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Objective: Family‐based treatment (FBT) is an efficacious treatment for adolescent anorexia nervosa (AN). A parent‐only guided self‐help version of FBT (GSH‐FBT) demonstrated preliminary efficacy in pilot investigations. To address challenges in access to care, we adapted GSH‐FBT into a parent‐only multi‐family group format (MF‐GSH‐FBT) delivered via videoconferencing. Method: This report details the feasibility and acceptability of a parent‐only group‐based multi‐family GSH‐FBT (MF‐GSH‐FBT) for adolescent AN delivered virtually. The MF‐GSH‐FBT intervention consisted of 12 weekly 60‐min sessions facilitated by a clinician in addition to online FBT video content and recommended readings. Adolescents and parents completed assessments at baseline and post‐treatment. Parents reported their child's weight each week. Results: A total of 13 adolescents (15.57 + 1.63 years; 92% female; 23% Hispanic) with AN and their parents enrolled and initiated treatment. Four consecutive cohorts of groups of 3–4 families were completed from April 2022 to April 2023. Across cohorts, parents attended 85% of sessions. Most parents rated the treatment sessions as helpful (79%; agree/strongly agree) and felt supported by the other group members (84%). All parents (100%) reported MF‐GSH‐FBT helped their child, and most (90%) reported their child had improved by end‐of‐treatment. On average, adolescents gained 3.53 kg (SD: 3.76) from pre‐ to post‐treatment, with percent estimated mean body weight increasing 5% on average. Parental self‐efficacy also increased from baseline to end‐of‐treatment. Discussion: MF‐GSH‐FBT for AN appears feasible and acceptable to parents participating in this pilot study. Challenges with recruitment and adolescent data collection remain questions for future investigation. Public significance: This study describes initial pilot testing of a virtual guided self‐help family‐based treatment for adolescents with anorexia nervosa delivered in a multi‐family group format. This treatment aims to enhance access to family‐based treatment for anorexia nervosa whilst providing additional support to parents. [ABSTRACT FROM AUTHOR]

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.

BACKGROUND: Family-based treatment (FBT) is the first-line treatment for adolescent anorexia nervosa (AN). Yet, remission is not achieved for about half of adolescents with AN receiving FBT. Understanding patient- and parent-level factors that predict FBT response may inform treatment development and improve outcomes. METHODS: Network analysis was used to identify the most central symptoms of AN in adolescents who completed the Eating Disorder Examination (EDE) prior to FBT (N = 409). Bridge pathways between adolescent AN and parental self-efficacy in facilitating their childs recovery from AN were identified in a subset of participants (n = 184). Central and bridge symptoms were tested as predictors of early response (⩾2.4 kg weight gain by the fourth session of FBT) and end-of-treatment weight restoration [⩾95% expected body weight (EBW)] and full remission (⩾95% EBW and EDE score within 1 standard deviation of norms). RESULTS: The most central symptoms of adolescent AN included desiring weight loss, dietary restraint, and feeling fat. These symptoms predicted early response, but not end-of-treatment outcomes. Bridge symptoms were parental beliefs about their responsibility to renourish their child, adolescent discomfort eating in front of others, and adolescent dietary restraint. Bridge symptoms predicted end-of-treatment weight restoration, but not early response nor full remission. CONCLUSIONS: Findings highlight the prognostic utility of core symptoms of adolescent AN. Parent beliefs about their responsibility to renourish their child may maintain associations between parental self-efficacy and AN psychopathology. These findings could inform strategies to adapt FBT and improve outcomes.

Background: Although over one-third of adolescents presenting with restrictive eating disorders have a history of being overweight, there is no evidence-based treatment for atypical anorexia nervosa (AAN). Family-Based Treatment (FBT) is a feasible treatment and is routinely applied to treat atypical anorexia nervosa in adolescents; however, identifying a treatment target weight within FBT for these patients is a challenge. Objective: This study aimed to 1) increase understanding regarding recommendations for weight gain versus weight stabilization in FBT for adolescents with AAN and 2) examine treatment outcomes in FBT for adolescents with AAN. Method: Using a retrospective design, we reviewed the files of 41 patients with AAN who were referred for FBT at a pediatric eating disorder program located within a tertiary care health centre. Results: We found variability in recommendations for weight gain, with 56% of the sample recommended to gain weight and 44% recommended to stabilize weight. Baseline BMI for age appeared to be a key factor in establishing recommendations for weight gain. AAN patients in our sample gained a significant amount of weight across treatment, with those recommended to gain weight showing more weight gain during treatment. Forty-nine percent of the sample completed FBT; those patients displayed a mean of 10kg of weight gain during treatment. Conclusions: Findings suggest that many patients gained weight during the course of FBT for AAN. Further study on weight changes during FBT for adolescents with AAN and increased diagnostic consistency for AAN will be important for this field. [ABSTRACT FROM AUTHOR]

Schleider et al. (2023, International Journal of Eating Disorders, current issue) propose multiple applications of single‐session intervention (SSI) models to the eating disorders (EDs) intervention spectrum. In this commentary, we propose extending the potential of SSIs to target parents as agents of change for youth with restrictive EDs, particularly anorexia nervosa (AN). Directing SSIs to parents of children with AN can circumvent psychological barriers to care while capitalizing on the unique level of motivation in a parent to protect a child and advance their capacity to thrive. Key design components of effective SSIs map well onto the core principles of family‐based treatment (FBT), which can be distilled to inform the development of SSIs for parents of youth at risk or exhibiting emerging or diagnostic AN. The participatory action research framework highlighted by Schleider et al. (2023) speaks to the importance of developing SSIs using co‐design methodologies with parents. Doing so reflects the FBT principle of parent empowerment, acknowledges the research on parental self‐efficacy as a mediator of FBT, and recognizes parents as both key stakeholders in the prevention and treatment of child and adolescent EDs, and as the intended recipients of the SSIs created for this population. Public Significance: Schleider et al. (2023, International Journal of Eating Disorders, current issue) propose multiple applications of single‐session intervention (SSI) models to eating disorders (EDs). In this commentary, we extend the potential of SSIs to target parents as agents of change for youth with restrictive EDs. Parent‐focused SSIs can circumvent psychological barriers to care while capitalizing on the unique level of motivation in a parent to advance their child's capacity to thrive. [ABSTRACT FROM AUTHOR]

Family-based treatments for specific disorders have been shown to be efficacious and cost-effective. However, there is no transdiagnostic model for treatment-resistant, severely ill children and adolescents. This article describes a new family-based model, Intensive In-Home Family Treatment (IIFT) designed to fill this gap. IIFT is based on the theory that children and their families are in a state of bidirectional mutual influence that contributes to the child's mental health condition, which can be mitigated through clinical interventions. A case study highlights IIFT's underlying theory and demonstrates the interventions used to achieve significant clinical improvement and prevent higher-level mental health care. [ABSTRACT FROM AUTHOR]

ObjectiveThis 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.MethodSeventy-seven adolescents were randomized to FBT-PO or NEC across two sites.ResultsResults 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.ConclusionsFBT-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.

