Open Trial of Family-Based Treatment for Full and Partial Anorexia Nervosa in Adolescence: Evidence of Successful Dissemination

Loeb, Katharine L.; Walsh, B. Timothy; Lock, James; Grange, Daniel Le; Jones, Jennifer; Marcus, Sue M.; Weaver, James; Dobrow, Ilyse

doi:10.1097/chi.0b013e318058a98e

Cited by 85 publications

(60 citation statements)

References 31 publications

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“…To date, five relatively small studies have examined the effectiveness of FBT for youth with AN (Couturier, Iserlin, & Lock, 2010: N = 14; Hughes et al, 2013: N s = 14 and 21; Loeb et al, 2007: N = 20; Paulson-Karlsson et al, 2009: N = 32; Turkiewicz, Pinzón, Lock, & Fleitlich-Bilyk, 2009: N = 9). While each utilized clinically-referred samples and practicing therapists, their generalizability to usual care is limited by the absence of a comparison condition, the provision of treatment at no cost (Couturier et al, 2010; Loeb et al, 2007; Turkiewicz et al, 2009) and the exclusion of boys (Couturier et al, 2010; Paulson-Karlsson et al, 2009; Turkiewicz et al, 2009). Another potential reason for the low use of ESTs in usual care is that these treatments perform more poorly in usual care than in research settings (Wampold et al, 2011; Weisz, Jensen-Doss, & Hawley, 2006).…”

Section: Introductionmentioning

confidence: 99%

From efficacy to effectiveness: Comparing outcomes for youth with anorexia nervosa treated in research trials versus clinical care

Accurso

Fitzsimmons‐Craft

Ciao

et al. 2015

Behaviour Research and Therapy

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This study examined outcomes for 84 youth with anorexia nervosa (AN) who received family-based treatment (FBT) in a research trial (randomized trial care [RTC]: n = 32) compared to fee-for-service care (specialty clinical care [SCC]: n = 52) at an outpatient eating disorder clinic. Weight was collected up to 12 months post-baseline. Survival curves were used to examine time to weight restoration as predicted by type of care, baseline demographic and clinical characteristics, and their interaction. There was not a significant main effect for type of care, but its interaction with initial %EBW was significant (p = .005), indicating that weight restoration was achieved faster in RTC compared to SCC for youth with a lower initial %EBW (i.e., ≤ 81), while rates of weight restoration were comparable for those with a higher initial %EBW (i.e., > 81). These data suggest that FBT is as effective as it is efficacious, except for youth with lower initial body weights. Therefore, clinicians may need to be particularly active in encouraging early weight gain for this subset of patients. Nevertheless, this study suggests that FBT is appropriate as a first-line treatment for youth with AN who present for clinical care.

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Section: Introductionmentioning

confidence: 99%

From efficacy to effectiveness: Comparing outcomes for youth with anorexia nervosa treated in research trials versus clinical care

Accurso

Fitzsimmons‐Craft

Ciao

et al. 2015

Behaviour Research and Therapy

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“…Family therapy (FT) has been reported to be the most effective treatment for AN adolescents [13]–[15]. Specifically, studies in AN adolescents have documented the impact of family interventions that directly mobilize family resources in tackling anorexic behaviours [16]–[25].…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial of Adjunctive Family Therapy and Treatment as Usual Following Inpatient Treatment for Anorexia Nervosa Adolescents

