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ObjectiveFamily-based treatment (FBT) is a well-established intervention for adolescent anorexia nervosa (AN). Although FBT is efficacious in promoting weight gain and improvements in psychological symptoms, for some adolescents, cognitive/attitudinal recovery lags behind weight gain. This study conducted an exploratory post hoc analysis of outcomes of adolescents who achieved weight gain by the end of FBT but continued to experience elevated psychological symptoms post-treatment.MethodsData were drawn from two randomised controlled trials (RCTs) testing two forms of FBT (conjoint/whole family and parent-focussed). Descriptive statistics and generalised estimating equations were used to examine differences in treatment outcomes between non-cognitive responders (NCRs) (those who regained weight but continued to experience psychological symptoms) and full responders (FRs) (those who achieved both weight and cognitive restoration by the end of treatment) (n = 80; 83.7% female, Agemean [SD] = 14.66 [1.73]).ResultsBy 12 months post-treatment, there were no differences in weight between NCRs and FRs. However, NCRs had a slower trajectory of weight gain than FRs and continued to have elevated levels of psychological symptoms throughout the follow-up period.ConclusionsA subset of adolescents appear to continue to experience clinically significant levels of eating pathology up to 12 months after FBT even when weight restoration is achieved.

ObjectiveRates of psychiatric comorbidity are elevated in adolescents with anorexia nervosa, but little is known about how psychiatric comorbidity changes following family-based treatment (FBT).MethodsAdolescents with anorexia nervosa (N = 107) enrolled in a randomized controlled trial comparing two forms of FBT completed the Mini International Neuropsychiatric Interview for Children and Adolescents at baseline and end of treatment. Analyses tested whether baseline comorbid diagnoses predicted the presence of comorbid diagnoses at end of treatment and if baseline eating disorder psychopathology impacted this association.ResultsRates of comorbid diagnoses decreased from 54% at baseline to 26% at end of treatment. Logistic regression analyses indicated that individuals with multiple comorbid diagnoses at baseline were more likely to meet criteria for a comorbid condition at end of treatment (b = 2.00, p

ObjectiveThis exploratory study is the first to examine family-based treatment (FBT) adherence and association to treatment outcome in the context of a large-scale, multi-centre study for the treatment of adolescents with anorexia nervosa.MethodOne hundred and ninety recorded FBT sessions from 68 adolescents with anorexia nervosa and their families were recruited across multiple sites (N = 6). Each site provided 1-4 tapes per family over four treatment time points, and each was independently rated for therapist adherence.ResultsThere were differences in adherence scores within and between sites. ANOVA produced a main effect for site, F(5, 46) = 8.6, p

Objective: This study investigated treatment‐engagement fears, self‐efficacy, and accommodating and enabling in mothers and fathers of adolescent and adult children with eating disorders. Methods: This study involved a secondary analysis of pre‐treatment data from a subsample of 143 parents (95 mothers; 48 fathers) from a Canada‐wide multi‐site study. Parents completed the Caregiver Traps Scale, Parents Versus Anorexia Scale, and the Accommodation and Enabling Scale for Eating Disorders. Data were analysed using factorial Multivariate Analysis of Variance and mediation via multiple regression. Results: Mothers reported higher levels of treatment‐engagement fears than fathers. Among mothers, higher fear predicted lower self‐efficacy and more accommodating and enabling behaviours. Among fathers, neither fear nor self‐efficacy predicted accommodating and enabling. No differences in treatment‐engagement fear or self‐efficacy between parents of adolescent child and adult children were found at pre‐treatment. Conclusions: Mothers' and fathers' experience different levels of fear related to their involvement in their ill‐child's treatment at pre‐treatment, and that fear is uniquely related to variables that impact treatment outcomes. There is a need to support parents even when their child is an adult. This study can inform family‐based treatments vis‐a‐vis tailoring interventions for mothers and fathers and providing support to parents of children with eating disorders across the lifespan. Key points: Mother's experience higher levels of fear related to their involvement in their child's treatment than fathers at pre‐treatment.Fear predicted self‐efficacy and accommodating and enabling behaviours among mothers whereas neither fear nor self‐efficacy predicted accommodating and enabling behaviours among fathers.Parents of adult children experience the same degree of treatment‐engagement fear and self‐efficacy than parents of adolescent children. [ABSTRACT FROM AUTHOR]

This study examined the effect of family-based treatment for bulimia nervosa (FBT-BN) and cognitive behavioral therapy for adolescents (CBT-A) on depressive symptoms and self-esteem in adolescents with BN. Data were collected from 110 adolescents, ages 12-18, who met Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, text revision criteria for BN or partial BN. Participants were randomly assigned to FBT-BN or CBT-A and completed measures of depressive symptoms and self-esteem before and after treatment and at 6- and 12-month follow-up assessments. Depressive symptoms and self-esteem significantly improved in both treatments, and neither treatment appeared superior on these clinical outcomes. Parents often worry whether FBT-BN addresses comorbid depressive symptoms and low self-esteem. Our findings address this concern, as they demonstrate that FBT-BN does not differ from CBT-A in improving depressive symptoms and self-esteem, and both treatments result in symptom improvement. These findings can help clinicians guide families to choose a treatment that addresses BN and depressive symptoms and low self-esteem.