Objective: Misconceptions around which patients will and will not benefit from family‐based treatment (FBT) for adolescent eating disorders (EDs) limit referrals and access to this treatment modality. The present study explored whether common demographic and clinical factors that may prevent referral to FBT predict treatment outcomes in adolescent anorexia nervosa (AN) and bulimia nervosa (BN). Method: The following predictors of treatment outcomes were assessed: baseline family and diagnostic factors (socioeconomic status, comorbidity, illness duration, parent feelings of self‐efficacy, family status, prior treatment, sex and prior hospitalizations) in a combined sample of adolescents receiving FBT compared to those randomized to other treatment conditions, across six clinical trials in the United States and Canada (total n = 724, ages 12–18, 90% female across both diagnoses). AN and BN samples were examined separately. Results: Any prior ED treatment emerged as the only predictor of outcome in AN and BN, such that having no prior treatment predicted better outcomes in FBT for AN, and in both FBT and other treatment modalities for BN. No other sociodemographic or clinical variables predicted outcomes for AN or BN in FBT or in other evidence‐based treatment modalities. Conclusions: The findings of this exploratory analysis suggest that commonly assumed factors do not predict outcome in FBT. Specifically socioeconomic and demographic factors or clinical variability in families seeking treatment do not predict treatment outcomes in FBT, or other evidence‐based treatment modalities, with the exception of prior treatment. Providers should consider referring to FBT even when these factors are present. Public Significance: This manuscript reports that commonly assumed family, sociodemographic and diagnostic factors do not predict outcome in FBT or other evidence‐based treatment modalities, with the exception of prior treatment. This data may be helpful for providers when considering referrals to FBT in the context of variability in these variables. [ABSTRACT FROM AUTHOR]

Objective: Though virtual outpatient psychotherapy for eating disorders is likely effective, less is known about virtual higher levels of care. The current study examined the clinical outcomes of a family‐based virtual intensive outpatient program (vIOP) for youth with eating disorders which was developed in response to the COVID‐19 pandemic, compared to the same institution's in‐person partial hospital program (PHP). Methods: Treatment outcomes were assessed via chart review in 102 patients between the ages of 9–23 (M = 15.2, SD = 2.5) who were predominantly cisgender female (84.3%) and primarily diagnosed with anorexia nervosa (64.7%) or atypical anorexia (23.5%). Participants were either treated in the in‐person PHP before the pandemic (n = 49) or the vIOP during the pandemic (n = 53). Percent expected body weight (%EBW) was examined at baseline, end of treatment, 3‐months post‐treatment, and 6‐months post‐treatment, as well as the frequency of medical, psychiatric, and residential admissions before, during, and after vIOP or PHP participation. Results: Linear mixed models demonstrated no effect of treatment modality (in‐person versus virtual) on %EBW over time. The duration of the vIOP was, on average, 12 calendar days longer, though the amount billed for the vIOP was lower. Survival analyses and Cox regression models did not suggest differences in the frequency of hospital and residential treatment admissions during treatment (vIOP: 9.4%, PHP: 10.0%) or post‐treatment (vIOP: 15.0%, PHP: 10.2%). Discussion: Findings support virtual family‐based programs as suitable alternatives to in‐person treatment and underscore the potential cost‐effectiveness of a family‐based IOP versus PHP. Public Significance: This study demonstrates that a virtual, family‐based, intensive outpatient program for youth with eating disorders had similar treatment outcomes to an in‐person partial hospitalization program. Specifically, the virtual and in‐person programs had similar weight restoration outcomes and rates of medical, psychiatric, or residential treatment admissions during or after treatment initiation. Findings support the use of virtual treatment, even for youth requiring a high level of intervention. [ABSTRACT FROM AUTHOR]

Eating disorders are undoubtedly challenging for the adolescents experiencing them, but they can also be challenging for their parents. The current study employed a qualitative research design to examine the challenges endured by parents raising adolescents with eating disorders and undergoing a Family-Based Treatment (FBT) program. Six mothers of adolescents with anorexia nervosa or bulimia were interviewed about the challenges they face as parents of a child with an eating disorder and the changes they have had to make in their lives. Overall, results highlighted challenges from a personal, family, and parental role lens. Findings also call attention to the difficult responsibilities placed on parents during FBT programs such as involvement in their child's refeeding plan and the emotional toll their child's experience places on them. Implications for the level of support needed by parents are discussed according to their role in FBT programs. [ABSTRACT FROM AUTHOR]

Objective: Although family‐based treatment (FBT) is considered a first‐line treatment for adolescent anorexia nervosa (AN), it is underutilized in community settings and is unavailable to many families for a multitude of practical reasons (e.g., costs of treatment, transportation constraints). Adapting FBT interventions for delivery in home‐based and community‐based settings may reduce pragmatic barriers to treatment uptake and engagement. Methods: This pilot effectiveness‐implementation trial will assess outcomes, implementation, and mechanisms of FBT adapted for the home setting (FBT‐HB), delivered in the context of community‐based behavioral health agencies. Adolescents with AN‐spectrum disorders (n = 50) and their caregivers will be randomly assigned to either FBT‐HB or home‐based treatment as usual (TAU; integrated family therapy approach). Caregivers and adolescents will provide data on weight, eating, and putative treatment mechanisms, including caregiver self‐efficacy and adolescent eating‐related and weight‐related distress. Implementation constructs of feasibility, acceptability, and appropriateness will be measured among providers and participating families. Hypotheses: We expect that FBT‐HB will be feasible, acceptable, and appropriate, and will outperform TAU in terms of improvements in adolescent weight and eating‐related psychopathology. We further expect that caregiver self‐efficacy and adolescent eating‐related and weight‐related distress, but not general distress, will show greater improvements in FBT‐HB relative to TAU and will be associated with better adolescent weight and eating outcomes in FBT‐HB. Potential implications: The proposed study has clear potential to advance scientific and clinical understanding of the real‐world effectiveness of FBT for AN, including whether adapting it for the home setting improves its accessibility and effects on treatment outcome. [ABSTRACT FROM AUTHOR]

