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Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management.

Existing descriptions of the treatment of avoidant/restrictive food intake disorder (ARFID) at higher levels of care (HLOC) for eating disorders are limited, despite HLOC settings frequently serving patients with ARFID. The purpose of this commentary is to expand on the preliminary literature that describes pediatric ARFID treatment at HLOC by describing two specific components of our approach to treating pediatric ARFID that may not yet have traction in the current literature. Specifically, we highlight the utility of (1) treatment accommodations that appropriately account for patients neurodevelopmental needs (e.g., executive functioning, sensory processing) and (2) the adjunctive use of Dialectical Behavior Therapy (DBT) elements within family-based pediatric ARFID treatment. We also describe necessary future directions for research in these domains to clarify if incorporating these considerations and approaches into pediatric ARFID treatment at HLOC does indeed improve treatment outcomes.

BACKGROUND: Family-based treatment (FBT) is the leading intervention for adolescents with anorexia nervosa (AN); however, it is under researched in socioeconomically disadvantaged and racially diverse youth. METHODS: Semi-structured interviews were completed with ten FBT clinicians who practice in publicly-funded settings. Interview questions were focused on implementation challenges, overall acceptability and appropriateness of FBT, and naturally-occurring treatment adaptations. RESULTS: Content analysis revealed common themes relating to the implementation of FBT in publicly-funded, community-based settings: acceptability and appropriateness, complexity and learnability, perceived core components of FBT, cultural adaptations, socioeconomic factors, logistical considerations, organizational and systemic barriers, training acceptability, participants self-efficacy, and telehealth accommodations. CONCLUSION: The discussed themes offer insights into the implementation of FBT for settings with limited resources, aligning with prior research on clinical adaptations for multicultural patients. Recognizing these themes can guide clinical adjustments and refine the adapted treatment model in real-world settings for patients facing systemic barriers.

Background: Temperament Based Therapy with Support (TBT‐S) is an emerging intervention based on empirically supported neurobiological models. Due to its novelty, only a handful of studies to date have examined TBT‐S, and none of these previous studies have provided a qualitative evaluation of how TBT‐S is perceived by the target population. Therefore, the aim of the current study was to provide an increased understanding of how TBT‐S is experienced by patients with an eating disorder and their supports. Method: Forty‐six patients with an eating disorder and 63 supports consented to be included in the study. The participants provided written responses to six open‐ended questions during the post‐treatment assessment, detailing their treatment experiences and offering additional feedback. Thematic analysis (TA) was used to analyze their written responses, aiming for a combination of latent and semantic themes. Results: The results reveal a substantial overlap between patients' and supports' experiences with TBT‐S. In both groups, identified themes suggest increased knowledge and hopefulness as key benefits of the intervention. While both patients and support persons considered TBT‐S to be worthwhile, patients also reported finding the intervention quite challenging. Additionally, both groups emphasized the neurobiological rationale as an essential component of TBT‐S. Conclusions: The qualitative evaluations from this study offer new insights into how TBT‐S is experienced by the target population. The findings provide an opportunity to incorporate participant suggestions for improving the treatment, and serve as an important building block for future studies aimed at assessing the effectiveness of TBT‐S as an augmentation to treatment‐as‐usual. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion While Family‐based treatment for anorexia nervosa (FBT‐AN) is effective for weight restoration and improvement in eating‐related cognitions, its effect on exercise attitudes and behaviors is little studied. Compulsive exercise is common in AN and often challenging to change.This secondary analysis examined changes in attitudes toward compulsive exercise (Compulsive Exercise Test‐CET) and behaviors (Eating Disorder Examination‐EDE) using data from a randomized clinical trial testing an adjunctive treatment for adolescents with AN who failed to gain 2.4 kg by Session 4—a predictor of poor outcome. The main hypothesis is that attitudes toward compulsive exercise and decreases in compulsive exercise behavior would improve over the course of treatment.Participants reported decreases in compulsive exercise attitudes by Session 4 and compulsive exercise episodes by end of treatment (EOT). There were no differences between early FBT responders (weight gain of 2.4 kg by session 4) and early non‐responders.These results suggest that FBT facilitates adolescents with AN to change attitudes toward compulsive exercise early in treatment (by Session 4) as well as reduction in compulsive exercise behaviors by EOT. Future studies should assess whether changes in attitudes toward compulsive exercise early in treatment is a mechanism of FBT treatment effect. [ABSTRACT FROM AUTHOR]

To increase the number of family‐based interventions and deal directly with the family dynamic that creates maladaptive manners of coping and connection, structural family therapy (SFT) for autism spectrum disorder (ASD) was developed. The model slowly supports families in being more flexible in their relationships and dynamics while imparting interpersonal skills which enhance communication particularly between the children with ASD and their parents by reforming and supporting an appropriate family structure and family dynamic. [ABSTRACT FROM AUTHOR]

Avoidant restrictive food intake disorder (ARFID), a recently described eating disorder categorized under DSM-5, has varied clinical presentations. The primary eating disorders have well-established practice parameters for management. However, there is no evidence-based first line of management for ARFID. There is a significant gap in this evolving construct and clinical practice. We present a case series from a tertiary care center in India, focusing on clinical management. Four adolescents with 3 girls and 1 boy between 12 and 17 years of age were included in the study. Diagnosis and management were delayed in all. Mean body mass index was 15.36 (5.26) kg/m2 at the time of diagnosis. Key drivers were dread of choking, sensory characteristics, and avoidance of unpleasant upper and lower gastrointestinal symptoms. This series supports a culturally cognizant hypothesis, an evidence based, viable management model for ARFID in low- and middle-income countries (LMIC). A combination of family-based treatment (FBT) and cognitive behavior therapy is an effective treatment model for India and other LMICs.

