Who’s in the Room? A Parent-Focused Family Therapy for Adolescent Anorexia Nervosa

Hughes, Elizabeth K.; Sawyer, Susan Μ; Loeb, Katharine L.; Grange, Daniel Le

doi:10.1080/10640266.2015.1042314

Cited by 12 publications

(7 citation statements)

References 36 publications

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“…PFT adopts similar goals but does not involve the therapist having direct contact with the adolescent; instead, the therapist works only with the parents. Detailed intervention protocols of FBT and PFT have been previously reported (Hughes et al, 2014, 2015; Le Grange et al, 2016). Participants and parents completed interviews and self-reported written assessments at baseline, throughout treatment, at end of treatment, and at 6- and 12-month follow-up.…”

Section: Methodsmentioning

confidence: 99%

“…Notably, current treatments for adolescent AN yield only modest outcomes (Brockmeyer, Friederich, & Schmidt, 2017; Murray, Quintana, Loeb, Griffiths, & Le Grange, 2018; Watson & Bulik, 2013). Indeed, family-based treatment (FBT; Lock & Le Grange, 2013) and analogues such as parent-focused treatment (PFT; Hughes, Sawyer, Loeb, & Le Grange, 2015) are considered the most efficacious treatment for medically stable AN of short duration (Brockmeyer et al, 2017). Yet approximately only 25% to 40% of those who undergo FBT will typically be remitted of symptoms by the end of treatment (Le Grange et al, 2016; Lock et al, 2010), and about one third will sustain remission at long-term follow-up (Le Grange et al, 2014).…”

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confidence: 99%

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Reciprocal relations between dietary restraint and negative affect in adolescents receiving treatment for anorexia nervosa.

Pila¹,

Murray²,

Grange³

et al. 2019

Journal of Abnormal Psychology

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Recent research has identified the important but overlooked role of negative affect in the maintenance of dietary restriction. However, understanding how fluctuations in negative affect relate to symptoms of anorexia nervosa (AN) during treatment is limited. In a longitudinal study, the reciprocal associations between higher and lower order dimensions of negative affect and dietary restraint were examined in adolescents undergoing treatment for AN. The sample consisted of 107 adolescents (M age ϭ 15.5, SD ϭ 1.5 years) who underwent family-based treatment over the course of 6 months. Self-report data assessing negative affect and dietary restraint were collected at baseline, 6 times throughout treatment, and again at the end of treatment. Findings from lagged hierarchical linear models revealed reciprocal associations between higher order negative affect and dietary restraint but unidirectional associations among some dimensions of lower order affect. Specifically, dietary restraint predicted increased guilt and hostility, whereas fear predicted increased dietary restraint. These findings highlight the importance of examining the distinct dimensions of negative emotion and the temporal role of fear in precipitating dietary restraint, and guilt and hostility in proceeding dietary restraint. Collectively, these findings emphasize the functional nature of different emotions in the process of AN remission and provide preliminary evidence of affective mechanisms related to change in symptomatology during treatment for adolescent AN.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Reciprocal relations between dietary restraint and negative affect in adolescents receiving treatment for anorexia nervosa.

Pila¹,

Murray²,

Grange³

et al. 2019

Journal of Abnormal Psychology

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“…To our knowledge, the grief process in parents of youngsters with AN has been addressed in only one clinical publication [ 26 ], describing a useful targeted loss and grief program for parent groups. Aside from this particular psychoeducational module, parental experiences of loss and grief have not been specifically addressed in major existing evidence-based therapeutic programs for AN, such as Family-Based Treatment (FBT) [ 34 ], Parent-Focused Treatment (PFT) [ 35 ], or Multi-Family Therapy (MFT) [ 36 ]. Even the transdiagnostic model of Emotion-Focused Family Therapy (EFFT) [ 37 ], which is tailored to coach and process a whole array of caregivers’ emotional experiences that are similar to those involved in grief (sadness, anger, fear, shame, loneliness), does not precisely do so within the loss and grief framework.…”

Section: Introductionmentioning

confidence: 99%

Caregivers in anorexia nervosa: is grief underlying parental burden?

