail to gain 2.3 kg by the fourth week of treatment have a 40–50% lower chance of recovery than those who do. Because of the high risk of developing enduring AN, improving outcomes in this group of poor responders is essential. This study examines the feasibility and effects of a novel adaptive treatment (i.e., Intensive Parental Coaching-IPC) aimed at enhancing parental self-efficacy related to re-feeding skills in poor early responders to FBT. Method 45 adolescents (12 – 18 years of age) meeting DSM TR IV criteria for AN were randomized in an unbalanced design (10 to standard FBT; 35 to the adaptive arm). Attrition, suitability, expectancy rates, weight change, and psychopathology were compared between groups. Outcomes There were no differences in rates of attrition, suitability, expectancy ratings, or most clinical outcomes between randomized groups. However, the group of poor early responders that received IPC achieved full weight restoration (>95% of expected mean BMI) by EOT at similar rates as those who had responded early. Conclusions The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT. The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early. A sufficiently powered study is needed to confirm these promising findings.

Heterogeneous weight restoration trajectories during partial hospitalization treatment for anorexia nervosa

“…An important focus of FBT is helping parents understand that patients restrict their food intake because they are in the grip of a powerful disorder that is causing them to be fearful of food and weight gain. Lock et al (2015) have shown that intensified treatment improves outcome for families identified as at risk for poor outcomes based on lack of early weight gain. Interventions specifically to reduce expressed emotion in eating disorders have been shown to improve patient outcome (Hibbs et al, 2015).…”

Randomized Clinical Trial of Family-Based Treatment and Cognitive-Behavioral Therapy for Adolescent Bulimia Nervosa

“…Future studies might consider utilizing CBT-E, adapted for adolescents, as this approach is the latest iteration of CBT for eating disorders now available. Alternatively, the utility of integrative cognitive-affective therapy 41 or interpersonal therapy, 6 if adapted for adolescents, or a stepped-care approach for early non-responders, 42 could also be explored. Finally, this is only the third, though largest, RCT conducted to examine treatments for adolescents with BN.…”

Assessment and treatment of eating disorders in children and adolescents

“…These include Enhancing parents’ self-efficacy through intensive parent coaching alongside FBT23 or through groups’ teaching communication skills, motivational interviewing and meal support to parents and carers 24

Providing therapy to parents alone using an FBT format (separated FBT) if levels of criticism and conflict are high in conjoint therapy 25

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“…Enhancing parents’ self-efficacy through intensive parent coaching alongside FBT23 or through groups’ teaching communication skills, motivational interviewing and meal support to parents and carers 24…”