Abstract Eating disorders can significantly impact the psychosocial functioning and physical health of adolescents. Early and effective treatment is crucial to prevent long-lasting and potentially devastating adverse effects. The National Institute for Health and Care Excellence has recommended cognitive behaviour therapy (CBT) for eating disorders in adolescents when family therapy is unacceptable, contraindicated, or ineffective. This recommendation was primarily based on the review of promising results from the enhanced version of CBT (CBT-E) adapted for adolescents with eating disorders aged between 12 and 19 years. A non-randomized effectiveness trial has also shown that CBT-E achieved a similar outcome to family-based treatment (FBT) at 6- and 12-months. CBT-E has several advantages. It is acceptable to young people, and its collaborative nature suits ambivalent young patients who may be particularly concerned about control issues. The transdiagnostic scope of the treatment is an advantage as it can treat the full range of disorders that occur in adolescent patients. It is an individual one-on-one treatment that does not necessitate the full involvement of the family. This approach is particularly beneficial for families that can only provide limited support. Future challenges include clarifying the relative efficacy of CBT-E and family therapy for the treatment of adolescent patients with eating disorders in a randomized control trial and increasing its effectiveness, identifying the reasons for the lack of response, and modifying the treatment accordingly.

Eating disorders can significantly impact the psychosocial functioning and physical health of adolescents. Early and effective treatment is crucial to prevent long-lasting and potentially devastating adverse effects. The National Institute for Health and Care Excellence has recommended cognitive behaviour therapy (CBT) for eating disorders in adolescents when family therapy is unacceptable, contraindicated, or ineffective. This recommendation was primarily based on the review of promising results from the enhanced version of CBT (CBT-E) adapted for adolescents with eating disorders aged between 12 and 19 years. A non-randomized effectiveness trial has also shown that CBT-E achieved a similar outcome to family-based treatment (FBT) at 6- and 12-months. CBT-E has several advantages. It is acceptable to young people, and its collaborative nature suits ambivalent young patients who may be particularly concerned about control issues. The transdiagnostic scope of the treatment is an advantage as it can treat the full range of disorders that occur in adolescent patients. It is an individual one-on-one treatment that does not necessitate the full involvement of the family. This approach is particularly beneficial for families that can only provide limited support. Future challenges include clarifying the relative efficacy of CBT-E and family therapy for the treatment of adolescent patients with eating disorders in a randomized control trial and increasing its effectiveness, identifying the reasons for the lack of response, and modifying the treatment accordingly. [ABSTRACT FROM AUTHOR]

The multiple benefits of family-based treatment (FBT) used in substance use disorder (SUD) treatment include increased treatment engagement, better treatment outcomes, and cost-effectiveness compared to other behavioral health treatment modalities. However, the prevalence and types of FBTs offered among SUD treatment facilities are largely unknown. The present study used data collected during 2009–2010 from 325 treatment centers in the United States to (1) explore the prevalence in the utilization of FBT in SUD treatment, and (2) identify differences between treatment facilities that do and do not offer FBT. Results indicated that the adoption of FBT was negatively associated with the percentage of clients who were unemployed or involved in the criminal justice system at time of intake, and positively related to the number of hours of individual therapy and treatment center emphasis on utilizing the 12 Steps. Additionally, the majority of treatment centers that followed the American Society of Addiction Medicine (ASAM) clinical guidelines offered FBT. Lastly, the percentage of families involvement was negatively associated with centers' proportion of revenues from Medicaid (i.e., health insurance for those with limited income) and positively associated with treatment center revenues from private insurance. The impact of having FBT in SUD treatment centers is discussed. [ABSTRACT FROM AUTHOR]

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]

ABSTRACT Objective Methods Results Discussion Trial Registration To systematically review and evaluate the efficacy of eating disorder focused family therapy (FT‐ED) in comparison to all other forms of psychotherapy for children and adolescents with anorexia nervosa. A secondary aim is to assess the relative efficacy of different variations of FT‐ED (e.g., shorter vs. longer dose, parent‐focused).A search with relevant terms was systematically conducted on four databases. Twenty‐three publications across 18 randomized controlled trials met inclusion criteria. Outcomes of interest included variables related to weight, eating psychopathology, and remission status. Study quality was assessed, and data were extracted by two independent researchers.Adolescents receiving FT‐ED gained significantly more weight by the end of treatment in comparison to those receiving individual psychotherapy. FT‐ED that was delivered just to parents or to parents and child separately offered preferable weight outcomes and rates of recovery at the end of treatment in comparison to conjoint FT‐ED. No other outcomes tested in the meta‐analysis were statistically significant at the end of treatment or follow‐up.Currently available data suggest the use of FT‐ED in its conjoint or separated/parent focused format is the best outpatient treatment option for adolescents with anorexia nervosa when immediate weight gain is paramount. The variability of outcome measurement, including the tools used and timepoints chosen, limit comparison among no more than a handful of studies. The field would benefit from the standardization of measurement and reporting guidelines for future clinical trials.PROSPERO number: CRD42023396263. [ABSTRACT FROM AUTHOR]

