Home treatment as an add-on to family-based treatment for adolescents with anorexia nervosa compared with standard family-based treatment and home-based stress reduction training: study protocol for a randomized clinical trial

Abstract

Background Family-based treatment (FBT) is currently the most effective evidence-based treatment approach for adolescents with anorexia nervosa (AN). Home treatment (HT) as an add-on to FBT (FBT-HT) has been shown to be acceptable, feasible and effective. The described three-arm randomized clinical trial (RCT) is intended to investigate whether FBT-HT demonstrates higher efficacy compared to standard outpatient FBT with supplemental mindfulness-based stress reduction training (FBT-MBSR). Methods This RCT compares FBT-HT to standard outpatient FBT and FBT-MBSR as a credible home-based control group in terms of efficacy and delivery. Adolescents with AN or atypical AN disorder (n = 90) and their parent(s)/caregiver(s) are to be randomly assigned to either FBT, FBT-HT or FBT-MBSR groups. Eating disorder diagnosis and symptomatology are to be assessed by eating disorder professionals using standardized questionnaires and diagnostic instruments (Eating Disorder Examination, Eating Disorder Inventory, Body Mass Index). In addition, parents and caregivers independently provide information on eating behavior, intrafamily communication, stress experience and weight. The therapeutic process of the three treatments is to be measured and assessed among both participants and care providers. The feasibility, acceptability and appropriateness can thus also be evaluated. Discussion We hypothesize that FBT-HT will be an acceptable, appropriate and feasible intervention and, importantly, will outperform both established FBT and FBT-MBSR in improving adolescent weight and negative eating habits. Secondary outcome measures include the reduction in the stress experienced by caregivers, as well as the regulation of perceived expressed emotions within the family, while the intrafamily relationships are hypothesized to mediate/moderate the effectiveness of FBT. The proposed study has the potential to enhance the scientific and clinical understanding of the efficacy of FBT for AN, including whether the addition of HT to FBT versus another home-based adjunct intervention improves treatment outcomes. Furthermore, the study aligns with public health priorities to optimize the outcomes of evidence-based treatments and integrate the community setting. Trial registration This study is registered at ClinicalTrials.gov (NCT05418075).

Involuntary Treatment for Child and Adolescent Anorexia Nervosa—A Narrative Review and Possible Advances to Move Away from Coercion

“…Thus, possible treatment advances in alternatives to hospital treatment, in order to move away from coercive treatment for child and adolescent AN, should be investigated in the future. Among other treatment options, such as day patient treatment, home treatment might offer a promising new and alternative treatment approach for children and adolescents with severe AN to shorten [71] or even avoid (involuntary) hospitalization stays [78][79][80][81][82]. Pilot studies of both approaches thus far suggest that these approaches provide patients and their families with the right to make choices, thus strengthening their autonomy in the treatment process.…”

“…In recent years, specific home treatment programs have been developed in the field of child and adolescent AN [71,[78][79][80][81]. These programs either aim at preventing hospitalization (augmented outpatient interventions) [78][79][80][81][82] or at shortening hospital stays (stepped-care interventions) [71].…”

“…In recent years, specific home treatment programs have been developed in the field of child and adolescent AN [71,[78][79][80][81]. These programs either aim at preventing hospitalization (augmented outpatient interventions) [78][79][80][81][82] or at shortening hospital stays (stepped-care interventions) [71]. Focusing on preventing (in)voluntary hospital admissions, different research groups around the world are aiming to improve the existing outpatient approach and develop home treatment programs as supportive add-ons to outpatient FBT [77][78][79][80][81][82].…”

“…These programs either aim at preventing hospitalization (augmented outpatient interventions) [78][79][80][81][82] or at shortening hospital stays (stepped-care interventions) [71]. Focusing on preventing (in)voluntary hospital admissions, different research groups around the world are aiming to improve the existing outpatient approach and develop home treatment programs as supportive add-ons to outpatient FBT [77][78][79][80][81][82]. The main aim of these "add-on home sessions" is to provide practical support for caregivers.…”

Stationsäquivalente Behandlung suchterkrankter Kinder und Jugendlicher. Eine qualitative Untersuchung

“…Ein klinischer Konsenspunkt in der S3-Leitlinie "Screening, Diagnostik und Behandlung alkoholbezogener Störungen" besteht darin, dass weitere suchtmedizinische und -therapeutische Hilfen möglichst nahtlos angeboten und vermittelt werden sollen [4]. Die häusliche Behandlung zeigt sich als umsetzbar und wirksam und wird international erfolgreich eingesetzt [29,30]. Die StäB bietet eine große Chance, Perspektivenklärung direkt im häuslichen Umfeld umzusetzen und passgenaue Angebote zeitnah zu installieren.…”