Multi‐family therapy for eating disorders: A systematic scoping review of the quantitative and qualitative findings

Abstract

Objective This study reviewed the quantitative and qualitative evidence‐base for multi‐family therapy (MFT) for eating disorders regarding change in physical and psychological symptoms, broader individual and family factors, and the experience of treatment. Method A systematic scoping review was conducted. Four databases (PsycInfo, Medline, Embase, CENTRAL) and five grey literature databases were searched on 24th June 2021 for relevant peer‐reviewed journal articles, book chapters, and dissertations. No beginning time‐point was specified. Only papers that presented quantitative or qualitative data were included. No restrictions on age or diagnosis were imposed. Studies were first mapped by study design, participant age, and treatment setting, then narratively synthesized. Results Outcomes for 714 people who received MFT across 27 studies (one mixed‐method, 17 quantitative and nine qualitative) were synthesized. MFT is associated with improvements in eating disorder symptomatology and weight gain for those who are underweight. It is also associated with improvements in other individual and family factors including comorbidities, self‐esteem, quality of life, and some aspects of the experience of caregiving, although these findings are more mixed. MFT is generally experienced as both helpful and challenging due to the content addressed and intensive group process. Discussion MFT is associated with significant improvements in eating disorder symptoms across the lifespan and improvement in broader individual and family factors. The evidence base is small and studies are generally underpowered. Larger, higher‐quality studies are needed, as is research investigating the unique contribution of MFT on outcomes, given it is typically an adjunctive treatment.

Multi-family therapy for bulimia nervosa: a qualitative pilot study of adolescent and family members’ experiences

“…The current findings are broadly consistent with previous research on MFT for adolescent eating disorders [ 19 ]. This literature highlights the group as place of support and learning associated with symptom change [ 21 – 24 ].…”

“…One important point of difference between MFT-BN and other types of MFT for eating disorders is its intensity. In several MFT-AN models, the group meets for 4 or 5 consecutive full days of intervention [ 17 , 37 , 38 ], which can be followed by additional stand-alone full days of intervention spread over several months [ 19 ]. Perhaps participants in the current study felt unchallenged by the group process, at times, simply due to this less intensive format.…”

“…In the UK, MFT is now a recommended treatment for adolescents with AN (MFT-AN) [ 11 ] and has been manualised for both adolescents [ 17 ] and young adults [ 18 ]. MFT-AN interventions can be useful as a stand-alone treatment, or as an adjunct treatment alongside other interventions [ 19 ]. In the only adolescent outpatient RCT to include MFT-AN, Eisler et al [ 20 ] showed that offering adjunctive MFT-AN alongside family therapy for AN (FT-AN) is associated with better outcomes than FT-AN alone.…”

“…Qualitative research into the experience of MFT-AN has identified several benefits afforded from the unique group context [ 19 ]. Patients and caregivers describe valuing being able to hear new perspectives, share their own experiences, and learning new skills [ 21 – 23 ].…”

“…In an attempt to improve upon outcomes for young people with BN, MFT has recently been adapted specifically for this group (MFT-BN). To date, there has been very little research into MFT interventions for BN; indeed, only one peer review article has been published [ 19 ]. In an uncontrolled case series, Stewart et al [ 27 ] found that MFT-BN for adolescents was associated with improvements in bingeing and purging behaviours, co-morbid mood, anxiety and emotional regulation difficulties, and parent/caregiver perceived burden.…”