Objective: Data suggest that obsessive–compulsive (OC) symptoms are commonly observed in adolescents with eating disorders and predict poorer treatment response. Further, emerging data among adults suggest that changes in OC symptoms relate to changes in eating disorder symptoms across treatment. Given evidence that early invention decreases risk for protracted illness, evaluating processes that may relate to treatment response will be useful in increasing the effectiveness of existing interventions. Therefore, the current investigation explored changes in general and eating disorder‐specific OC symptoms throughout family‐based treatment (FBT) and cognitive behavioral therapy (CBT) for bulimia nervosa (BN), as well as associations among these changes and eating disorder outcomes at follow‐up. Method: Participants (N = 110) received 18 sessions of FBT or CBT and completed measurements of general and eating disorder‐specific OC symptoms at baseline, end‐of‐treatment, and 6‐ and 12‐month follow‐up. Results: Multilevel models indicated that across both treatments, there was no change in general OC symptoms, whereas all eating disorder‐related OC symptoms decreased over treatment and follow‐up. Exploratory analyses indicated that lower severity in discharge eating‐disorder‐specific OC symptoms contributed to lower eating pathology at follow‐up. Discussion: Together, findings support the efficacy of both FBT and CBT in helping to reduce eating disorder‐specific OC symptoms and suggest that adjunctive intervention may be required for ameliorating general OC symptoms in this population. Public significance: BN is associated with significant increases in mortality and societal cost, and there is a pressing need for innovations within available treatments for young people with this disorder. In the current study, we explore the extent to which existing evidence‐based treatments for adolescent BN are effective in targeting obsessive–compulsive symptoms, a known predictor of treatment response and common co‐morbidity in this population. [ABSTRACT FROM AUTHOR]

Background: Family-based treatment (FBT) is an efficacious intervention for adolescents with an eating disorder. Evaluated to a lesser degree among adolescents, enhanced cognitive-behavior therapy (CBT-E) has shown promising results. This study compared the relative effectiveness of FBT and CBT-E, and as per manualized CBT-E, the sample was divided into a lower weight [<90% median body mass index (mBMI)], and higher weight cohort (⩾90%mBMI). Method: Participants (N = 97) aged 12–18 years, with a DSM-5 eating disorder diagnosis (largely restrictive, excluding Avoidant Restrictive Food Intake Disorder), and their parents, chose between FBT and CBT-E. Assessments were administered at baseline, end-of-treatment (EOT), and follow-up (6 and 12 months). Treatment comprised of 20 sessions over 6 months, except for the lower weight cohort where CBT-E comprised 40 sessions over 9–12 months. Primary outcomes were slope of weight gain and change in Eating Disorder Examination (EDE) Global Score at EOT. Results: Slope of weight gain at EOT was significantly higher for FBT than for CBT-E (lower weight , est. = 0.597, s.e. = 0.096, p < 0.001; higher weight , est. = 0.495, s.e. = 0.83, p < 0.001), but not at follow-up. There were no differences in the EDE Global Score or most secondary outcome measures at any time-point. Several baseline variables emerged as potential treatment effect moderators at EOT. Choosing between FBT and CBT-E resulted in older and less well participants opting for CBT-E. Conclusions: Results underscore the efficiency of FBT to facilitate weight gain among underweight adolescents. FBT and CBT-E achieved similar outcomes in other domains assessed, making CBT-E a viable treatment for adolescents with an eating disorder. Clinical Trial Registration Information: Treatment Outcome in Eating Disorders; https://clinicaltrials.gov/ ; NCT03599921. [ABSTRACT FROM AUTHOR]

Family‐based treatment (FBT) is an evidence‐based treatment for adolescent eating disorders that incorporates many principles from family therapy. It uses the externalisation of anorexic thoughts and behaviours to separate the person from the anorexia nervosa (AN) through language and metaphor. Little is known about how clinicians understand, conceptualise and support families to externalise. Semi‐structured interviews conducted with FBT‐trained clinicians working in child and adolescent mental health services were analysed using thematic analysis. Three themes emerged: the clinician's use of externalisation, the impact on family functioning and the barriers to externalisation. Externalisation can support a young person's recovery from AN when used in conjunction with other therapeutic skills. Clinicians should be aware of potential barriers to the implementation of externalisation, such as problem awareness, age and duration of illness. Practitioner pointsClinicians value externalisation as an important therapeutic technique within the FBT model, while acknowledging that the 'ED as illness' metaphor can challenge their own beliefs.Externalisation can improve family functioning, family communication and reducing conflict within relationships in families with AN.Lack of insight into the AN can present as a barrier to externalisation for a young person. [ABSTRACT FROM AUTHOR]

Guided self-help has become an important treatment option in the field of eating disorders as access to in person evidence-based treatments is limited. Given the scant amount of literature published on guided self-help for the treatment of eating disorders in the child and adolescent population, our aim was to describe online GSH-FBT sessions in detail as conducted as part of a larger feasibility study, examining quotations from therapists that illustrate the GSH-FBT stance and also describing how online GSH-FBT differs from FBT delivered by videoconferencing within a descriptive case report. [ABSTRACT FROM AUTHOR]

Objective: This report describes the feasibility, acceptability, and outcomes from a pilot randomized clinical trial (RCT) comparing an online guided self‐help program version of family‐based treatment (GSH‐FBT) for parents with a child with DSM‐5 anorexia nervosa (AN) to FBT delivered via videoconferencing (FBT‐V). Method: Between August 2019 and October 2020, 40 adolescents ages 12–18 years with DSM‐5 AN and their families were recruited at two sites and randomized to either twelve 20‐min guided sessions of GSH‐FBT for parents or fifteen 60‐min sessions of FBT‐V for the entire family. Recruitment, retention, and acceptability of treatment were the primary outcomes. Secondary outcomes were changes in weight, eating disorder examination (EDE), parental self‐efficacy, weight remission, full remission, and outcome efficiency (therapist time needed to achieve treatment outcomes). Results: Descriptive data are reported. Recruitment and retention rates are similar to RCTs using in‐person treatments. Both treatments received similar acceptability rates. Medium and large effect sizes (ES) related to improvements in weight, EDE, parental self‐efficacy, and remission were achieved in both treatments and were maintained at a 3‐month follow‐up. Clinical outcomes between groups were associated with a small ES. Differences in efficiency (outcome/therapist time) were associated with a large ES difference favoring GSH‐FBT. Discussion: These data support the feasibility of conducting an adequately powered RCT comparing online GSH‐FBT to FBT‐V to determine which approach is more efficient in achieving improvements in clinical outcomes in adolescents with AN. [ABSTRACT FROM AUTHOR]

