Family therapy for anorexia nervosa

Fisher, Caroline A.; Hetrick, Sarah; Rushford, Nola

doi:10.1002/14651858.cd004780.pub2

Cited by 97 publications

(68 citation statements)

References 73 publications

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“…It was found that the second modality was more promising, which suggests that interventions that include the family in the treatment have a greater reach than those only involving the adolescent. This finding is corroborated by previous studies 13,14,27 .…”

Section: Efficacy Of the Treatmentsupporting

confidence: 92%

“…Some controlled studies suggest that family-based approaches produce more satisfactory results when compared to individual therapies, among adolescents with AN [13][14][15] . However, a systematic review with meta-analysis 16 found that at the end of family-based treatment (FBT) 15 no improvement was shown in comparison with the outcome of the individual intervention (Z = 1.62, p = 0.11).…”

Section: Introductionmentioning

confidence: 99%

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Evidence-based psychotherapy for treatment of anorexia nervosa in children and adolescents: systematic review

Alckmin-Carvalho

Vega

Cobelo

et al. 2018

Arch. Clin. Psychiatry (São Paulo)

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Background: Efficacy studies on the treatment of anorexia nervosa (AN) in childhood and adolescence are scarce and systematic reviews are almost non-existent. Objective: Systematic review of the literature regarding the modalities of psychological intervention based on evidence used in the treatment of AN in childhood and adolescence. Methods: The research was carried out in the databases: PubMed, PsycINFO and Cochrane, using the combined keywords: anorexia nervosa and evidence-based therapy. Articles published between 1990 and 2015 were assessed. Results: Of the 139 eligible articles, 14 were selected, of which 10 (71.4%) were conducted in the United States and England. The sample ranged from 9 to 167 participants. Randomized Clinical Trial represented the most frequent design (n = 9; 63.4%), with more than half of the interventions structured in 20 or more sessions (n = 9, 64.3%). Nine types of treatments were tested, with the most tested being Family-Based Treatment (FBT) (n = 7; 50%). Interventions involving the family seem to be more effective, however, the rates for complete remission are modest. Discussion: Although evidence of efficacy was verified in the treatments analyzed, the limited number of studies, the various methodological limitations and the methodological heterogeneity between studies make the findings inconclusive.

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Section: Efficacy Of the Treatmentsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Evidence-based psychotherapy for treatment of anorexia nervosa in children and adolescents: systematic review

Alckmin-Carvalho

Vega

Cobelo

et al. 2018

Arch. Clin. Psychiatry (São Paulo)

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“…For example, family therapy is effective only as an early intervention. 194 Over half of the patients in this sample (n = 83; 55%) fulfil the criteria for being in a severe and/or enduring stage of illness. Such patients are considered to be resistant to all forms of treatment.…”

Section: Limitationsmentioning

confidence: 87%

“…194,195 However, individuals who develop AN later in life or have an illness duration of more than 3 years respond less well to this intervention. 194 Therefore, there is uncertainty about whether or not and DOI: 10.3310/pgfar05160 PROGRAMME GRANTS FOR APPLIED RESEARCH 2017 VOL. 5 NO.…”

Section: Introductionmentioning

confidence: 99%

Treatment of anorexia nervosa: a multimethod investigation translating experimental neuroscience into clinical practice

Schmidt

Sharpe

Bartholdy

et al. 2017

Programme Grants Appl Res

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BackgroundAnorexia nervosa (AN) is a severe psychiatric condition and evidence on how to best treat it is limited.ObjectivesThis programme consists of seven integrated work packages (WPs) and aims to develop and test disseminable and cost-effective treatments to optimise management for people with AN across all stages of illness.MethodsWP1a used surveys, focus groups and a pre–post trial to develop and evaluate a training programme for school staff on eating disorders (EDs). WP1b used a randomised controlled trial (RCT) [International Standard Randomised Controlled Trial Number (ISRCTN) 42594993] to evaluate a prevention programme for EDs in schools. WP2a evaluated an inpatient treatment for AN using case reports, interviews and a quasi-experimental trial. WP2b used a RCT (ISRCTN67720902) to evaluate two outpatient psychological therapies for AN. WP3 used a RCT (ISRCTN06149665) to evaluate an intervention for carers of inpatients with AN. WP4 used actimetry, self-report and endocrine assessment to examine physical activity (PA) in AN. WP5 conducted a RCT (ISRCTN18274621) of an e-mail-guided relapse prevention programme for inpatients with AN. WP6 analysed cohort data to examine the effects of maternal EDs on fertility and their children’s diet and growth. WP7a examined clinical case notes to explore how access to specialist ED services affects care pathways and user experiences. Finally, WP7b used data from this programme and the British Cohort Study (1970) to identify the costs of services used by people with AN and to estimate annual costs of AN for England.ResultsWP1a: a brief training programme improved knowledge, attitudes and confidence of school staff in managing EDs in school. WP1b: a teacher-delivered intervention was feasible and improved risk factors for EDs in adolescent girls. WP2a: both psychological therapies improved outcomes in outpatients with AN similarly, but patients preferred one of the treatments. WP2b: the inpatient treatment (Cognitive Remediation and Emotional Skills Training) was acceptable with perceived benefits by patients, but showed no benefits compared with treatment as usual (TAU). WP3: compared with TAU, the carer intervention improved a range of patient and carer outcomes, including carer burden and patient ED symptomatology. WP4: drive to exercise is tied to ED pathology and a desire to improve mood in AN patients. PA was not increased in these patients. WP5: compared with TAU, the e-mail-guided relapse prevention programme resulted in higher body mass index and lower distress in patients at 12 months after discharge. WP6: women with an ED had impaired fertility and their children had altered dietary and growth patterns compared with the children of women without an ED. WP7a: direct access to specialist ED services was associated with higher referral rates, lower admission rates, greater consistency of care and user satisfaction. WP7b: the annual costs of AN in England are estimated at between £45M and £230M for 2011.ConclusionsThis programme has produced evidence to inform future intervention development and has developed interventions that can be disseminated to improve outcomes for individuals with AN. Directions for future research include RCTs with longer-term outcomes and sufficient power to examine mediators and moderators of change.Trial registrationCurrent Controlled Trials ISRCTN42594993, ISRCTN67720902, ISRCTN06149665 and ISRCTN18274621.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 16. See the NIHR Journals Library website for further project information.

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“…Although encouraging, however these conclusions are based on few trials that included only small numbers of participants with several issues regarding potential bias. The field would benefit from large, well-conducted trials (Fisher et al, 2010). There are several limitations to this study that must be acknowledged.…”

Section: Discussionmentioning

confidence: 99%