et al. 2012

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Research on treatments in anorexia nervosa (AN) is scarce. Although most of the therapeutic programs used in ‘real world practice’ in AN treatment resort to multidisciplinary approaches, they have rarely been evaluated.ObjectiveTo compare two multidimensional post-hospitalization outpatients treatment programs for adolescents with severe AN: Treatment as Usual (TAU) versus this treatment plus family therapy (TAU+FT).MethodSixty female AN adolescents, aged 13 to 19 years, were included in a randomized parallel controlled trial conducted from 1999 to 2002 for the recruitment, and until 2004 for the 18 months follow-up. Allocation to one of the two treatment groups (30 in each arm) was randomised. The TAU program included sessions for the patient alone as well as sessions with a psychiatrist for the patient and her parents. The TAU+FT program was identical to the usual one but also included family therapy sessions targeting intra-familial dynamics, but not eating disorder symptoms. The main Outcome Measure was the Morgan and Russell outcome category (Good or Intermediate versus Poor outcome). Secondary outcome indicators included AN symptoms or their consequences (eating symptoms, body mass index, amenorrhea, number of hospitalizations in the course of follow-up, social adjustment). The evaluators, but not participants, were blind to randomization.ResultsAt 18 months follow-up, we found a significant group effect for the Morgan and Russell outcome category in favor of the program with family therapy (Intention-to-treat: TAU+FT :12/30 (40%); TAU : 5/29 (17.2%) p = 0.05; Per Protocol analysis: respectively 12/26 (46.2%); 4/27 (14.8%), p = 0.01). Similar group effects were observed in terms of achievement of a healthy weight (i.e., BMI≥10th percentile) and menstrual status.ConclusionsAdding family therapy sessions, focusing on intra-familial dynamics rather than eating symptomatology, to a multidimensional program improves treatment effectiveness in girls with severe AN.Trial RegistrationControlled-trials.com ISRCTN71142875

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“…According to this theory, different studies found that severe concerns about body shape and weight can play a significant role in the persistence of EDs [6,7,8,9,10,11]. Furthermore, shape and weight concerns have been associated with different responses to psychological treatment in several reports [12,13,14,15]. …”

Section: Introductionmentioning

confidence: 99%

Identity and Eating Disorders (IDEA): A Questionnaire Evaluating Identity and Embodiment in Eating Disorder Patients

et al. 2012

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Background: In this paper we tested the hypothesis that persons with eating disorders (EDs) are affected by disturbances of the way they experience their own body (embodiment) and shape their personal identity, assuming that the various kinds of anomalies of eating behavior are consequences thereof. Sampling and Methods: We developed and validated a new self-reported questionnaire named IDEA (IDentity and EAting disorders), which was administered to 147 ED patients and 187 healthy controls. Test-retest reliability, internal consistency, psychopathological correlates, and concurrent validity were evaluated. A factor analysis was performed to verify the distribution of items into subscales. Results: The questionnaire showed good test-retest reliability, and internal consistency. IDEA scores were specifically associated with ED psychopathology, and they did not show any correlation with sociodemographic and general clinical variables. Four factors were extracted, which were related to the following phenomena: ‘feeling oneself only through the gaze of the other and defining oneself only through the evaluation of the other’, ‘feeling oneself only through objective measures’, ‘feeling extraneous from one’s own body’, and ‘feeling oneself through starvation’. Conclusions: IDEA represents a multidimensional, brief, versatile, easy-to-perform instrument for clinical evaluation, assessing abnormalities in lived corporeality, and of personal identity, which appeared to be specifically associated with the core features of ED psychopathology. The main limitations of the study are the cross-sectional design. Also, it is impossible to ascertain whether the domains we assessed are specific traits of patients with EDs, or state-related features. To answer this question, a longitudinal study is needed.

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Open Trial of Family-Based Treatment for Full and Partial Anorexia Nervosa in Adolescence: Evidence of Successful Dissemination

Cited by 85 publications

References 31 publications

From efficacy to effectiveness: Comparing outcomes for youth with anorexia nervosa treated in research trials versus clinical care

From efficacy to effectiveness: Comparing outcomes for youth with anorexia nervosa treated in research trials versus clinical care

A Randomized Controlled Trial of Adjunctive Family Therapy and Treatment as Usual Following Inpatient Treatment for Anorexia Nervosa Adolescents

Identity and Eating Disorders (IDEA): A Questionnaire Evaluating Identity and Embodiment in Eating Disorder Patients

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