Objective: Stepped‐care models of treatment are underexplored in eating disorders. To enhance treatment outcomes, and informed by literature about adaptations to family‐based treatment (FBT), we developed an FBT‐based stepped‐care model for adolescents with anorexia nervosa (AN) that was consistent with family preference (i.e., tailored) and responsive to adolescent needs (i.e., intensity). The aim of this study was to evaluate the effectiveness of this model in terms of remission at end‐of‐treatment. Method: Adolescents (N = 82), aged 12–18 years (M = 15.1, SD = 1.8) and meeting Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria for AN, were assessed at baseline, Weeks 24 and 48. FBT was tailored to family preference and clinical need, with 16–18 sessions by Week 24. This was followed by three FBT booster sessions or an extension of FBT plus booster sessions (Week 48). The primary outcome was defined as weight > 95% of %median body mass index plus within 1 SD of the Eating Disorder Examination (EDE) global score community norms. Results: Remission rates were 45.1% and 52.4% at Weeks 24 and 48, respectively. Commensurable improvements were evident across secondary outcomes (e.g., EDE subscale scores). As a reference point, remission rates compared positively with results from a recent randomized clinical trial from the same center and at the same time points (Week 24:45.1% vs. 32.1% and Week 48:52.4% vs. 30.2%). Controlling for propensity score, no statistically significant differences were observed. Discussion: This stepped‐care model, designed to be responsive to the individual needs of adolescents and their families, achieved encouraging rates of remission. This study provides an important signal that supports future clinical trials of stepped‐care models for adolescents with AN. [ABSTRACT FROM AUTHOR]

Összefoglaló. Az 1-es típusú diabetes mellitus (T1DM-) betegek körében az evészavarok előfordulása az átlagpopulációhoz képest körülbelül kétszeresre tehető. Ez a komorbiditás különösen veszélyes mind a magas mortalitási rizikó, mind a súlyos szövődmények lehetősége miatt. Az evészavarban szenvedő, T1DM-mel élő gyermekek és fiatalok hatékony kezelése a diabetológusok, pszichiáterek, pszichológusok, nővérek és dietetikusok összehangolt munkájával valósítható meg. Közleményünkben egy 14,5 éves, T1DM-mel élő, anorexia nervosával diagnosztizált páciensünk multidiszciplináris terápiáját mutatjuk be, kiemelve a különböző szakemberek együttműködésének főbb metszéspontjait. A szoros diabetológiai gondozással párhuzamosan az anorexia nervosa terápiájában a protokollok ajánlásaival megegyezően családterápiát és kognitív viselkedésterápiás elemekkel bővített egyéni terápiát alkalmaztunk. A terápiás folyamat összesen 18 hónapig tartott. Esetünk korábban le nem írt diabetológiai érdekessége, hogy a számottevő súlycsökkenéssel párhuzamosan betegünk inzulinigénye a töredékére csökkent, ami jelentős mértékben érintette a bazálisinzulin-szükségletet is. Orv Hetil. 2021; 162(33): 1341–1346. Summary. The incidence of eating disorders is approximately twice as high in type 1 diabetes mellitus (T1DM) compared to the general population. Comorbidity is related to potentially severe organ complications and consequently higher mortality risk. The effective treatment of eating disorders in T1DM is provided by the teamwork of diabetologists, psychiatrists, psychologists, nurses and dietitians. The purpose of this paper is to present the multidisciplinary treatment of a 14.5-year-old adolescent with T1DM and diagnosed with anorexia nervosa, focusing on the cooperation of the professionals. In line with the current guidelines, both family therapy and cognitive behavioral therapy-informed individual psychotherapy were applied beside the strict diabetes control. Her therapy process lasted 18 months. The unusual diabetological aspect of our case is that the significant weight loss was associated with highly decreased insulin requirement affecting also the basal insulin requirements. Orv Hetil. 2021; 162(33): 1341–1346. [ABSTRACT FROM AUTHOR]

ObjectiveLong-term follow-up studies documenting maintenance of treatment effects are few in adolescent anorexia nervosa (AN). This exploratory study reports relapse from full remission and attainment of remission during a 4-year open follow-up period using a convenience sample of a subgroup of 65% (n = 79) from an original cohort of 121 participants who completed a randomized clinical trial comparing family-based therapy (FBT) and adolescent-focused individual therapy (AFT).MethodFollow-up assessments were completed up to 4 years posttreatment (average, 3.26 years). Available participants completed the Eating Disorder Examination as well as self-report measures of self-esteem and depression at 2 to 4 years posttreatment.ResultsTwo participants (6.1%) relapsed (FBT: n = 1, 4.5%; AFT: n = 1, 9.1%), on average 1.98 years (SD = 0.14 years) after remission was achieved at 1-year follow-up. Ten new participants (22.7%) achieved remission (FBT: n = 1, 5.9%; AFT: n = 9, 33.3%). Mean time to remission for this group was 2.01 years (SD = 0.82 years) from 1-year follow-up. There were no differences based on treatment group assignment in either relapse from full remission or new remission during long-term follow-up. Other psychopathology was stable over time.ConclusionThere were few changes in the clinical presentation of participants who were assessed at long-term follow-up. These data suggest that outcomes are generally stable posttreatment regardless of treatment type once remission is achieved. Clinical trial registration information-Effectiveness of Family-Based Versus Individual Psychotherapy in Treating Adolescents With Anorexia Nervosa; http://www.clinicaltrials.gov/; NCT00149786.

Objective: This study describes the implementation of family‐based treatment (FBT) in an eating disorder program in Asia as well as clinical outcomes of Asian adolescents with anorexia nervosa (AN) treated with FBT. Method: This retrospective consecutive cohort study of 147 Asian adolescents with AN was compared between those in FBT (n = 65) versus treatment as usual (TAU) (n = 82). Variables associated with weight restoration were analyzed between groups. Results: Participants' mean age was 14.2 (SD = 1.5) years and 93% were female. Mean presenting %mBMI was 74.0 (SD = 7.8) and average illness duration was 7.7 (SD = 6.1) months. The two groups' baseline characteristics were not significantly different. Weight restoration rates in the FBT group were significantly higher than the TAU group at 6‐, 12‐, and 24‐month time points. A linear mixed model showed the mean %mBMI was significantly higher at 0, 6, 12, and 24 months in the FBT group. The median time to weight restoration for patients on FBT was shorter (FBT: 7.0 months, TAU: 19.0 months; 95% CI [14.5, 23.5] χ2 = 15.84, p <.001). Within the FBT group, those that completed ≥9 FBT sessions had significantly higher rates of weight restoration at 12 months. Across all participants, those with a lower starting %mBMI were less likely to achieve weight restoration by 12 months. Conclusion: FBT can be effectively implemented in a multidisciplinary eating disorder program managing Asian adolescents with AN with improved rates of weight restoration. Further research is needed to understand the predictors and moderators of remission using FBT in Asian adolescents with AN. [ABSTRACT FROM AUTHOR]