ObjectiveAnorexia nervosa (AN) is often first diagnosed in the adolescent years. The treatment with the greatest evidence during this time is family-based treatment (FBT). In FBT, siblings are expected to attend treatment sessions; however, sibling well-being during this time has not been well researched. This study aimed to explore sibling well-being when the ill child was initially diagnosed with AN and after FBT had been completed.MethodEighty-five parents and 55 siblings of adolescents with AN completed the Strengths and Difficulties Questionnaire at diagnosis. In addition, 88 parents and 46 siblings completed the Strengths and Difficulties Questionnaire after finishing treatment.ResultsMothers and fathers reported siblings to have lower levels of conduct problems in comparison with population norms. Mothers also reported lower levels of prosocial behaviours. Siblings reported higher levels of emotional difficulties and hyperactivity in comparison with their peers. There were no differences in reported psychosocial well-being of siblings between diagnosis and following FBT.ConclusionsSiblings of adolescents with AN have poorer psychosocial adjustment than their peers, both before and after FBT. Clinicians and parents are encouraged to be aware of sibling difficulties and seek additional support if required. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Objective: This pilot study examines the feasibility and the effectiveness of add‐on home treatment (HT) to family‐based treatment (FBT) in adolescents with anorexia nervosa (AN). The HT intervention is delivered by specialised nurses and aims at supporting patients and parents to re‐establish family meals in the home environment. Method: We performed a 3‐month study in AN patients with a waiting‐list control design comparing 45 (43 females, 2 males) adolescents receiving FBT augmented with HT compared to 22 (21 females, 1 male) participants receiving FBT alone on the waiting list for additional HT. Eating disorder diagnosis, psychopathology and severity of clinical symptoms were assessed using the Eating Disorder Examination (EDE) interview, the Eating Disorders Inventory (EDI‐2) and clinical parameters (BMI, menstrual status, level of over‐exercising) at baseline and after 3 months. Results: After 3 months of treatment, both treatment groups showed a significant early weight gain, a reduction in the rate of AN diagnoses assessed with the EDE interview and a reduction in EDI‐2 total scores. The combined HT/FBT group showed a significantly greater increase in BMI than the FBT‐only group. In the combined HT/FBT group, none of the patients had to be admitted to hospital, while three (13.6%) of the FBT‐only group had to be referred to inpatient treatment. Discussion: Our results suggest that HT augmented FBT might be useful compared to FBT alone in terms of early weight gain and might reduce the risk of hospital admission in adolescent AN. Key points: Home treatment as an add‐on to family‐based treatment seems to be a well‐accepted and very effective method for the treatment of eating disorders in adolescence.Combining family‐based treatment with home treatment thus seems to even enhance the therapy effectiveness of FBT in terms of initial weight gain as well as psychopathology [ABSTRACT FROM AUTHOR]

ObjectiveThis study aimed to describe the role of parent alliance in Family-Based Treatment (FBT) for adolescents with anorexia nervosa (AN). Differences between parent and child alliance with the therapist, mothers' and fathers' alliance, and their relationship to outcome were examined.MethodIndependent observers rated audiotapes of early therapy sessions to assess the therapeutic alliance of parents and adolescents with AN in FBT. Outcome was defined using a previously established cut-point for recovery from AN.ResultsMothers' and fathers' alliance scores with the therapist were similar and significantly higher than adolescent alliance scores early in treatment. Combined parent alliance did not predict recovery at the end of treatment. Difference in alliance scores between mothers and fathers, and parents and their child also did not predict recovery at the end of treatment.ConclusionsIn FBT, parents developed a strong alliance with the therapist early in treatment. These scores were consistent with the focus in FBT on parental management of eating disorder symptoms, as was the fact that alliance between adolescents and therapists was lower. Although parental therapeutic alliance was likely important in FBT, its role in treatment response remains uncertain.

