Understanding the uptake of family‐based treatment for adolescents with anorexia nervosa: Therapist perspectives

Couturier, Jennifer; Kimber, Melissa; Jack, Susan M.; Niccols, Alison; Blyderveen, Sherry Van; McVey, Gail

doi:10.1002/eat.22049

Cited by 79 publications

(111 citation statements)

References 45 publications

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“…This process enabled the parents to work on family interactions and family history [38,56]. This therapy also enabled the family to play an active role in care [56,57,58]. Parents described it as a space for expression, sharing emotions, identifying family conflicts, and reconstructing a bond of trust [38,51,56].…”

Section: Resultsmentioning

confidence: 99%

Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals

et al. 2017

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BackgroundAnorexia nervosa in adolescents can be a difficult-to-treat disease. Because qualitative research is a well-established method for deepening our understanding of subjective experiences, such as eating disorders and their treatment, we sought to perform a systematic review of qualitative studies to synthesize the views of adolescents with this disease, their parents, and their healthcare providers about its treatment.MethodsWe performed a thematic synthesis to develop the central themes that summarize all of the topics raised in the articles included in our review. The quality of the articles was assessed by the Critical Appraisal Skills Program.ResultsWe included 32 articles from seven different countries. Two central themes were inductively developed from the analysis: (1) the treatment targets (i.e., symptoms and patients in context), and (2) a therapeutic tool—a relationship, specifically the core concept of the therapeutic relationship.ConclusionOur results underline the difficulty in establishing a therapeutic alliance, the barriers to it, especially the risk that professionals, adolescents, and parents will not converse about treatment; although such a dialogue appears to be an essential component in the construction of a therapeutic alliance.

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Section: Resultsmentioning

confidence: 99%

Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals

et al. 2017

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“…The comorbidity rate was greater in the randomized trial at large (26%) (Lock et al, 2010), but these data still suggest that families of patients with psychiatric comorbidity are less likely to participate in research trials, perhaps perceiving FBT as inappropriate in the context of multiple presenting problems. Understandably, clinicians’ attitudes towards FBT are negatively impacted by concerns about sample representativeness, and patient clinical complexity may preclude them from utilizing FBT (Couturier et al, 2013); therefore, increasing the representativeness of research samples is critical.…”

Section: Discussionmentioning

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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“…It has not been compared to other potentially effective treatments such as cognitive behaviour therapy or interpersonal psychotherapy. While preliminary data support the view that mental health therapists can be trained and utilise FBT in diverse clinical settings (Kimber et al, 2014), other data show that many therapists are hesitant to adopt FBT because of organisational, clinical, personal, and further contextual factors (Couturier et al, 2013b). Consequently, there is an urgent need to explore adaptations to FBT and effective ways to disseminate and implement FBT in order to improve patient outcomes.…”

Section: Final Commentmentioning

confidence: 97%

Family-based treatment is overvalued: reply to Strober

Grange

Lock

2014

Advances in Eating Disorders

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Depending on who you talk to and what you read, there are two, very different, attitudes towards family based treatment (FBT): the only treatment for which empirical support is strong, an approach too mechanical to trust. Each camp views the conclusion of the other as not only wrong, but backward. The debates have been contentious; they have also ignored issues which, if properly considered, would be grounds for a thoughtful perspective, one that better serves the public health. Achieving the middle ground is imperative. In a discipline as young as ours weighing evidence cautiously can have a civilising influence, not only on how we are perceived by patients and families but also on how we will be judged by other disciplines and by purchasers of care. This article offers a carefully measured, detailed argument for consensus. It reviews the evidence-base for FBT and shows why broad claims of its benefit are greatly overstated, but also why it should not be discounted. Understanding the circumstances when use of FBT is inappropriate and when failure to consider it might be equally so addresses an important question on which our field is presently divided.

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Understanding the uptake of family‐based treatment for adolescents with anorexia nervosa: Therapist perspectives

Abstract: Further investigation into the barriers and facilitating factors to the use of FBT is warranted. Understanding effective dissemination and training strategies is critical to ensuring patients receive the best possible care.

Cited by 79 publications

References 45 publications

Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals

Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals

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

Family-based treatment is overvalued: reply to Strober

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