Objective: Rates of psychiatric comorbidity are elevated in adolescents with anorexia nervosa, but little is known about how psychiatric comorbidity changes following family‐based treatment (FBT). Methods: Adolescents 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. Results: Rates 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 <.05). Individuals with reported psychotropic medication use were less likely to meet criteria for a comorbid condition at end of treatment (b = −1.63, p =.04). Diagnostic rates for major depressive disorder, generalized anxiety disorder, and panic disorder/agoraphobia decreased following FBT. Conclusions: Findings suggest that FBT for adolescent anorexia nervosa may aid in the resolution of some co‐occurring psychiatric diagnoses. Continued research is needed to understand factors contributing to comorbid symptom improvement throughout treatment. [ABSTRACT FROM AUTHOR]

Family-based treatment (FBT) for anorexia nervosa (AN) is an empirically supported treatment for this disorder. Derived from several different schools of family therapy, it is a highly focused approach that initially targets weight restoration under parental management at home. However, the view that manualized FBT is solely a behavioral therapy directing parents to refeed their children AN with the single purpose of weight gain is a common but misleading over simplification of the therapy. Indeed, weight restoration is the main goal only in phase 1 of this 3-phase treatment. When practiced with fidelity and skill, FBT's broadest aim is to promote adolescent development without AN thoughts and behaviors interfering and disrupting these normal processes. Although weight restoration is a key starting point in FBT, the entire course of treatment takes into consideration the ongoing impact of starvation, cognitions, emotions, and behaviors on adolescent development. These factors associated with maintaining low weight are viewed in FBT as interfering with the adolescent being able to take up the tasks of adolescence and thus must be overcome before fully turning to those broader adolescent tasks. In addition, FBT recognizes that adolescence takes place in the context of family and community and respects the importance of learning in a home environment both for weight gain as well as related developmental tasks to have a lasting effect. Specifically, in this article we describe how the current FBT manualized approach addresses temperament/personality traits, emotional processing, cognitive content and process, social communication and connections, psychiatric comorbidity, and family factors. This report makes no claim to superiority of FBT compared to other therapies in addressing these broader concerns nor does it add interventions to augment the current manual to improve FBT. [ABSTRACT FROM AUTHOR]

Anorexia Nervosa (AN) is a serious psychiatric disorder that manifests physically, resulting in severe detriment of the individual’s appearance and psychiatric profile. Among the predisposing factors of AN that cause an individual to be susceptible to its manifestations include genotypic influential risks, psychosocial and interpersonal parameters can cause the ailment’s inception. Moreover, from the somatic perspective, any alteration or substantial changes to the neural networks can prolong the duration of the illness. Advanced milestones in the therapeutic approach and treatment of this illness, especially in the adolescent age group afflicted with Anorexia Nervosa highlights the paramount benefits of implementing a specialised family oriented/based intervention. Adults suffering from Anorexia Nervosa have a plausible opportunity to experience recovery or dramatic improvement, paying close attention that there are no specific methods that take precedent in adult therapy. Furthermore, an eclectic combination of both guided nourishment and psychotherapeutic techniques specific for the treatment of Anorexia Nervosa have yielded promising results. To properly approach and treat this multi-faceted illness, an in depth comprehension of the causative biological and psychosocial mechanisms, must be attained modification and implementation of prevention and early interventional protocols and procedures, all the latter while grasping a more catered targeting strategy for treatment through an in depth comprehension of the disease’s specific pathophysiology and mechanism. [ABSTRACT FROM AUTHOR]

Objective: This 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. Method: One 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. Results: There were differences in adherence scores within and between sites. ANOVA produced a main effect for site, F(5, 46) = 8.6, p <.001, and phase, F(3, 42) = 12.7, p <.001, with adherence decreasing in later phases. Adherence was not associated to end of treatment percent ideal body weight after controlling for baseline percent ideal body weight (r =.088, p =.48). Conclusions: Results suggest that FBT can be delivered with adherence in phase one of treatment. Adherence was not associated with treatment outcome as determined using percent ideal body weight. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Family‐based treatment (FBT) is an evidence‐based approach to anorexia nervosa in young people. Because it is not always successful, attention has been given to how families experience the treatment. A number of therapists have proposed possible additions to, or improvements in, the model. In successful cases relational containment may be achieved in the first phase of treatment. The treatment is often successful, but when initial goals, such as weight recovery, are not achieved, continuing to use the techniques described in the manual may become unhelpful. Sometimes therapists may need to address issues such as emotion coaching that are not specifically addressed in the FBT model. We describe a case in which the therapist addressed the family's emotional style in the first stage of treatment. This focus enabled progress to be achieved despite the adolescent's continuing difficulty in eating without parental support, and her escalating symptoms of anxiety and obsessional compulsive disorder (OCD). Therapy helped the adolescent and family understand that anorexic and OCD symptoms can be understood as a way of distracting from and managing distress. When this connection was made in therapy, the parents could help their daughter to manage distress in more adaptive ways. Parents may need help with their own difficulties in processing distress. In this case the parents needed the opportunity to resolve feelings of grief about a miscarriage in order to do so. We propose that therapy should address family difficulties with managing distress from an early stage. [ABSTRACT FROM AUTHOR]

Objective: This study tested clinical utility of the DSM‐5 severity specifier for bulimia nervosa (BN) in predicting treatment response among adolescents (N = 110) within a randomized clinical trial of two psychosocial treatments. Method: Analyses grouped individuals meeting criteria for BN diagnosis by baseline severity, per DSM‐5. Associations among baseline severity classification and BN behavior (i.e., binge eating and compensatory behavior) and eating disorder examination (EDE) Global scores at end‐of‐treatment (EOT), 6‐ and 12‐month follow‐up were examined. Results: Associations between severity categories with BN symptoms were not significant at EOT, or follow‐up. Test for linear trend in BN behavior was significant at EOT, F = 5.23, p = 0.02, without demonstrating a linear pattern. Relation between severity categories with EDE Global scores was significant at 6‐month follow‐up, F = 3.76, p = 0.01. Tests for linear trend in EDE Global scores were significant at EOT, F = 5.40, p = 0.02, and at 6 months, F = 10.73, p = 0.002, with the expected linear pattern. Discussion: Findings suggest the DSM‐5 BN severity specifier holds questionable utility in anticipating outpatient treatment response in adolescents with BN. The specifier may have improved ability to predict attitudinal rather than behavioral treatment outcomes. [ABSTRACT FROM AUTHOR]