BACKGROUND: Temperament Based Therapy with Support (TBT-S) aims to target the mechanisms underlying the aetiology and maintenance of eating disorders, and was developed as an adjunct to treatment as usual. There is limited research investigating acceptability, feasibility and possible benefits of TBT-S. Therefore, the primary aim of the current study was to assess treatment feasibility and acceptability at a tertiary specialized eating disorders service in Norway, with a secondary aim to explore possible benefits in clinical outcome. METHODS: Forty-one patients (mean age 25.3, range 18-43) and 58 supports were assessed pre- and post TBT-S. The majority of the patients were diagnosed with either anorexia nervosa or atypical anorexia nervosa. Participants completed an 18-item Patient and Support Satisfaction Questionnaire, in addition to a questionnaire assessing the usefulness of the different intervention components and strategies utilised in TBT-S, as well as a 4-item treatment satisfaction questionnaire. Measures of treatment efficacy were completed at both time-points, whereas treatment acceptability was only assessed post-treatment. RESULTS: Findings reveal that TBT-S is a feasible treatment with high client satisfaction. Preliminary outcome data were also encouraging, and in line with previous studies. There were no voluntary drop-outs. All participants, both patients and supports, reported that TBT-S helped them deal more effectively with their challenges. After completing treatment, there was a significant decrease in patients self-reported eating disorder psychopathology, psychosocial impairment and state anxiety, while trait anxiety remained unchanged. Patients also reported significantly improved social relationships, whereas supports reported a significant increase in (own) psychological health. There were no differences in family functioning. CONCLUSIONS: TBT-S is a promising new treatment for eating disorders with high acceptability scores and low treatment attrition. Future studies should aim to explore methods which can most appropriately measure the effect of TBT-S and the usefulness of the different components of this treatment. Randomised controlled trials are needed to assess treatment efficacy of TBT-S.

BACKGROUND: Anorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is unavailable to many families, particularly those from lower income and racial and ethnic minority backgrounds. Furthermore, some families do not respond optimally to FBT, possibly because of challenges translating skills acquired in office-based treatment settings to naturalistic settings. Home-based treatment could reduce barriers to access and enhance generalization of newly learned treatment skills. Home-based models demonstrate initial feasibility, acceptability, and efficacy for adolescent AN, however, FBT principles have yet to be applied as a stand-alone intervention in a home-based level of care. This paper describes the rationale for and process of adapting FBT principles/interventions to improve fit within a home-based model delivered in the context of community mental health, and discusses potential strengths and opportunities associated with this approach. RESULTS: Adaptations were made through consultation with collaborating community agencies and were guided by the complex interventions framework. The primary modifications included: (1) altered dose; (2) multiple family meals; (3) additional support for meal preparation and supervision; (4) clinician attendance at medical appointments; (5) cultural adaptation; and (6) introduction of distress tolerance and emotion regulation skills. CONCLUSIONS: Implementing FBT in the home may present one promising and novel approach to enhance engagement and treatment outcomes for adolescents with restrictive eating disorders, particularly those who are underserved, but evaluation of efficacy/effectiveness is needed.

BackgroundTo investigate the KAP toward family-based treatment among parents of children with leukemia.MethodsThis cross-sectional study was conducted between December, 2022 and July, 2023 in the Pediatric hematologic oncology department of West China Second University Hospital, Sichuan University. The study population consisted of parents of children diagnosed with leukemia. Their demographic characteristics and KAP toward family-based treatment for leukemia were collected by self-administered questionnaires.ResultsA total of 482 parents participated, including 379 (78.63%) females, with an average age of 35.83 ± 6.40 years. The mean scores for KAP were 7.28 ± 1.13 (possible range: 0–10), 37.82 ± 4.38 (possible range: 9–45), and 40.09 ± 4.17 (possible range: 9–45), respectively. Multivariate logistic regression analysis indicated that the knowledge score (OR = 1.48, 95% CI: [1.08–2.05], P = 0.016), attitude score (OR = 1.31, 95% CI: [1.18–1.46], P < 0.001), education of junior college and above (OR = 11.28, 95% CI: [1.94–65.65], P = 0.007), and monthly income of 5,000–10,000 Yuan (OR = 10.88, 95% CI: [1.15–102.98], P = 0.037) were independently associated with a proactive practice. Structural equation modeling (SEM) results highlighted the significant direct impact of knowledge on attitude (β = 0.72, P = 0.002), attitude on practice (β = 0.57, P < 0.001), and knowledge on practice (β = 0.81, P < 0.001).ConclusionParents of children with leukemia demonstrated inadequate knowledge, but positive attitudes and proactive practices toward family-based treatment for leukemia. Future interventions should not only prioritize augmenting parental knowledge through educational initiatives but also focus on fostering positive attitudes and providing support for both knowledge and practical parenting skills to facilitate proactive involvement.

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.

Family-based treatment (FBT) is recommended for anorexia nervosa (AN) in young people (YP). However, a substantial proportion of YP undergoing FBT do not recover. Several modifications to standard FBT have been tested to improve recovery rates. This review provides an updated overview of empirically tested modifications to FBT for AN in YP and estimates whether such modifications increase the percentage recovering. Computerized searches performed in five databases resulted in the inclusion of 43 papers (representing 40 original studies), highlighting that a variety of modifications to standard FBT have been tested and appear promising. However, only 11 studies compared the results of a modification to standard FBT. In conclusion, some modifications, such as parent-focused treatment, the addition of home treatment, or interventions for families at risk of non-response, appear to have the potential to improve the recovery rate, either at the group or subgroup level. Other modifications, such as FBT-based guided self-help, virtually delivered FBT, or FBT delivered during in- or day-patient stays, enable the dissemination of FBT principles to other contexts and to patient groups with limited access. Small additions to FBT, such as a workshop or parent-to-parent consultation, do not seem to improve the recovery rate.

ObjectiveMisconceptions 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).MethodThe 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.ResultsAny 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.ConclusionsThe 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 significanceThis 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.

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.

Overweight and obesity affect 45% of children and increases the risk for several negative health sequelae. Family-Based Behavioral Treatment (FBT) is the most efficacious treatment for child weight management and consists of nutrition and physical activity education, behavior change skills and parenting skills training. FBT is time and staff intensive and can include 20, 60-min separate groups for parents and children, as well as 20-min behavior coaching sessions to help problem solve barriers to implementing the skills learned and individualize the program. Guided self-help (GSH) therapies involve providing families a manual to review independently and brief coaching sessions by an interventionist to facilitate adherence. We developed a GSH version of FBT (gshFBT) which provides a manual to both parents and children and includes 14, 20-min coaching sessions over 6-months. The current study randomized 150 children (mean age = 10.1 years (SD = 1.38); mean BMI% = 97.3% (SD = 2.84); mean BMIz = 2.09 (SD = 0.40); 49% female; 43% Hispanic) and one of their parents (mean age = 41.8 years (SD = 6.52); mean BMI = 32.0 (SD = 7.24); 87.3% female; 43% Hispanic) to either a group-based FBT program or a gshFBT program. Assessments are conducted at baseline, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). Primary outcomes are child weight change (BMIz) and cost effectiveness. Recruitment occurred between May 2017 and October 2021 and follow-up assessments are underway. Given the public health concern for children with obesity and the low level of access to FBT, gshFBT could prove extremely useful to provide intervention to a greater proportion of the population.

