Short‐Term Intensive Family Therapy for Adolescent Eating Disorders: 30‐Month Outcome

Abstract

Family therapy approaches have generated impressive empirical evidence in the treatment of adolescent eating disorders (EDs). However, the paucity of specialist treatment providers limits treatment uptake; therefore, our group developed the intensive family therapy (IFT)-a 5-day treatment based on the principles of family-based therapy for EDs. We retrospectively examined the long-term efficacy of IFT in both single-family (S-IFT) and multi-family (M-IFT) settings evaluating 74 eating disordered adolescents who underwent IFT at the University of California, San Diego, between 2006 and 2013. Full remission was defined as normal weight (≥ 95% of expected for sex, age, and height), Eating Disorder Examination Questionnaire (EDE-Q) global score within 1 SD of norms, and absence of binge-purging behaviours. Partial remission was defined as weight ≥ 85% of expected or ≥ 95% but with elevated EDE-Q global score and presence of binge-purging symptoms (<1/week). Over a mean follow-up period of 30 months, 87.8% of participants achieved either full (60.8%) or partial remission (27%), while 12.2% reported a poor outcome, with both S-IFT and M-IFT showing comparable outcomes. Short-term, intensive treatments may be cost-effective and clinically useful where access to regular specialist treatment is limited.

Two models of multiple family therapy in the treatment of adolescent anorexia nervosa: a systematic review

“…A retrospective study [64], which compared MFT plus treatment as usual (TAU) to a matched control group receiving only TAU, found that both cases and controls experienced significant weight restoration, but the addition of MFT led to quicker weight gain and higher rates of full weight restoration. Another retrospective study carried out within the framework of an intensive therapeutic program in San Diego [26,65] MFT treatments with a psychoeducational orientation have generated only one comparative study. In a small RCT involving AN adolescent inpatients, Geist et al [32] compared 8 sessions of individual family therapy (FT) with 8 sessions of family group psychoeducation (FGP) over a 4-month study period and found that both treatment modalities equally supported weight restoration, the preference being once more given to FGP because of its better cost-effectiveness.…”

Anorexia nervosa: diagnosis, risk factors and evidence‐based treatments

“…85 Marzola et al followed up 54 adolescents, 30 months after a brief intensive MFT intervention, reporting 59.3% remission (>95% expected body weight [EBW]) rates and a further 27.7% partial remission (>85% EBW). 86 MFT-AN is a highly acceptable intervention to families, with more than 90% completing the treatment, with significant improvement in weight and other patient symptoms, improvements in parents' mood and better family relationships. 87,88 Pharmacological treatment -efficacy of antidepressants and atypical antipsychotics NICE does not support medication as a primary or only treatment for AN.…”

A Brief, Intensive Application of Multi-Family-Based Treatment for Eating Disorders

“…Other components include daily parent-only and patient-only group sessions, and individual family psychiatric and medical evaluations. Multi-family intensive family treatment (IFT) is deemed suitable by families and has demonstrated preliminary efficacy for patients with a broad range of ages (8-27), eating disorder diagnoses (Marzola et al, 2015;Rockwell et al, 2011), and phases of treatment. This heterogeneous group composition serves a number of diverse patient needs including supporting transitions between phases of treatment or levels of care, augmenting traditional individual therapy, and as a booster for patients failing to make gains in outpatient care.…”

“…In response to these barriers, recent endeavors by our group have sought to establish short-term intensive treatment programs, which allow temporary immersion into otherwise inaccessible evidence-based treatment programs, with preliminary reports suggesting promising findings (Marzola et al, 2015;Rockwell, Boutelle, Trunko, Jacobs, & Kaye, 2011). Initially, these short-term intensive treatments were developed for individual families (Rockwell et al, 2011), although recently have evolved into a more costeffective multi-family format (Marzola et al, 2015), demonstrating promising outcomes comparable to both outpatient FT-AN (Lock & Le Grange, 2012) and intensive family therapy for individual families (Rockwell et al, 2011).…”

“…Initially, these short-term intensive treatments were developed for individual families (Rockwell et al, 2011), although recently have evolved into a more costeffective multi-family format (Marzola et al, 2015), demonstrating promising outcomes comparable to both outpatient FT-AN (Lock & Le Grange, 2012) and intensive family therapy for individual families (Rockwell et al, 2011). However, alongside the emerging empirical evidence supporting intensive multi-family therapy, it is important that the clinical content of this approach is outlined such that dissemination and widespread implementation is facilitated.…”