Given the lack of clear consensus on effective treatment models for adolescent anorexia nervosa in Japan, treatment programs offered to this population vary widely between treatment facilities with limited testing of outcomes. Importantly, families have traditionally been left out of the core treatment process, as they are commonly viewed as being powerless in renourishing their child. The purpose of this commentary was to report the authors' preliminary efforts to introduce and implement family‐based treatment (FBT) in Japan so that, on par with international standards of practice, FBT may become the first‐line treatment option for Japanese families. This commentary will describe the systemic and cultural barriers which posed as challenges in introducing FBT to Japan in its manualized standard format and how these were addressed by introducing FBT during the patient's hospital admission and by assigning the father with a role which resembles the traditional gender role within the Japanese family culture. Authors have thus far observed that these adaptations led to increased accessibility of FBT and improved outcomes such as reduced number of hospitalizations and shorter time taken to reach 85–90% EBW. Further considerations for the broad dissemination and implementation of FBT in Japan are also presented. [ABSTRACT FROM AUTHOR]

Objective: Our aim was to investigate the benefit of ongoing family-based treatment (FBT) sessions for adolescent anorexia nervosa if remission criteria were not met at session 20. Method: Participants were 69 medically unstable adolescents with Diagnostic and Statistical Manual of Mental Disorders (4th ed; DSM-IV) anorexia nervosa from a randomized controlled trial investigating length of hospital admission prior to outpatient FBT. Participants were divided post hoc into those meeting remission criteria at session 20 (n = 16), those that had not remitted but continued with FBT (n = 39) and those who ceased FBT undertaking alternative treatments (n = 14). Outcome was assessed as remission and hospital readmission days at 12 months after FBT session 20. Results: There were no differences between groups at baseline. There was a significant difference in the use of hospital admission days with those in the Alternate Treatment Group who did not continue with FBT using 71.93 days compared to those in Additional FBT Group with only 12.51 days (F(2, 66) = 13.239, p < .01). At 12 months after FBT session 20, the Additional FBT Group had a 28.2% increase in remission rate, significantly higher than those in the Alternate Treatment Group (χ2(2) = 17.68, p < .001). Discussion: Continuing FBT after session 20 if remission is not achieved can significantly reduce hospital readmission days and improve remission rates. [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]

Abstract: Objective: Family‐based treatment (FBT) is an efficacious treatment for adolescent eating disorders, yet it is not routinely implemented in clinical practice. Given that consumers play a role in treatment selection, this study sought to examine families’ perspectives on FBT and remission markers associated with increased treatment satisfaction across families. Method: Participants were 40 adolescents and 43 caregivers who received outpatient FBT. FBT helpfulness was assessed using a treatment follow‐up questionnaire, and eating disorder symptomatology was assessed using percent expected body weight (%EBW) and the eating disorder examination (EDE). Regression analyses were used to assess whether changes in symptoms from baseline to end‐of‐treatment (EOT) were significantly associated with helpfulness reports. Results: On average, patients and their parents perceived FBT as “quite helpful” and “extremely helpful,” respectively. Improvements in all EDE subscales, with the exception of restraint, were significantly associated with adolescent report of helpfulness (all p < .05); increase in %EBW was significantly associated with maternal report of helpfulness (p = .03). There were no significant findings for paternal report. Discussion: Both patients and their parents perceived FBT as helpful, but patients seemed to prioritize cognitive improvements while mothers prioritized physical improvements in rating their satisfaction with FBT. [ABSTRACT FROM AUTHOR]

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Objective This study aimed to examine the trajectory of symptom remission and affective functioning throughout the course of two family-based treatments for adolescent anorexia nervosa (AN): conjoint family-based treatment (FBT) and parent-focused treatment (PFT). Method Participants were 107 adolescents ( Mage = 15.5 years, SD = 1.5) with a primary diagnosis of AN who participated in a randomized clinical trial comparing FBT ( N = 55) and PFT ( N = 51). Patient weight and self-reported assessments of dietary restraint and positive and negative affect were recorded at regular intervals throughout treatment. Results Multilevel models revealed increases in weight (β = 0.33, p < .001) and positive affect (β = 0.03, p < .001), and decreases in dietary restraint (β = -0.03, p < .001) and negative affect (β = −0.04, p < .001) over the course of treatment. No significant effects emerged by treatment type. Discussion These findings suggest that PFT may bring about comparable trajectories of weight gain and reduced dietary restraint as conjoint FBT, despite adolescents not being directly involved in treatment. These findings also highlight that the exclusively behavioral focus throughout both PFT and FBT is associated with significant increments in positive affect and significant reductions in negative affect. [ABSTRACT FROM AUTHOR]

Enhanced cognitive behaviour therapy (CBT-E) is the first-line treatment for bulimia nervosa (BN) in adulthood. There is limited evidence for therapies for children and adolescents with BN; however family-based treatment (FBT) is being increasingly used. This case study contrasts the delivery of FBT with an augmented version (CBT-E) in two adolescents presenting with BN. In both cases, the adolescents achieved remission from BN symptoms, (cessation of bingeing and compensatory behaviour) at the end of treatment. The families reported that FBT provided a platform for them to work together and view BN as a family issue, rather than leaving the onus on the young person to recover independently. The addition of CBT-E strategies assisted with managing cognitions associated with bodyweight and shape concerns and appeared to be useful in a more complex presentation with comorbidities. Future research should examine the effectiveness of augmenting CBT-E strategies to FBT using larger samples and more rigorous research designs. Practitioner points Involving families in the treatment of adolescent BN is both effective and acceptable to young people and their families., Two promising treatment approaches, FBT-BN and CBT-E, can effectively be combined to provide a therapy which has the strengths of both modalities alone., Adolescents with comorbidities or complex presentations may benefit most from combining the two modalities to develop additional skills and strategies. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Examine relationships between parental mealtime strategies used in the family meal session of family-based treatment (FBT) and adolescent outcomes at EOT (session 20). Method Eighteen families with an adolescent receiving FBT-AN participated. Parental strategies during videoed family meals were assessed using a family mealtime coding system. Change scores were calculated for both adolescent %EBW and EDE scores. Results Increased use of parental direct and non-direct eating prompts during the family meal was associated with greater adolescent weight gain at EOT. Use of parental mealtime strategies was not associated with any significant change in adolescent eating psychopathology at EOT. Discussion Parental verbal eating prompts during the family meal may be effective in promoting short-term weight gain. During the family meal session, parents should be encouraged to maintain a direct focus on their adolescent child's eating behaviour which may assist their child with food consumption and potential weight gain. Further research examining food-based interactions among parents and their adolescent child with AN is needed. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:433-436) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Anorexia nervosa (AN) is a severe psychiatric illness with little evidence supporting treatment in adults. Among adolescents with AN, family-based treatment (FBT) is considered first-line outpatient approach, with a growing evidence base. However, research on FBT has stemmed from specialist services in research/public health settings. This study investigated the effectiveness of FBT in a case series of adolescent AN treated in a private practice setting. Method Thirty-four adolescents with full or partial AN, diagnosed according to DSM-IV criteria, participated, and were assessed at pretreatment and post-treatment. Assessments included change in % expected body weight, mood, and eating pathology. Results Significant weight gain was observed from pretreatment to post-treatment. 45.9% of the sample demonstrated full weight restoration and a further 43.2% achieved partial weight-based remission. Missing data precluded an examination of change in mood and ED psychopathology. Discussion Effective dissemination across different service types is important to the wider availability of evidence-based treatments. These weight restoration data lend preliminary support to the implementation of FBT in real world treatment settings. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1023-1026) [ABSTRACT FROM AUTHOR]