BackgroundEating disorders are associated with substantial morbidity and mortality that can be minimized by timely access to evidence-based treatment. However, disparate access to eating disorders treatment may contribute to significant health disparities amongst marginalized groups. This study examined the association between insurance type (public vs. private) and receipt of recommended mental health treatment in a sample of racially/ethnically diverse youth who presented to an adolescent medicine clinic with malnutrition secondary to disordered eating.MethodsA retrospective chart review was conducted for youth ages 11-25 years (N = 1060) who presented to an urban adolescent medicine specialty program between June 1, 2012 and December 31, 2019 for malnutrition secondary to disordered eating. Bivariate and logistic regression analyses examined the association between insurance type (public vs. private) and other demographic/clinical factors on receipt of recommended treatment within six months of the initial evaluation.ResultsPatients with public insurance were one third as likely to receive recommended treatment as patients with private insurance (AOR = 3.23; 95% CI = 1.99, 4.52), after adjusting for demographic and clinical factors. Latinx (AOR = 0.49; 95% CI = 0.31, 0.77) and Asian (AOR = 0.55; 95% CI = 0.32, 0.94) patients were half as likely to receive recommended treatment as White patients.ConclusionsAccess to evidence-based mental health treatment is a necessary first step towards health equity for individuals with eating disorders. Additional work is needed to dismantle systemic inequities that contribute to disparities in care for youth of color and those with public insurance.

PurposeCaregivers play a pivotal role in the success of family-based treatment (FBT) for anorexia nervosa (AN). Caregiver burden is frequently demonstrated in eating disorders (EDs) and may impact FBT outcomes. This study examined factors associated with caregiver burden before starting FBT and whether pre-treatment caregiver burden was associated with weight gain during FBT.MethodsParticipants included 114 adolescents with AN or atypical AN (mean age = 15.6 years, SD = 1.4) and a primary caregiver (87.6% mothers) who received FBT in the United States. Before starting treatment, participants completed self-report measures of caregiver burden (via the Eating Disorder Symptom Impact Scale), caregiver anxiety, caregiver depression, and ED symptoms. Clinical characteristics and percentage of target goal weight (%TGW) at FBT session 1 and 3 and 6 months after starting treatment were obtained via retrospective chart review. Hierarchical regressions examined predictors of caregiver burden before FBT initiation. Associations between pre-treatment caregiver burden and %TGW gain at 3 and 6 months after starting FBT were assessed with hierarchical regressions.ResultsCaregiver anxiety (p

Anorexia nervosa (AN) is a serious psychiatric disorder with high morbidity and mortality. The current evidence supports the use of family-based treatment (FBT), but recovery rates are only about 40%. Improving treatment outcomes among adolescents with AN will save lives, improve health, and prevent chronicity. This study examined the relative efficacy of adding intensive parental coaching (IPC) to standard FBT for patients who do not respond by weight gain of 2.4 kg by session 4, a clinical predictor of outcome at the end of treatment, to improve remission rates (>94% of expected mean body mass index). The study recruited 107 participants and their families from across the United States; 69 participants failed to respond early and were randomly assigned to continue with standard FBT or to receive 3 sessions of IPC. Participants were adolescents (ages 12-18) meeting DSM-5 criteria for AN; 6.5% were male, and 11% were Hispanic. Main outcomes were mean body mass index >94% expected for age, height, and sex. Secondary outcomes included change in eating-related cognitions. Adding IPC to early nonresponders did not improve outcomes except for participants whose parents demonstrated low parental self-efficacy at baseline (moderator). Early weight gain of 2.4 kg by session 4 was replicated as a predictor of end of treatment remission. Parental self-efficacy moderates IPC as an adaptive treatment for adolescents with AN. Baseline parental self-efficacy assessment can be used to identify families most likely to benefit from adding IPC to FBT. Future studies should consider earlier interventions to improve early response rates. Anorexia nervosa is a serious psychiatric disorder. While family-based treatment (FBT) has the largest evidence base for adolescents with anorexia, recovery rates are only about 40%. This study investigated the addition of 3 sessions of intensive parental coaching intervention (IPC) to FBT among youth with anorexia who did not gain adequate weight early in treatment, a predictor of recovery by the end of treatment. Youth with inadequate weight gain were randomized to either receive FBT with IPC or FBT as usual. Overall, adding IPC did not improve outcomes among youth with anorexia. However among those whose parents demonstrated low parental self-efficacy at baseline, youth who received FBT with IPC had higher remission rates than youth who received FBT alone. Intensive parental coaching shows promise for improving outcomes among youth with anorexia whose parents report low parental self-efficacy. Adaptive Treatment for Adolescent Anorexia Nervosa; https://clinicaltrials.gov/ ; NCT03097874. [ABSTRACT FROM AUTHOR]

