Family-Based Treatment for Anorexia Nervosa Symptoms in High-Risk Youth: A Partially-Randomized Preference-Design Study

Abstract

This pilot study adapted family-based treatment (FBT) for youth with potentially prodromal anorexia nervosa (AN). Fifty-nine youth with clinically significant AN symptom constellations, but who never met full Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) (DSM-IV) criteria for AN, were enrolled in a partially randomized preference design study. Participants were offered randomization to FBT or supportive psychotherapy (SPT); those who declined to be randomized because of a strong treatment preference were entered into a parallel, non-randomized self-selected intervention study. Without accessing outcome data, an observational analysis with three diagnostic subclasses was designed based on AN symptom severity profiles, combining randomized and non-randomized participants, such that participants receiving FBT and SPT within each subclass were similar on key baseline characteristics. Outcomes of this pilot study were explored by calculating effect sizes for end-of-treatment values within each subclass, and also with a longitudinal mixed effect model that accounted for subclass. Weight trajectory was measured by percent expected body weight. Psychological outcomes were fear of weight gain, feeling fat, importance of weight, and importance of shape. Results show that the pattern of symptom observations over time was dependent on subclass of SAN (least symptomatic, moderately symptomatic, or most symptomatic) and on the target outcome variable category (weight or psychological). Results from this study, which should be considered in the context of the small sample sizes overall and within groups, can generate hypotheses for future,

A Performance-Based Teleintervention for Adults in the Chronic Stage after Acquired Brain Injury: An Exploratory Pilot Randomized Controlled Crossover Study

“…The next 10 participants were randomized using the minimization randomization technique of the WINPEPI software [ 42 ] to minimize differences in age and mRS levels between the groups at the baseline. This partially randomized preference design is relevant for complex intervention research [ 43 ] and technology-based intervention research, which are known for their recruitment challenges [ 44 ]. This design allowed us to collect data from participants who would otherwise not have been observed.…”

Psychometric properties of the Parent Eating Disorder Examination Questionnaire

“…The PEDE-Q would more accurately identify a full-syndrome ED diagnosis than the EDE-Q among participants with both full-and partial-syndrome EDs. Data from the five sites were merged into an overall sample (N = 476), which was reduced to a clinical sample of youth with DSM-IV or DSM-5 AN or BN, DSM-IV eating disorder not otherwise specified (EDNOS), DSM-5 other specified feeding and eating disorder (OSFED), or a site-specific research category of subsyndromal AN (SAN; Loeb et al, 2020). SAN participants, a research-specific presentation that would fall under EDNOS/OSFED, were defined as youth at high risk for AN by virtue of meeting partial AN criteria with no prior history of AN.…”

Eating disorders in young people

“…8 An adapted M-FBT delivered in the prodrome of AN has been recently piloted with promising results. 18 The First episode Rapid Early intervention service for Eating Disorders (FREED) program is also to be delivered within the first three years, with outcome data available only on AN presentations to date. 19,20 Over the course of the first year, ED outcomes improved from baseline; however, there was no comparison group to establish if these outcomes were enhanced relative to treatment as usual.…”