Objective: To study the effect of clearly defined and decisive parental interventions at the start of treatment of restrictive eating disorders (ED) in adolescents. Method: Forty-seven adolescents with ED (anorexia nervosa = 6, bulimia nervosa = 1, EDNOS = 40) and their families participated. Parents were advised to (1) keep the adolescent home from school, (2) eat all meals together with the adolescent, (3) prevent any form of exercise, and (4) prevent vomiting during the first week of treatment. Weight change was followed up to three months and EDE-Q administered at start of treatment and at three months. Results: Thirty (64%) of the families accomplished all four interventions during the first week of treatment. Their adolescents gained ~1 kg of weight at one week, 2 kg at one month, and 4 kg at three months while adolescents in families who did not accomplish all four interventions gained only 1.4 kg up to three months. Scores on the EDE-Q decreased during treatment and in adolescents of families who accomplished all four interventions they were in the range of a reference population. Discussion: Decisive parental management of eating disturbed behaviors at the start of treatment of adolescents with ED promotes later clinical outcome. The finding supports the view that family based therapies are effective in adolescent ED. Results has to be followed up for evaluation of the long term effects of this type of intervention. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective To determine whether increases in adolescent or parental self-efficacy predicted subsequent weight gain in two different therapies for adolescent anorexia nervosa (AN). Method Participants were 121 adolescents with AN ( M = 14.4 years, SD = 1.6), from a two-site randomized clinical trial for family-based treatment (FBT) and individual adolescent focused therapy (AFT). Both adolescent and parental self-efficacy were assessed at baseline and sessions 2, 4, 6, and 8. Adolescent self-efficacy was assessed using a generic measure of self-efficacy, while parental self-efficacy was assessed using a measure specific to the recovery of an eating disorder. Weight was assessed at baseline, sessions 1 through 8, and end of treatment. Mixed-effects models were used to evaluate the relation between patient and parent self-efficacy and subsequent weight gain, controlling for weight at the previous time point. Results For families who received FBT, greater within-treatment increases in parental self-efficacy predicted greater subsequent adolescent weight gain compared to those who received FBT with lesser change in parental self-efficacy and those who received AFT. Interestingly, adolescent self-efficacy did not significantly predict subsequent weight gain. Discussion Greater increases in parental self-efficacy predicted significantly greater subsequent weight gain for adolescents who received FBT, but the same was not true for adolescents who received AFT. Neither overall level nor change in adolescent self-efficacy significantly predicted subsequent weight gain in either treatment group. These findings emphasize the importance of increasing parental self-efficacy in FBT in order to impact adolescent weight outcomes. © 2015 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:883-888) [ABSTRACT FROM AUTHOR]

A growing body of evidence suggests that the prevalence of male body dissatisfaction and muscle dysmorphia is rising. To date, however, there is no published evidence on the efficacy of treatments for muscle dysmorphia. We present the case of a 15-year-old boy who met full diagnostic criteria for muscle dysmorphia, whose symptoms were treated into remission with eating disorder-focused, family-based treatment. The age of this patient fell within the time period in which symptoms of muscle dysmorphia are most likely to develop and this case represents the first published case report of family-based treatment for muscle dysmorphia in this age group. Thus, this case report has important implications for clinicians considering treatment options for presentations of muscle dysmorphia when first presenting in adolescence. Implications for the development of treatment guidelines for muscle dysmorphia and for the diagnostic debate surrounding muscle dysmorphia are also discussed. [ABSTRACT FROM PUBLISHER]

There is increasing research evidence that family-based treatment ( FBT) is the most effective form of treatment currently available for adolescents with anorexia nervosa, while preliminary evidence suggests that it may also be effective for adolescents with bulimia nervosa. Originally designed as a weekly outpatient treatment, FBT's efficacy has led to its adaptation for use in other treatment settings, such as partial hospitalization or intensive outpatient programmes. Although FBT cannot be replicated in these treatment settings, FBT principles can be borrowed and implemented. This article reviews challenges that arise when incorporating FBT into more intensive treatment settings while attempting to remain true to the intent of the original treatment approach. Practitioner points FBT cannot be replicated in higher levels of care, but FBT principles can be effectively incorporated into a day treatment programme for eating disorders., Challenges in incorporating FBT into higher levels of care include adequate parental involvement and empowerment. [ABSTRACT FROM AUTHOR]

BackgroundAnorexia nervosa (AN) is a serious disorder incurring high costs due to hospitalization. International treatments vary, with prolonged hospitalizations in Europe and shorter hospitalizations in the USA. Uncontrolled studies suggest that longer initial hospitalizations that normalize weight produce better outcomes and fewer admissions than shorter hospitalizations with lower discharge weights. This study aimed to compare the effectiveness of hospitalization for weight restoration (WR) to medical stabilization (MS) in adolescent AN.MethodWe performed a randomized controlled trial (RCT) with 82 adolescents, aged 12–18 years, with a DSM-IV diagnosis of AN and medical instability, admitted to two pediatric units in Australia. Participants were randomized to shorter hospitalization for MS or longer hospitalization for WR to 90% expected body weight (EBW) for gender, age and height, both followed by 20 sessions of out-patient, manualized family-based treatment (FBT).ResultsThe primary outcome was the number of hospital days, following initial admission, at the 12-month follow-up. Secondary outcomes were the total number of hospital days used up to 12 months and full remission, defined as healthy weight (>95% EBW) and a global Eating Disorder Examination (EDE) score within 1 standard deviation (s.d.) of published means. There was no significant difference between groups in hospital days following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome but participants with higher eating psychopathology and compulsive features reported better clinical outcomes in the MS group.ConclusionsOutcomes are similar with hospitalizations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalization with FBT. [ABSTRACT FROM PUBLISHER]