Objective: The therapeutic alliance is broadly linked with positive outcomes. However, nearly all research in this area involves in‐person therapy, whereas teletherapy has grown increasing common since the COVID‐19 pandemic. There is now a pressing need to establish whether the nature and importance of the therapeutic alliance is impacted by teletherapy. This study examined therapeutic alliance in families of youth with anorexia nervosa who were participating in a randomized controlled trial that transitioned from in‐person to telehealth visits during the COVID‐19 pandemic. Method: We analysed data from 53 adolescents and their parents (20 began in‐person, 33 began with telehealth). Both parents, youth and therapist completed the Working Alliance Inventory–Short Revised after 4 weeks of treatment. Results: We found no significant differences across telehealth and in‐person treatment for paternal or therapist reported data. However, both adolescents and mothers reported higher bond and goal‐related alliance for in‐person sessions compared to telehealth. Conclusions: Findings regarding alliance across telehealth and in‐person sessions were mixed, with some preference among mothers and youth for in‐person treatment. Future studies should determine whether possible adaptations can improve working alliance during family‐based treatment for anorexia nervosa via telehealth. [ABSTRACT FROM AUTHOR]

Marchetti and Sawrikar's (2024) systematic review of parent illness representations of their child's anorexia nervosa provides a valuable synthesis of 32 qualitative studies. The key themes that emerge paint a concerning picture of parents' perceptions of AN as: difficult to identify and understand; of chronic duration; uncontrollable; severe; and associated with serious consequences. A sense of hopelessness and low‐parental self‐efficacy was identified. This Commentary explores the key findings of this review in four areas: AN treatment and recovery (control/cure); emotional representations of the illness; parent understanding of the illness (coherence) and its causes; and consequences of the AN. These illness perceptions are discussed along with relevant quantitative investigations of parent experiences, with a view to suggesting how the toll on parents might be reduced and how reducing burdens on parents might also lead to improved timely treatment outcomes. It is proposed that two broad features are needed: improved help‐seeking experiences in the health care system; and, more parent‐focussed support. [ABSTRACT FROM AUTHOR]

In their systematic review on parent illness representations in their children with anorexia nervosa (AN), Marchetti and Sawrikar (International Journal of Eating Disorders, 2023) integrate past research on the parental experience of the illness, investigating whether the Common Sense Model of Self‐Regulation (CSM) is a useful framework for understanding parental responses to AN. Given that family‐based treatment (FBT) is a first‐line treatment for adolescents with eating disorders and is based upon integrating parents into the treatment process, it is especially relevant to explore how parent illness representations may impact FBT. In this commentary, we describe how FBT is designed to support parents and address many of the common unhelpful beliefs and emotions associated with parenting an adolescent with AN. We include specific examples of how parents can be supported within FBT as manualized. We also examine parental representations that may not be addressed by FBT, and how these may impact treatment outcomes in FBT, possibly via the impact of expressed emotion. Future research is needed to determine if modifications to FBT are required to address parental representations of the illness. We end by expanding upon Marchetti and Sawrikar's suggestions on how treatment could be extended to better support parents as necessary. [ABSTRACT FROM AUTHOR]

BackgroundFamily-based treatment (FBT) is the leading intervention for adolescents with anorexia nervosa (AN); however, it is under researched in socioeconomically disadvantaged and racially diverse youth.MethodsSemi-structured interviews were completed with ten FBT clinicians who practice in publicly-funded settings. Interview questions were focused on implementation challenges, overall acceptability and appropriateness of FBT, and naturally-occurring treatment adaptations.ResultsContent analysis revealed common themes relating to the implementation of FBT in publicly-funded, community-based settings: acceptability and appropriateness, complexity and learnability, perceived core components of FBT, cultural adaptations, socioeconomic factors, logistical considerations, organizational and systemic barriers, training acceptability, participant’s self-efficacy, and telehealth accommodations.ConclusionThe discussed themes offer insights into the implementation of FBT for settings with limited resources, aligning with prior research on clinical adaptations for multicultural patients. Recognizing these themes can guide clinical adjustments and refine the adapted treatment model in real-world settings for patients facing systemic barriers.

Family-based treatment (FBT) is the leading treatment for adolescent eating disorders and is based on five tenets, or fundamental assumptions: (1) the therapist holds an agnostic view of the cause of the illness; (2) the therapist takes a non-authoritarian stance in treatment; (3) parents are empowered to bring about the recovery of their child; (4) the eating disorder is separated from the patient and externalized; and (5) FBT utilizes a pragmatic approach to treatment. Learning these tenets is crucial to the correct practice and implementation of manualized FBT. The purpose of the current paper is to provide an in-depth overview of these five tenets and to illustrate how they are used in clinical practice. This overview will aid clinicians who are learning FBT.

Over the course of the COVID-19 pandemic, rates of eating disorders have increased, further straining systems of care that were already overburdened. The current paper describes novel interventions, largely informed by Family-Based Treatment (FBT), that were implemented by a tertiary specialist adolescent eating disorders service. In response to the pandemic, programming was designed to bridge access to care while waiting for availability of evidence-based therapy. The Brief Psychology Consultation Clinic provides several sessions to patients and families, focused on psychoeducation and problem-solving informed by FBT and other evidence-based therapies. Two groups, the FBT Caregiver Workshop Series and FBT Caregiver Support Group, provide psychoeducation and support for caregivers of youth with eating disorders. Perceived strengths and benefits of these services, as well as barriers to implementation and future research directions are discussed.

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.

ObjectiveData 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.MethodParticipants (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.ResultsMultilevel 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.DiscussionTogether, 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 significanceBN 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.