et al. 2023

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Abstarct Purpose Anorexia Nervosa (AN) is a severe chronic disorder and parents’ experience of caregiving is usually marked by emotional distress and burden. Severe chronic psychiatric disorders are known to be linked with the concept of grief. Grief has not been investigated in AN. The aim of this study was to explore parents’ and adolescents’ characteristics that may be related to parental burden and grief in AN, and the link between these two dimensions. Methods Eighty mothers, 55 fathers and their adolescents (N = 84) hospitalized for AN participated in this study. Evaluations of clinical characteristics of the adolescent’s illness were completed, as well as self-evaluations of adolescent and parental emotional distress (anxiety, depression, alexithymia). Levels of parental burden were evaluated with the Experience of Caregiving Inventory and levels of parental grief with the Mental Illness Version of the Texas Revised Inventory of Grief. Results Main findings indicated that the burden was higher in parents of adolescents with a more severe AN; fathers’ burden was also significantly and positively related to their own level of anxiety. Parental grief was higher when adolescents’ clinical state was more severe. Paternal grief was related to higher anxiety and depression, while maternal grief was correlated to higher alexithymia and depression. Paternal burden was explained by the father’s anxiety and grief, maternal burden by the mother’s grief and her child’s clinical state. Conclusion Parents of adolescents suffering from AN showed high levels of burden, emotional distress and grief. These inter-related experiences should be specific targets for intervention aimed at supporting parents. Our results support the extensive literature on the need to assist fathers and mothers in their caregiving role. This in turn may improve both their mental health and their abilities as caregivers of their suffering child. Level of evidence Level III: Evidence obtained from cohort or case-control analytic studies.

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“…Direct contact between the therapist and adolescent was limited to the introductory session and the concluding session. Unlike conjoint FBT, there was no family meal session in PFT (Hughes, Sawyer, Loeb, & Le Grange, 2015).…”

Section: Methodsmentioning

confidence: 99%

Family‐based treatment for adolescent anorexia nervosa: Outcomes of a stepped‐care model

Grange

Pradel

Pogos

et al. 2021

Intl J Eating Disorders

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ObjectiveStepped‐care models of treatment are underexplored in eating disorders. To enhance treatment outcomes, and informed by literature about adaptations to family‐based treatment (FBT), we developed an FBT‐based stepped‐care model for adolescents with anorexia nervosa (AN) that was consistent with family preference (i.e., tailored) and responsive to adolescent needs (i.e., intensity). The aim of this study was to evaluate the effectiveness of this model in terms of remission at end‐of‐treatment.MethodAdolescents (N = 82), aged 12–18 years (M = 15.1, SD = 1.8) and meeting Diagnostic and Statistical Manual of Mental Disorders 5th Edition criteria for AN, were assessed at baseline, Weeks 24 and 48. FBT was tailored to family preference and clinical need, with 16–18 sessions by Week 24. This was followed by three FBT booster sessions or an extension of FBT plus booster sessions (Week 48). The primary outcome was defined as weight > 95% of %median body mass index plus within 1 SD of the Eating Disorder Examination (EDE) global score community norms.ResultsRemission rates were 45.1% and 52.4% at Weeks 24 and 48, respectively. Commensurable improvements were evident across secondary outcomes (e.g., EDE subscale scores). As a reference point, remission rates compared positively with results from a recent randomized clinical trial from the same center and at the same time points (Week 24:45.1% vs. 32.1% and Week 48:52.4% vs. 30.2%). Controlling for propensity score, no statistically significant differences were observed.DiscussionThis stepped‐care model, designed to be responsive to the individual needs of adolescents and their families, achieved encouraging rates of remission. This study provides an important signal that supports future clinical trials of stepped‐care models for adolescents with AN.

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Who’s in the Room? A Parent-Focused Family Therapy for Adolescent Anorexia Nervosa

Cited by 12 publications

References 36 publications

Reciprocal relations between dietary restraint and negative affect in adolescents receiving treatment for anorexia nervosa.

Reciprocal relations between dietary restraint and negative affect in adolescents receiving treatment for anorexia nervosa.

Caregivers in anorexia nervosa: is grief underlying parental burden?

Family‐based treatment for adolescent anorexia nervosa: Outcomes of a stepped‐care model

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