ABSTRACT Objective Family functioning impairment is widely reported in the eating disorders literature, yet few studies have examined the role of family functioning in treatment for adolescent anorexia nervosa (AN). This study examined family functioning in two treatments for adolescent AN from multiple family members' perspectives. Method Participants were 121 adolescents with AN ages 12-18 from a randomized-controlled trial comparing family-based treatment (FBT) to individual adolescent-focused therapy (AFT). Multiple clinical characteristics were assessed at baseline. Family functioning from the perspective of the adolescent and both parents was assessed at baseline and after 1 year of treatment. Full remission from AN was defined as achieving both weight restoration and normalized eating disorder psychopathology. Results In general, families dealing with AN reported some baseline impairment in family functioning, but average ratings were only slightly elevated compared to published impaired functioning cutoffs. Adolescents' perspectives on family functioning were the most impaired and were generally associated with poorer psychosocial functioning and greater clinical severity. Regardless of initial level of family functioning, improvements in several family functioning domains were uniquely related to full remission at the end of treatment in both FBT and AFT. However, FBT had a more positive impact on several specific aspects of family functioning compared to AFT. Discussion Families seeking treatment for adolescent AN report some difficulties in family functioning, with adolescents reporting the greatest impairment. Although FBT may be effective in improving some specific aspects of family dynamics, remission from AN was associated with improved family dynamics, regardless of treatment type. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2015; 48:81-90) [ABSTRACT FROM AUTHOR]

ABSTRACT Objective In keeping with broader efforts to identify mediators and moderators of treatment outcome in anorexia nervosa, this pilot study investigated the association between collegial alliance, which refers to the perceived alliance between case-involved professionals, and treatment outcomes in adolescent patients undergoing family-based treatment (FBT) for anorexia nervosa. Method The self-reported collegial alliance scores of five FBT practitioners were collected, alongside weight- and cognitive-related outcomes for 29 consecutive cases of adolescent anorexia nervosa under their care. Results Collegial alliance discriminated between patients who dropped out of treatment and patients who completed treatment, t(27) = 3.68, p = .001, η2 = .33. Furthermore, there was a strong negative correlation between collegial alliance scores early on in treatment and disordered eating symptoms later in treatment, r(23) = −.67, p < .001. Moderate but non-significant associations were observed between early collegial alliance and patient's percentage of expected body weight later in treatment, r(23) = .32, p = .13. Discussion These findings have important implications for the augmentation of FBT, suggesting that unity amongst clinicians promotes positive treatment outcomes, particularly with regard to disordered eating symptomatology. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2014; 47:418-421) [ABSTRACT FROM AUTHOR]

Family therapy has featured in the treatment of adolescent eating disorders for over 40 years, and the evolution of family therapy approaches, through a variety of theoretical lenses, has been significant. For instance, the recent dissemination of family-based treatment has resulted in a growing number of controlled empirical trials which continue to inform and augment treatment outcomes. In addition, a burgeoning number of alternate approaches to family therapy for eating disorders leave clinicians with more clinical considerations in practicing family therapy for eating disorders. In this paper, we aim to review the recent developments in family therapy for adolescent eating disorders, underscoring the impact on clinical practice and the likely implications for future research. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Determine whether early weight gain predicts full remission at end-of-treatment (EOT) and follow-up in two different treatments for adolescent anorexia nervosa (AN), and to track the rate of weight gain throughout treatment and follow-up. Method Participants were 121 adolescents with AN (mean age = 14.4 years, SD = 1.6), from a two-site (Chicago and Stanford) randomized controlled trial. Adolescents were randomly assigned to family-based treatment (FBT) ( n = 61) or individual adolescent focused therapy (AFT) ( n = 60). Treatment response was assessed using percent of expected body weight (EBW) and the global score on the Eating Disorder Examination (EDE). Full remission was defined as having achieved ≥95% EBW and within one standard deviation of the community norms of the EDE. Full remission was assessed at EOT as well as 12-month follow-up. Results Receiver operating characteristic analyses showed that the earliest predictor of remission at EOT was a gain of 5.8 pounds (2.65 kg) by session 3 in FBT (area under the curve (AUC) = 0.670; p = .043), and a gain of 7.1 pounds (3.20 kg) by session 4 in AFT (AUC = 0.754, p = .014). Early weight gain did not predict remission at follow-up for either treatment. A survival analysis showed that weight was marginally superior in FBT as opposed to AFT (Wald chi-square = 3.692, d f = 1, p = .055). Discussion Adolescents with AN who receive either FBT or AFT, and show early weight gain, are likely to remit at EOT. However, FBT is superior to AFT in terms of weight gain throughout treatment and follow-up. (Int J Eat Disord 2014; 47:124-129) [ABSTRACT FROM AUTHOR]

Objective This 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. Method Independent 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. Results Mothers' 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. Conclusions In 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. Copyright © 2013 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]

The use of empirically supported treatment (EST) has been shown to enhance treatment outcome. The purpose of this case study was to suggest that ESTs further encourage effective reconceptualisation and the ongoing delivery of effective treatment, especially in the case of complex or atypical presentations or response to treatment. This report describes the case of an adolescent girl who underwent Maudsley family-based treatment for anorexia nervosa (AN) for a period of 12 months. Atypical response lead to an understanding of her presentation as representing a primary conversion disorder, within which AN symptoms were conceptualised as another somatic conversion of emotional distress. The report details her clinical presentation and management over the course of her illness. The case offers an important opportunity to explore the central role of the use of ESTs in guiding effective treatment delivery. [ABSTRACT FROM PUBLISHER]

Objective: To explore and describe therapists' perceptions of the factors affecting their uptake of family-based treatment (FBT) for adolescents with anorexia nervosa (AN). Method: Fundamental qualitative description guided the sampling and data collection in this study. A purposeful sample of 40 therapists providing treatment to youth with AN, completed an in-depth interview. Conventional content analysis guided the development of initial codes and categories, whereas constant comparison analytic techniques were used to compare and contrast therapist perceptions across contexts. Summative content analysis was used to provide counts of keywords, phrases, and themes. Results: Therapists face several barriers to the implementation of FBT, divided broadly into interventional, organizational, interpersonal, patient/family, systemic, and illness factors. Therapists support the implementation of evidence-based practices, including FBT for AN, but fidelity to this model is not practiced. Specific concerns about the intervention included weighing the patient, providing nutritional advice, and the family meal. Ninety-five percent of therapists requested further training in the FBT model. Discussion: 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. © 2012 by Wiley Periodicals, Inc. (Int J Eat Disord 2013) [ABSTRACT FROM AUTHOR]