BackgroundFamily-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 [

Abstract Purpose Family-based treatment (FBT) has contributed significantly to the treatment of anorexia nervosa (AN) in young people (YP). However, parents are concerned that FBT and the active role of parents in the task of refeeding may have a negative impact on family relations. The aim of the review is to assess whether families engaged in FBT for AN are more or less impacted in their family wellbeing and caregiver burden, compared to families with a YP diagnosed with AN, who are not undergoing treatment with FBT. Method Computerized searches across six databases complemented by a manual search resulted in 30 papers being included in the scoping review. Results The review identified 19 longitudinal studies on change in family wellbeing in families in FBT-like treatments, and 11 longitudinal studies on change in family wellbeing in treatment where parents are not in charge of refeeding. Only three randomized controlled studies directly compare FBT to treatment without parent-led refeeding. Conclusion The available research suggests no difference between intervention types regarding impact on family wellbeing. Approximately half of the studies find improvements in family wellbeing in both treatment with and without parent-led refeeding, while the same proportion find neither improvement nor deterioration. As parents play a pivotal role in FBT, there is a need for good quality studies to elucidate the impact of FBT on family wellbeing. Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Abstract Background Outpatient family-based treatment (FBT) is effective in treating restrictive eating disorders among adolescents. However, little is known about whether FBT reduces higher level of care (HLOC) utilization or if utilization of HLOC is associated with patient characteristics. This study examined associations between utilization of eating disorder related care (HLOC and outpatient treatment) and reported adherence to FBT and patient characteristics in a large integrated health system. Methods This retrospective cohort study examined 4101 adolescents who received care for restrictive eating disorders at Kaiser Permanente Northern California. A survey was sent to each medical center to identify treatment teams as high FBT adherence (hFBT) and low FBT adherence (lFBT). Outpatient medical and psychiatry encounters and HLOC, including medical hospitalizations and higher-level psychiatric care as well as patient characteristics were extracted from the EHR and examined over 12 months post-index. Results 2111 and 1990 adolescents were treated in the hFBT and lFBT, respectively. After adjusting for age, sex, race/ethnicity, initial percent median BMI, and comorbid mental health diagnoses, there were no differences in HLOC or outpatient utilization between hFBT and lFBT. Females had higher odds of any utilization compared with males. Compared to White adolescents, Latinos/Hispanics had lower odds of HLOC utilization. Asian, Black, and Latino/Hispanic adolescents had lower odds of psychiatric outpatient care than Whites. Conclusions Reported FBT adherence was not associated with HLOC utilization in this sample. However, significant disparities across patient characteristics were found in the utilization of psychiatric care for eating disorders. More efforts are needed to understand treatment pathways that are accessible and effective for all populations with eating disorders.

Abstract Existing descriptions of the treatment of avoidant/restrictive food intake disorder (ARFID) at higher levels of care (HLOC) for eating disorders are limited, despite HLOC settings frequently serving patients with ARFID. The purpose of this commentary is to expand on the preliminary literature that describes pediatric ARFID treatment at HLOC by describing two specific components of our approach to treating pediatric ARFID that may not yet have traction in the current literature. Specifically, we highlight the utility of (1) treatment accommodations that appropriately account for patients’ neurodevelopmental needs (e.g., executive functioning, sensory processing) and (2) the adjunctive use of Dialectical Behavior Therapy (DBT) elements within family-based pediatric ARFID treatment. We also describe necessary future directions for research in these domains to clarify if incorporating these considerations and approaches into pediatric ARFID treatment at HLOC does indeed improve treatment outcomes.

Abstract Objective Eating disorders are characterized by disturbances in nutritional intake and abnormal mealtime behaviors. Laboratory eating paradigms offer a unique opportunity to accurately measure dietary intake and eating behaviors, however, these studies have predominantly occurred in adults. This paper describes the development and preliminary psychometric examination of the Buffet Challenge, a laboratory-based meal task for youths with an eating disorder. Method We recruited and assessed 56 participants as part of a randomized controlled trial of Family-Based Treatment for adolescents with anorexia nervosa. Adolescents completed the Buffet Challenge at baseline, midway through treatment (~ week 16 of a 6 months course), and end of treatment. Participants and their parents also reported eating disorder symptomatology and treatment related variables of interest were recorded. Results All adolescents were willing to complete the Buffet Challenge at all time points, although one refused to give up their cellphone, and there were no significant adverse events recorded. Preliminary results are presented. Conclusions Our initial pilot of this task in adolescents with anorexia nervosa demonstrates its acceptability, although investigation of our hypotheses was hindered by significant missing data due to COVID-related research shutdowns. Future studies should replicate procedures in a larger sample to ensure analyses are adequately powered.

PurposeThis scoping review presents an up-to-date synthesis of the current evidence base for non-specific predictors, moderators, and mediators of family-based treatment (FBT) for adolescent anorexia and bulimia nervosa.MethodsWe identify ways in which end-of-treatment outcomes have been shown to differ based upon baseline clinical features and person-specific factors and explore psychological mechanisms that may explain differences in treatment response. We draw from this evidence base to outline recommendations for clinical practice, as well as directions for future clinical eating disorder research.ResultsNoted findings from review include that early response in weight gain and parental criticism may be particularly influential in treatment for anorexia nervosa. Further, for adolescents with either anorexia or bulimia nervosa, eating-related obsessionality may be a key intervention target to improve outcomes.ConclusionIn addition to highlighting a need for attention to specific patient- and caregiver-level factors that impact treatment response, recommendations for research and clinical practice include testing whether certain targeted treatments (e.g., exposure-based approaches) may be suitable within the context of FBT for eating disorders.Level of evidenceLevel I: Evidence obtained from: at least one properly designed randomized controlled trials; experimental studies.

