Emotion coaching skills as an augmentation to family‐based therapy for adolescents with anorexia nervosa: A pilot effectiveness study with families with high expressed emotion

Abstract

ObjectiveTo examine the feasibility and acceptability of augmenting family‐based treatment (FBT) for adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) with a parent emotion coaching intervention (EC) focused on reducing parent expressed emotion.MethodIn this pilot effectiveness trial, families of adolescents with AN/AAN exhibiting high expressed emotion received standard FBT with either (1) EC group or (2) support group (an attention control condition focused on psychoeducation).ResultsForty‐one adolescents with AN or AAN were recruited (88% female, Mage = 14.9 ± 1.6 years, 95% White: Non‐Hispanic, 1% White: Hispanic, 1% Bi‐racial: Asian). Most study adolescents were diagnosed with AN (59%) while 41% were diagnosed with AAN. Participating parents were predominantly mothers (95%). Recruitment and retention rates were moderately high (76% and 71%, respectively). High acceptability and feasibility ratings were obtained from parents and interventionists with 100% reporting the EC intervention was “beneficial”–“very beneficial.” The FBT + EC group demonstrated higher parental warmth scores at post‐treatment compared to the control group (standardized effect size difference, d = 1.58), which was maintained at 3‐month follow‐up. Finally, at post‐treatment, the FBT + EC group demonstrated higher rates of full remission from AN/AAN (40%) compared to FBT + support (27%), and were nine times more likely to be weight restored by 3‐month follow‐up.DiscussionAugmenting FBT with emotion coaching for parents with high expressed emotion is acceptable, feasible, and demonstrates preliminary effectiveness.Public SignificanceFamily based treatment for AN/AAN is the recommended treatment for youth but families with high criticism/low warmth are less likely to respond to this treatment. Adding a parent emotion coaching group (EC) where parents learn to talk to their adolescents about tough emotions is feasible and well‐liked by families.