Objective: This pilot study aimed to refine and test an adaption of family‐based treatment (FBT) for eating disorders that addressed the distinct clinical needs of adolescents with overweight or obesity in the absence of eating disorder pathology. Our hypothesis was that FBT for paediatric obesity (FBT‐PO) would be feasible to implement and superior to a nutrition education counselling (NEC) condition delivered to both parents and patients, thereby controlling for key information dissemination across groups while manipulating active therapeutic content and strategy. Method: Seventy‐seven adolescents were randomized to FBT‐PO or NEC across two sites. Results: Results supported our core prediction, in that weight status among adolescent study participants receiving FBT‐PO remained stable while increasing among participants randomized to NEC. Attrition was high in both conditions. Conclusions: FBT‐PO, while not seeming to yield a marked decrease in body mass index z‐score, may arrest an otherwise‐occurring weight‐gain trajectory for these adolescents. This efficacy finding is consistent with the overall PO literature supporting parental involvement in the treatment of PO. Future research efforts should address retention in FBT‐PO. [ABSTRACT FROM AUTHOR]

This study evaluated the effects of two treatments for adolescent bulimia nervosa (BN), family‐based treatment (FBT‐BN), and cognitive behavioral therapy (CBT‐A), on both attitudinal and behavioural outcomes at end‐of‐treatment. These associations were examined specifically relative to motivation for change in obsessive–compulsive (OC) features of eating disorder (ED) symptoms. Adolescents (N = 110) were randomly assigned to FBT‐BN or CBT‐A and completed assessments of eating pathology and OC‐ED behaviour. Across both treatments, greater motivation for change in OC‐ED behaviour was associated with improved attitudinal features of ED at end‐of‐treatment. Motivation for change did not demonstrate a direct or interaction effect on BN behavioural outcomes. Results suggest that adolescents with BN who are more motivated to change OC‐ED behaviours at the start of treatment, FBT‐BN or CBT‐A, are more likely to demonstrate improvements in cognitions, but not behaviours associated with EDs, at treatment conclusion. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study explored the relation between eating‐related obsessionality and weight restoration utilizing bivariate latent basis growth curve modelling. Eating‐related obsessionality is a moderator of treatment outcome for adolescents with anorexia nervosa (AN). This study examined the degree to which the rate of change in eating‐related obsessionality was associated with the rate of change in weight over time in family‐based treatment (FBT) and individual therapy for AN. Method: Data were drawn from a 2‐site randomized controlled trial that compared FBT and adolescent focused therapy for AN. Bivariate latent basis growth curves were used to examine the differences of the relations between trajectories of body weight and symptoms associated with eating and weight obsessionality. Results: In the FBT group, the slope of eating‐related obsessionality scores and the slope of weight were significantly (negatively) correlated. This finding indicates that a decrease in overall eating‐relating obsessionality is significantly associated with an increase in weight for individuals who received FBT. However, there was no relation between change in obsessionality scores and change in weight in the adolescent focused therapy group. Discussion: Results suggest that FBT has a specific impact on both weight gain and obsessive compulsive behaviour that is distinct from individual therapy. [ABSTRACT FROM AUTHOR]

Adolescents with anorexia nervosa who have obsessive-compulsive (OC) features respond poorly to family-based treatment (FBT). This study evaluated the feasibility of combining FBT with either cognitive remediation therapy (CRT) or art therapy (AT) to improve treatment response in this at-risk group. Thirty adolescents with anorexia nervosa and OC features were randomized to 15 sessions of FBT + CRT or AT. Recruitment rate was 1 per month, and treatment attrition was 16.6% with no differences between groups. Suitability, expectancy and therapeutic relationships were acceptable for both combinations. Correlations between changes in OC traits and changes in cognitive inefficiencies were found for both combinations. Moderate changes in cognitive inefficiencies were found in both groups but were larger in the FBT + AT combination. This study suggests that an RCT for poor responders to FBT because of OC traits combining FBT with either CRT or AT is feasible to conduct. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

This longitudinal study explored family functioning and relationship quality for adolescents with severe anorexia nervosa (AN). An important outcome given healthy family functioning supports effective adolescent development. Fifty-four female adolescents and their parents, treated with family-based treatment after inpatient admission, and 49 non-clinical age-matched adolescents and their parents were compared at assessment and 6 months after session 20. At baseline, AN group mothers and fathers reported poorer family function. AN adolescents were notably similar to controls, reporting poorer function in only one domain. There were no changes for adolescents, an improvement for mothers in the AN group, but an increase in perceived impairment for fathers in both groups, with AN fathers more affected. The similarity in adolescent reports and the increase for fathers over time may indicate that normal adolescent family processes occur even in the midst of serious illness. There is a need to provide intervention to ameliorate the impact of treatment on parents. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

Objective This study aims to examine the feasibility and acceptability of an Internet-based chat support group for parents implementing family-based treatment (FBT). Method Participants ( N = 13) were parents of adolescents with eating disorder who participated in 15 weekly online therapist-guided chat sessions. Sessions focused on encouraging and supporting parental efforts to help their child overcome an eating disorder. Results Chat programme satisfaction ratings were high (91.7%). Participants reported looking forward to chat sessions and would recommend the chat to others. The vast majority reported that the chat helped them cope with their child's eating disorder and to implement FBT. Participants reported feeling that they could talk openly and honestly in sessions and had a sense of belonging to the group. Relatively few technical problems were reported, and the chat was rated as accessible, convenient and easy to use. Discussion Findings provide preliminary support for the utility of an online parent chat as an adjunct to FBT. Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]