BackgroundAnorexia nervosa (AN) is often diagnosed in adolescence, and most evidence-based treatments for AN in young people involve the family. Family therapies for AN are intensive, outpatient treatments that utilise the parents as the primary resource in the young person's recovery. Research regarding family treatment for AN is often conducted in specialist settings-with relatively little data reporting the translation of this specialised treatment into real-world, non-specialist settings. This systematic review and meta-analysis aims to determine the efficacy of family treatments for adolescents with AN in specialist settings versus non-specialist settings.MethodsThis systematic review and meta-analysis will be conducted according to the preferred reporting items for systematic reviews and meta-analyses guidelines. Retrospective cohort studies, pilot studies, case series, randomised controlled trials and qualitative investigations that present original data and investigated the efficacy of family treatments for adolescents with AN in either a specialist or non-specialist setting will be included in the review. Data will be extracted by two reviewers and study quality will be assessed. The primary outcome, change in weight, will be used to determine via meta-analysis and, depending on study heterogeneity, subgroup analysis or meta-regression whether there is a statistically significant subgroup difference between specialist and non-specialist treatment settings. The review will also consider changes in eating disorder symptomology and related constructs.DiscussionResults from this review will help determine if there is a difference in the efficacy of family treatments for adolescent AN in specialist versus non-specialist treatment settings, primarily in relation to weight recovery. This, in turn, will inform the translation of evidence-based interventions that are generally studied and implemented within specialist centres into the non-specialist health care system.

Efforts to increase accessibility of eating disorder (ED) treatment via telemedicine have been ongoing for the past decades. However, there has been a recent surge in research focused on remote delivery of interventions since the onset of the novel coronavirus pandemic (COVID-19) in 2020, the related lockdowns, and an exponential increase in ED symptoms in youth secondary to the pandemic worldwide. In the current review, we provide a focused summary of existing literature regarding telehealth for the treatment of EDs in adolescents using a frame of past, present, and future work. Specifically, we begin with a brief overview of research in remote delivery for EDs in youth prior to 2020. Then, we detail more recent studies in this domain, with a focus on research conducted during the COVID-19 pandemic. We close by outlining limitations of the existing data and future steps necessary to expand the rigor and impact of this work. Overall, there are considerable limitations associated with research conducted during the pandemic, but an increase in the acceptability of remote delivery methods and interest in hybrid care appears to be feasible, and likely to be lasting. Future work must replicate more recent research in non-pandemic contexts and prioritize evaluation of factors that will aid in matching patients to the most efficient and effective modalities of care moving forward.

BackgroundAdult eating disorder treatments are hampered by lack of access and limited efficacy. This open-trial study evaluated the acceptability and preliminary efficacy of a novel intervention for adults with eating disorders delivered to young adults and parent-supports in an intensive, multi-family format (Young Adult Temperament-Based Treatment with Supports; YA-TBT-S).Methods38 YA-TBT-S participants (m age = 19.58; SD 2.13) with anorexia nervosa (AN)-spectrum disorders, bulimia nervosa (BN)-spectrum disorders, and avoidant/restrictive food intake disorder (ARFID) completed self-report assessments at admission, discharge, and 12-month follow-up. Assessments measured program satisfaction, eating disorder psychopathology and impairment, body mass index (BMI), and trait anxiety. Outcomes were analyzed using linear mixed effects models to examine changes in outcome variables over time.ResultsTreatment was rated as highly satisfactory. 53.33% were in partial or full remission at 12-month follow-up. 56% of participants received other treatment within the 12-month follow-up period, suggesting that YA-TBT-S may be an adjunctive treatment. Participants reported reductions in ED symptomatology (AN and BN), increases in BMI (AN and ARFID), and reductions in clinical impairment (AN and ARFID) at 12-month follow-up.ConclusionsYA-TBT-S is a feasible and acceptable adjunctive treatment for young adults with a broad range of ED diagnoses and may be a method for involving parents in ED treatment in ways that are acceptable to both parents and YA. Further evaluation of efficacy is needed in larger samples, and to compare YA-TBT-S to other ED treatment approaches. Plain English summary Eating disorders are costly and dangerous psychiatric disorders that affect millions of individuals each year. Despite their risks and societal costs, currently available treatments are limited. This study examined the acceptability and efficacy of Young Adult, Temperament-Based Treatment with Supports (YA-TBT-S), a new treatment program for adults with eating disorders. YA-TBT-S was rated highly, and a significant portion of participants improved based on ratings collected 12 months after program participation. Those with anorexia nervosa (AN) and bulimia nervosa (BN) showed significant reductions in eating disorder pathology, and those with AN and avoidant/restrictive food intake disorder (ARFID) showed increases in BMI over time.

Abstract Background Temperament Based Therapy with Support (TBT-S) aims to target the mechanisms underlying the aetiology and maintenance of eating disorders, and was developed as an adjunct to treatment as usual. There is limited research investigating acceptability, feasibility and possible benefits of TBT-S. Therefore, the primary aim of the current study was to assess treatment feasibility and acceptability at a tertiary specialized eating disorders service in Norway, with a secondary aim to explore possible benefits in clinical outcome. Methods Forty-one patients (mean age 25.3, range 18–43) and 58 supports were assessed pre- and post TBT-S. The majority of the patients were diagnosed with either anorexia nervosa or atypical anorexia nervosa. Participants completed an 18-item Patient and Support Satisfaction Questionnaire, in addition to a questionnaire assessing the usefulness of the different intervention components and strategies utilised in TBT-S, as well as a 4-item treatment satisfaction questionnaire. Measures of treatment efficacy were completed at both time-points, whereas treatment acceptability was only assessed post-treatment. Results Findings reveal that TBT-S is a feasible treatment with high client satisfaction. Preliminary outcome data were also encouraging, and in line with previous studies. There were no voluntary drop-outs. All participants, both patients and supports, reported that TBT-S helped them deal more effectively with their challenges. After completing treatment, there was a significant decrease in patients’ self-reported eating disorder psychopathology, psychosocial impairment and state anxiety, while trait anxiety remained unchanged. Patients also reported significantly improved social relationships, whereas supports reported a significant increase in (own) psychological health. There were no differences in family functioning. Conclusions TBT-S is a promising new treatment for eating disorders with high acceptability scores and low treatment attrition. Future studies should aim to explore methods which can most appropriately measure the effect of TBT-S and the usefulness of the different components of this treatment. Randomised controlled trials are needed to assess treatment efficacy of TBT-S.

