Variability in remission in family therapy for anorexia nervosa

Abstract

Objective The evolution toward more stringent conceptualizations of remission in family therapy for adolescent anorexia nervosa (AN) has, with time, introduced variability in outcomes across randomized controlled trials (RCTs). An examination of remission across the history of research on family therapy for AN shows that earlier studies adopted lenient definitions and generally yielded higher rates of remission than studies of the past decade that have used stricter definitions of remission. In this study, we investigate the reactivity of remission rates to the application of different definitions of remission used within the family therapy for AN literature, within a single RCT data set. Method We conducted a secondary analysis of data from a single‐site RCT which compared the relative efficacy of two formats of family therapy in a sample of 106 Australian adolescents with AN. Using end‐of‐treatment data, we compared remission rates using 11 definitions of remission that have been used in studies of family therapy for AN spanning more than three decades. Results We found wide variability in remission rates (21.7–87.7%; Cochran's Q χ2(10, N = 106) = 303.55, p = .000], depending on which definition of remission was applied. As expected, more lenient criteria produced higher remission rates than more stringent definitions. Discussion Applying different criteria of remission to a single data set illustrates the impact of changing how remission is defined. Failure to consider the greater stringency of remission criteria in recent studies could result in false inferences concerning the efficacy of family therapy for AN over time.

Adolescent and Parent Experience of Care at a Family-Based Treatment Service for Eating Disorders

“…For adolescents with anorexia nervosa (AN), current evidence supports family-based treatment [FBT (4)] preferably within a specialist multidisciplinary service (5)(6)(7). Despite its strong evidence base (8), FBT only achieves full remission in approximately one third of adolescents, although partial remission rates are higher (9)(10)(11)(12). Treatment engagement can be especially challenging for families and clinicians given the egosyntonic nature of AN (13) and the intense demands of FBT for the family.…”

Translating evidence-based treatment for digital health delivery: a protocol for family-based treatment for anorexia nervosa using telemedicine

“…Remission rates are particularly promising for adolescents with short illness duration [ 11 , 16 , 21 ]. The average remission rate for all participants at the end of FBT is approximately 40% [ 11 , 22 , 23 ]. An average of 75% of young people demonstrate improvement in weight and eating-related symptomatology at end of FBT [ 16 ].…”

External support and personal agency - young persons’ reports on recovery after family-based inpatient treatment for anorexia nervosa: a qualitative descriptive study

“…Although family-based treatments have a promising evidence-base [29], a large proportion of patients and families participating in clinical trials fail to achieve remission [25,30,31]. A more modest outcome becomes especially visible when strict remission criteria are applied [3]. Consequently, several questions remain on how we can optimize treatment to enable a better fit for both the young person and his and her family.…”

“…Recovery from anorexia nervosa (AN) is not universally defined in the literature [1], and quantitative research has demonstrated that recovery rates vary exceedingly depending on the definition used [2,3]. Moreover, recovery can be approached from several positions, as treatment providers, researchers and people with a lived experience may support different definitions.…”

“…In such a family-based framework, enhancing the young person's intrinsic motivation, promoting the adolescent's responsibility for change, and working with adolescent-related issues, both within and outside the family, is usually toned down or postponed to the end of treatment [27,28]. Although a predominantly family-based treatment approach is frequently portrayed in the literature as supported by promising research evidence [3,29], researchers have started to question the evidence-base [30][31][32], describing its outcome in clinical trials as modest at best [3,32] with some arguing that despite its promise, treatment needs to be augmented and better tailored to improve outcome [33,34].…”