Attitudes Toward Family-Based Treatment Impact Therapists’ Intent to Change Their Therapeutic Practice for Adolescent Anorexia Nervosa

Abstract

Community-based clinicians who treat patients with eating disorders rarely use empirically-supported treatments, and research demonstrates that clinicians make significant modifications when implementing family-based treatment (FBT) for anorexia nervosa. This study examined clinician attitudes toward FBT and explored the extent to which attitudes predicted intent to shift practices following training in FBT. Clinicians (N = 129) completed a standardized training in FBT for AN, either a two-day introductory training (n = 99) or a one-day "advanced" training (n = 30). Linear regressions were used to examine the association between therapists' attitudes toward FBT and their intent to use strategies consistent with FBT in the future, adjusting for pre-training use of strategies. Providers reported very positive attitudes toward evidence-based practices in general and moderately positive attitudes toward FBT. There were no significant differences between "novice" and "advanced" providers on attitudes toward evidence-based practices or FBT (ps > .10). For the subset of providers attending their first training in FBT, more positive attitudes toward FBT significantly predicted greater intent to use FBT-consistent strategies (p = .004), and more positive attitudes toward evidence-based practice significantly predicted lesser intent to use FBT-inconsistent strategies (p = .009). This study suggests that both general attitudes toward evidence-based practice and specific attitudes toward FBT may impact implementation. Future research might examine whether a brief intervention to improve attitudes toward FBT might increase the likelihood of seeking expert consultation post-training.

A brief session‐by‐session measure of eating disorder psychopathology for children and adolescents: Development and psychometric properties of the Eating Disorder‐15 for Youth (ED‐15‐Y)

“…Even when empirically‐supported treatments are implemented in the context of trials, only about half of youth respond well (Le Grange et al, 2015; Lock et al, 2010). Further, treatment effects may be diluted in “real world” practice due to implementation drift (Accurso, Fitzsimmons‐Craft, Ciao, & Le Grange, 2015; Accurso, Le Grange, & Graham, 2020; Kosmerly, Waller, & Robinson, 2015), highlighting the importance of other potential avenues to improve treatment outcomes in youth with eating disorders. To this aim, ROM may be an important potential avenue to pursue.…”

Adaptation to family-based treatment for Medicaid-insured youth with anorexia nervosa in publicly-funded settings: Protocol for a mixed methods implementation scale-out pilot study

“…The FBT-AS is a 20-item measure of clinician attitudes towards FBT. The FBT-AS has good reliability and validity, including predicting intent to change practice to be more consistent with FBT [40].…”

“…FBT Attitude Scale (FBT-AS) [40]. The FBT-AS is a 20-item measure of clinician attitudes towards FBT.…”

“…If not adapted, interventions may meet with therapist resistance and have poor organizational fit [38,39]. Clinicians report intention to "drift" from manualized FBT immediately post-training [40], and actual drift has been observed in real-world practice [13,41]. While FBT principles have been incorporated into higher level of care programs [42][43][44][45], little work has been done to adapt FBT, which is an outpatient treatment, to community-based outpatient settings.…”