Abstract Background Family therapy for adolescent anorexia nervosa (AN) has stronger evidence of efficacy in comparison with individual therapy, and family-based treatment (FBT) is the most evaluated in numerous randomized clinical trials. However, few studies have focused on how FBT performs outside of research settings. The current study is the first to assess clinical outcomes of FBT for adolescent AN in Finland, in a specialized outpatient clinic. Aim The naturalistic outcome of outpatient FBT for adolescent AN was investigated. Methods Fifty-two female patients and their families who received FBT at a tertiary eating disorders unit participated in the study. Data on their pre-treatment parameters, treatment details, and condition at the end of treatment (EOT) was collected from their medical records. Results At EOT, a majority (61.5%) had achieved a full weight restoration [percentage of expected body weight (%EBW) ≥ 95%]. Participants with an %EBW ≥ 95 at EOT had a significantly higher pre-treatment %EBW than those with an EBW

Abstract Background Family-based treatment (FBT) is currently the most effective evidence-based treatment approach for adolescents with anorexia nervosa (AN). Home treatment (HT) as an add-on to FBT (FBT-HT) has been shown to be acceptable, feasible and effective. The described three-arm randomized clinical trial (RCT) is intended to investigate whether FBT-HT demonstrates higher efficacy compared to standard outpatient FBT with supplemental mindfulness-based stress reduction training (FBT-MBSR). Methods This RCT compares FBT-HT to standard outpatient FBT and FBT-MBSR as a credible home-based control group in terms of efficacy and delivery. Adolescents with AN or atypical AN disorder (n = 90) and their parent(s)/caregiver(s) are to be randomly assigned to either FBT, FBT-HT or FBT-MBSR groups. Eating disorder diagnosis and symptomatology are to be assessed by eating disorder professionals using standardized questionnaires and diagnostic instruments (Eating Disorder Examination, Eating Disorder Inventory, Body Mass Index). In addition, parents and caregivers independently provide information on eating behavior, intrafamily communication, stress experience and weight. The therapeutic process of the three treatments is to be measured and assessed among both participants and care providers. The feasibility, acceptability and appropriateness can thus also be evaluated. Discussion We hypothesize that FBT-HT will be an acceptable, appropriate and feasible intervention and, importantly, will outperform both established FBT and FBT-MBSR in improving adolescent weight and negative eating habits. Secondary outcome measures include the reduction in the stress experienced by caregivers, as well as the regulation of perceived expressed emotions within the family, while the intrafamily relationships are hypothesized to mediate/moderate the effectiveness of FBT. The proposed study has the potential to enhance the scientific and clinical understanding of the efficacy of FBT for AN, including whether the addition of HT to FBT versus another home-based adjunct intervention improves treatment outcomes. Furthermore, the study aligns with public health priorities to optimize the outcomes of evidence-based treatments and integrate the community setting. Trial registration This study is registered at ClinicalTrials.gov (NCT05418075).

Abstract Background Anorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is unavailable to many families, particularly those from lower income and racial and ethnic minority backgrounds. Furthermore, some families do not respond optimally to FBT, possibly because of challenges translating skills acquired in office-based treatment settings to naturalistic settings. Home-based treatment could reduce barriers to access and enhance generalization of newly learned treatment skills. Home-based models demonstrate initial feasibility, acceptability, and efficacy for adolescent AN, however, FBT principles have yet to be applied as a stand-alone intervention in a home-based level of care. This paper describes the rationale for and process of adapting FBT principles/interventions to improve fit within a home-based model delivered in the context of community mental health, and discusses potential strengths and opportunities associated with this approach. Results Adaptations were made through consultation with collaborating community agencies and were guided by the complex interventions framework. The primary modifications included: (1) altered dose; (2) multiple family meals; (3) additional support for meal preparation and supervision; (4) clinician attendance at medical appointments; (5) cultural adaptation; and (6) introduction of distress tolerance and emotion regulation skills. Conclusions Implementing FBT in the home may present one promising and novel approach to enhance engagement and treatment outcomes for adolescents with restrictive eating disorders, particularly those who are underserved, but evaluation of efficacy/effectiveness is needed.

Purpose: Intuitive eating (IE) is an adaptive eating construct for which little research exists in eating disorder (ED) samples. IE is negatively correlated with disordered eating behaviors in healthy adolescents and adults, and similar associations have been found in adults with EDs. This study aims to examine IE in a treatment seeking sample of adolescents and their caregivers to understand the role of IE in weight gain during FBT. Methods: Descriptive statistics and bivariate correlations were calculated in a sample of 47 pairs of adolescent patients and their caregivers who initiated outpatient FBT at a large academic medical center. Analyses examined associations between caregiver and adolescent IE on the Intuitive Eating Scale (IES), change in percent expected body weight (%EBW) by session 4 and end of treatment (EOT), clinical impairment, and ED pathology. Results: Significant correlations were found between aspects of adolescent IE, ED symptoms, and clinical impairment. Caregiver IES scores (Reliance on Hunger and Satiety Cues, Body-Food Choice Congruence, IES Total) were negatively related to adolescent ED symptoms (EDE-Q Weight Concerns, EDE-Q Shape Concerns, EDE-Q Global) at baseline. Caregiver IE (Eating for Physical Rather than Emotional Reasons) was positively associated with adolescent weight gain at FBT session 4 and EOT, even when statistically adjusting for gender and initial level of care. Conclusion: Study results were consistent with past research indicating adolescent IE is negatively associated with ED behaviors, cognitions, and impairment. This study is the first to provide evidence that caregiver IE is positively associated with adolescent weight gain in FBT and is the first to provide evidence that caregiver IE is negatively related to adolescent ED symptoms. Future research should examine adolescent and caregiver IE throughout FBT to understand the role of IE in treatment response. Level of evidence: Level III: Evidence obtained from cohort or case-control analytic studies. [ABSTRACT FROM AUTHOR]