Augmentative Approaches in Family‐Based Treatment for Adolescents with Restrictive Eating Disorders: A Systematic Review

Richards, Imogen Lim; Subar, Anni R.; Touyz, Stephen; Rhodes, Paul

doi:10.1002/erv.2577

Cited by 30 publications

(32 citation statements)

References 74 publications

(193 reference statements)

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“…In this article we have identified a number of significant, commonly occurring problems in adolescent AN and described how the context, structure, and interventions of FBT can be used to successfully address many of them without introducing new content or augmentative treatments that to date have not been found systematically beneficial (83). Careful reading, accredited training, adequate supervision, and experience using manualized FBT would likely decrease concerns about how FBT helps with the full range of problems associated with adolescent AN.…”

Section: Concluding Commentmentioning

confidence: 99%

“…It may be particularly important to examine the relative effect of FBT compared to Systemic Family Therapy for adolescents with comorbid obsessive compulsive disorder as this was identified post hoc as a moderator favoring Systemic Family Therapy and should be confirmed (8). Furthermore, while FBT is effective for many, there is considerable room for improvement in outcomes and strategies to improve or augment FBT developed and tested (83). Careful study of the mechanisms mediating response to FBT, such as emotion regulation, trait characteristics, and social competence as well as parent factors as outlined above, may give clues to possible enhancements that would increase the proportion of patients responding to the intervention.…”

Section: Concluding Commentmentioning

confidence: 99%

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Toward A Greater Understanding of the Ways Family-Based Treatment Addresses the Full Range of Psychopathology of Adolescent Anorexia Nervosa

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Nicholls

2020

Front. Psychiatry

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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.

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Section: Concluding Commentmentioning

confidence: 99%

Section: Concluding Commentmentioning

confidence: 99%

Toward A Greater Understanding of the Ways Family-Based Treatment Addresses the Full Range of Psychopathology of Adolescent Anorexia Nervosa

Lock

Nicholls

2020

Front. Psychiatry

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“…Given the utility of FBT, treatment programs utilizing higher levels of care (e.g., partial hospitalization programs [PHP]), have integrated FBT strategies into treatment protocols (Richards, Subar, Touyz, & Rhodes, ). Although all aspects of manualized FBT cannot be translated to a PHP, family‐based PHPs attempt to reproduce core FBT tenets (e.g., focusing on parental empowerment and discouraging reliance on the program for refeeding; see Hoste, ).…”

Section: Introductionmentioning

confidence: 99%

Early weight gain predicts treatment response in adolescents with anorexia nervosa enrolled in a family‐based partial hospitalization program

Huysse

Smith

Mammel

et al. 2020

Intl J Eating Disorders

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Objective: Improved treatment outcome in family-based treatment (FBT) for anorexia nervosa (AN) is predicted by weight gain occurring early in the course of treatment (i.e., about 4 lbs by week 4). Although prior work suggests that early weight gain in higher levels of care (e.g., partial hospitalization programs [PHP]) predicts weight restoration at discharge, no study has examined the specific rate of gain within FBT-informed PHP programs that best predicts treatment response. Method: This study examined rate of weight gain in pounds and percent expected body weight (EBW) that predicts positive outcome in 70 patients (M age = 15.49 years, SD = 2.56) with AN who were enrolled in a family-based PHP. Results: Receiver operator characteristic analyses demonstrated that changes in % EBW during weeks 2-5 were more useful than changes in weight in predicting positive outcome. Gaining at least 8.9 pounds or over 8% of EBW in the first 4 weeks of treatment significantly predicted positive outcome. Discussion: Findings suggest that positive outcome in an FBT-informed PHP is predicted by rapid weight gain in the initial weeks of treatment. Research is needed to identify specific family and patient characteristics that facilitate weight gain and to develop corresponding interventions to improve outcome. K E Y W O R D S adolescent, anorexia nervosa, body weight, treatment outcome, weight gain

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“…In one way or another all these approaches facilitate emotionally laden communication between the young person and their parents. There is currently insufficient data to judge the therapeutic effectiveness of these approaches (Richards et al, 2018). We present here the case of an adolescent girl who remained dependent on parental supervision despite weight recovery and presented with disabling OCD after treatment.…”

mentioning

confidence: 99%

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confidence: 99%

Addressing Emotional Communication in Family Relationships in the Treatment of Young People with Anorexia: A Case Study

Joyce

Dring

2019

ANZ J of Family Therapy

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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.

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Augmentative Approaches in Family‐Based Treatment for Adolescents with Restrictive Eating Disorders: A Systematic Review

Cited by 30 publications

References 74 publications

Toward A Greater Understanding of the Ways Family-Based Treatment Addresses the Full Range of Psychopathology of Adolescent Anorexia Nervosa

Toward A Greater Understanding of the Ways Family-Based Treatment Addresses the Full Range of Psychopathology of Adolescent Anorexia Nervosa

Early weight gain predicts treatment response in adolescents with anorexia nervosa enrolled in a family‐based partial hospitalization program

Addressing Emotional Communication in Family Relationships in the Treatment of Young People with Anorexia: A Case Study

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