Family-based treatment is overvalued: reply to Lock and Le Grange

Abstract

Depending on who you talk to and what you read, there are two, very different, attitudes towards family based treatment (FBT): the only treatment for which empirical support is strong, an approach too mechanical to trust. Each camp views the conclusion of the other as not only wrong, but backward. The debates have been contentious; they have also ignored issues which, if properly considered, would be grounds for a thoughtful perspective, one that better serves the public health. Achieving the middle ground is imperative. In a discipline as young as ours weighing evidence cautiously can have a civilising influence, not only on how we are perceived by patients and families but also on how we will be judged by other disciplines and by purchasers of care. This article offers a carefully measured, detailed argument for consensus. It reviews the evidence-base for FBT and shows why broad claims of its benefit are greatly overstated, but also why it should not be discounted. Understanding the circumstances when use of FBT is inappropriate and when failure to consider it might be equally so addresses an important question on which our field is presently divided.

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders

“…Recent evidence reviews have reported that family therapy and a specific form of family therapy termed 'family based treatment' (FBT) remains the most well-studied treatment for young people with anorexia nervosa, and has been associated with persistent positive outcomes on physical and psychological parameters (Keel and Haedt, 2008;NEDC, 2010;Watson and Bulik, 2012); however, views are mixed (Couturier et al, 2013;Fisher et al, 2010;Strober, 2014). One of these reviews (Couturier et al, 2013) found that although FBT was not superior to individual treatment at the end of treatment, there did appear to be significant benefits at the 6-12 month follow-up.…”

Cognitive remediation therapy (CRT) for eating and weight disorders

“…However, the studies used as a base for this claim are overall relatively small, with very many methodological limitations (e.g. Fairburn, 2005;Strober, 2014), and nor has there has been suffi cient research comparing family therapy to other treatments (Eisler, 2005). Nevertheless, there is a general acceptance, for now, of family oriented approaches as being the primary intervention for adolescent anorexia nervosa, in the context of a lack of better evidence for other approaches.…”

Experiências de vida relatadas por genitores masculinos de adolescentes diagnosticadas com transtorno alimentar em tratamento ambulatorial

“…Esse tema foi ignorado como campo de pesquisa por mais de um século (35) e ainda é pouco estudado (36). No entanto, o convívio com uma pessoa que apresenta um TA pode trazer impactos significativos na vida dos cuidadores (8,(36)(37)(38).…”