Is Intensive Multi-Family Therapy Worthwhile?

One study is examining the possible benefits of shortened treatment.

A new feasibility trial will assess whether a 5-day course of intensive multi-family therapy (MFT) will produce better results for adolescents with anorexia nervosa than traditional single-family therapy. The concept involves adding 5-day MFT to the early stages of FT (J Eat Disord. 2021. 9:71).

As author Dr. Julian Baudinet and colleagues at Kings College and Maudsley Centre for Child and Adolescent Disorders, London, explain, the early stages of FT are very important: one principle is that weight gain within the first few weeks of treatment predicts improved outcome at the end of treatment. That is, as numerous studies have shown, 6 months of FT is just as effective as 12 months of treatment. And, family factors, such as increased emotion, including criticism, hostility and emotional over-involvement, for example, can reduce a patient’s response to treatment.

MFT for adolescent AN is associated with a reduction in ED symptoms, and improved mood and self-esteem, quality of life, and outcomes. Despite the promising findings, there have been few controlled trials, and a great variety in the ways MFT is administered, according to the authors.

The study design

The primary objective of the study is assessing whether adding a 5-day MFT intensive week in the first 2 months of FT-AN will improve outcomes for adolescent AN patients. The researchers are recruiting 60 adolescents and their families for the trial. All participants will receive FT-AN, so that all will receive the best available care, say the authors. The control group will receive 6 months of FT-AN, and the experimental group will receive 6 months of FT-AN plus a 5-day intensive course of MFT delivered within the first 2 months of treatment. Those in the 5-day intensive multi-family therapy group will have an adaptation of the usual manualized 10-day approach. In contrast, the intensive MFT group will include up to 8 families working together with a clinical team over a week to build skills, promote engagement, and increase understanding about the illness and family dynamics. The brief intensive version also includes between 2 and 8 families per group and condenses the main treatment content into 5 consecutive days (10 am to 4 pm, Monday through Friday) over one week. The treatment content matches the phases of regular FT-AN, and focuses on empowering parents to support their child to manage eating disorder symptoms and to restore weight. Two clinicians will deliver the extensive treatment. General function, reflexive functioning, emotion regulation by patients and their parents, parental mood and anxiety symptoms, expressed emotion, and therapeutic alliance will be measured with a number of questionnaires and other instruments.

Time will tell if it is feasible and acceptable to add 5-day intensive MFT to the critical early stages of FT for AN. The researchers point out two limitations to their study—one is the relatively small sample and the second is that MFT is added in the first 2 months of treatment rather than during the first month. (Increasing data are indicating that MFT may be more effective the earlier it is delivered.) However, in the authors’ study, having MFT during the first month is not possible, due to study time constraints. (One wonders if similar time constraints might present in real-world implementation of such a combined approach. If so, using MFT in the first 2 months in this study might reflect how this would be implemented over time.)

Study strengths include the use of a randomized controlled design and the inclusion of data collection points during treatment as well as at the end of treatment.

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