Family therapy approaches for anorexia nervosa: a Cochrane Review

Fisher, Caroline A.; Skocic, Sonja; Rutherford, Kathleen A; Hetrick, Sarah

doi:10.1192/bja.2020.15

Cited by 3 publications

(3 citation statements)

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“…The literature base for the evidence of family‐based therapy for early stage illness in adolescent AN is the longest and largest. Nevertheless, a recently updated Cochrane review (Fisher et al., 2020) concluded that the overall strength of the evidence was low to moderate. Most studies have focused on patient body mass index (BMI) at the end of treatment as the primary outcome, with less information about the rest of the family.…”

Section: The New Maudsley Model For Collaborative Carementioning

confidence: 99%

The value of including families in the treatment of anorexia nervosa

Treasure

Parker

Oyeleye

et al. 2020

Euro Eating Disorders Rev

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The aim of this paper is to consider family and wider carer involvement in the treatment of anorexia nervosa, and how this can be used to add value to services. We discuss widely adopted interventions involving the family that have been manualised and studied in trials that have outcome measures that are of relevance to illness costs. The therapeutic targets of these interventions range from a focus on feeding to the wellbeing of the whole family. The theoretical models that underpin interventions involving the family/wider carers include both intra and interpersonal processes, with the exception of family‐based therapy, which in its original form holds an agnostic stance towards aetiology. Although formal evaluation of the cost effectiveness of these interventions is minimal, there is evidence that involving the family can reduce bed use and improve the wellbeing of both patients and family members. Moreover, for the most part, these interventions are acceptable to patients and carers. Finally, we consider how these approaches can be disseminated and scaled up more widely into services.

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Section: The New Maudsley Model For Collaborative Carementioning

confidence: 99%

The value of including families in the treatment of anorexia nervosa

Treasure

Parker

Oyeleye

et al. 2020

Euro Eating Disorders Rev

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“…By contrast, the stronger recommendation to 'offer' family therapy was made by NICE for adolescent BN, on the basis of their meta-analysis of just two FT-BN studies (Le Grange et al, 2015; showing superior remission compared to individual approaches as follow-up, but not remission. The Cochrane review conducted by Fisher et al (2019) on family therapy approaches for anorexia nervosa included a number of meta-analyses, although differed from NICE in the choice of studies included in their analyses. The headline conclusion of the review was that there was low-quality evidence to support the efficacy of family therapy compared to treatment as usual in terms of remission posttreatment (based on two studies, with 81 participants), but not at follow-up.…”

Section: Reviewsmentioning

confidence: 99%

“…The analyses of greater relevance to FT-AN were the comparisons of family therapy to psychological interventions, which also included the Lock et al (2010), Robin et al (1999) and Russell et al (1987) trials, but also included adult studies by Dare et al (2001) and Crisp et al (1991). Fisher et al (2019) found no evidence of superiority of family therapy relative to psychological interventions in terms of remission; however, there were superior outcomes for FT-AN for weight at end of treatment, although not at follow-up, which is in keeping with the findings by NICE (2017) and the meta-analysis by Murray et al (2019) which is discussed below. The authors comment on the high risk of bias found in the included studies, for instance through outcome assessment being conducted by clinicians rather than blinded assessors.…”

Section: Reviewsmentioning

confidence: 99%

Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa (Thesis)

Jewell¹

2021

Preprint

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Family therapy for adolescent anorexia nervosa (FT-AN) is the first line treatment for the disorder, but little is known about who the treatment works for, or how it works. This thesis investigates the potential value of the constructs of attachment and mentalization as predictors of outcome in family therapy for adolescent AN. The thesis presents a systematic review of attachment and mentalization and their association with child and adolescent eating pathology in which 22 relevant studies were found. In keeping with the evidence base for adults with eating disorders, both attachment and mentalization were found to be correlates of eating pathology in childhood and adolescence. However, evidence for these constructs in the process of treatment in child and adolescent eating disorders is scarce. In a second systematic review, the psychometric properties of attachment measures in middle childhood and adolescence were investigated across 53 studies. The overall conclusion of the study is that there is a lack of evidence of adequate psychometric properties for attachment measures in this age group.In the main study, attachment and mentalization were investigated as predictors of outcome in a sample of adolescents and their parents (n = 192) receiving FT-AN across three specialist outpatient eating disorder services. Mentalization, but not attachment, was found to predict poor clinical outcome at nine months after starting of treatment, with the strongest predictive effect being excessive certainty about mental states as assessed in parents. Therapeutic alliance scores at one month were predictive of outcome but did not play a mediating role in relation to baseline attachment or mentalization. In a further empirical study, definitions of eating disorder recovery were investigated through a qualitative analysis of comments on recovery-focused social media forums. Two super-ordinate themes emerged: firstly, recovery was defined as encompassing broad psychosocial domains of wellbeing; secondly, recovery was understood to be an ongoing process. Social connectedness to others was regarded as important both to the process and definition of eating disorder recovery. The final chapter of the thesis integrates findings from across the studies with emerging theoretical developments in the fields of attachment and mentalization. It is argued that attachment and mentalization represent worthwhile constructs for further FT-AN research, with a particular emphasis on the need to better understand the mechanisms by which excessive mental state certainty might lead to poor clinical outcomes.

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Factors Influencing the Formation of Gender Differences in Adolescent Eating Disorders and Ways of Prevention and Treatment

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2024

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Family therapy approaches for anorexia nervosa: a Cochrane Review

Cited by 3 publications

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The value of including families in the treatment of anorexia nervosa

The value of including families in the treatment of anorexia nervosa

Attachment and mentalization as predictors of outcome in family therapy for adolescent anorexia nervosa (Thesis)

Factors Influencing the Formation of Gender Differences in Adolescent Eating Disorders and Ways of Prevention and Treatment

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