Over the long term, family-based therapy was best.
Reprinted from Eating Disorders Review
March/April 2011 Volume 22, Number 2
©2011 Gürze Books
Although various forms of individual and family therapy are used to treat adolescents with anorexia nervosa (AN), most have not been systematically examined. According to James Lock, MD, PhD and colleagues at Stanford University and the University of Chicago, only six randomized clinical trials thus far have examined family therapy and individual therapy for AN.
Dr. Lock and colleagues designed a two-site study to compare two approaches to treatment for AN: adolescent-focused individual therapy (AFT) and family-based treatment (FBT) (Arch Gen Psychiatry 2010; 67: 25).
AFT (also termed Ego-Oriented Individual Therapy) is a psychodynamically focused individual therapy approach that emphasizes enhancing autonomy, self-efficacy, individuation and assertiveness while also including collateral meetings with parents to support individual treatment.
In contrast, FBT promotes parental control of weight restoration while enhancing family function as it relates to the adolescent’s development. The treatment has three phases: during phase 1, attempts are made to help absolve the parents from the responsibility of causing the disorder and to compliment them on their positive parenting skills. In phase 2, the parents are helped to transition eating and weight control back to the adolescent in an age-appropriate way. In phase 3, the emphasis is on establishing a healthy adolescent relationship with the parents.
Participants were recruited from October 2004 through March 2007 by advertising to individual clinicians, organizations, and clinics that treat people with eating disorders. After telephone screening, 175 patients were invited for an assessment interview if they met DSM-IV criteria for AN. One hundred and twenty one participants, aged 12 through 18 years with DSM-IV diagnoses of AN (amenorrhea was not a requirement) were evaluated from April 2005 through March 2009. Participants received 24 outpatient hours of treatment (FBT or AFT) over 12 months. Participants were assessed at baseline and at the end of treatment, then at 6 and 12 months after treatment.
FBT: most effective over the long run
Both treatments led to considerable improvements with no difference in the primary outcome variablefull remissionat the end of treatment. There also were no differences between the two groups on rate of drop-out from treatment, average amount of treatment received, or continued use of treatment after the end of official treatment. During the 12-month follow-up period, however, FBT became statistically superior to AFT. This may have been due in part to different rates of relapse from full remission10% for FBT and 40% for AFT. Those in the FBT group gained weight more quickly, but this effect was no longer present at follow-up. Those in the FBT group also were hospitalized significantly less often.
The authors note that although FBT outperformed AFT on several important clinically significant measures, AFT in effect “caught up” in terms of age and gender-adjusted body mass index percentile and global Eating Disorder Examination scores during the follow-up period.
The authors concluded that FBT is superior to AFT as a treatment for adolescents with AN, although AFT is an important alternative treatment for families that would prefer a largely individual treatment for their child with AN.