1
|
Pedersen SH, Waage DA, Micali N, Bentz M. Families tackling adolescent anorexia nervosa: family wellbeing in family-based treatment or other interventions. A scoping review. Eat Weight Disord 2024; 29:20. [PMID: 38504003 PMCID: PMC10951015 DOI: 10.1007/s40519-024-01641-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 01/28/2024] [Indexed: 03/21/2024] Open
Abstract
PURPOSE Family-based treatment (FBT) has contributed significantly to the treatment of anorexia nervosa (AN) in young people (YP). However, parents are concerned that FBT and the active role of parents in the task of refeeding may have a negative impact on family relations. The aim of the review is to assess whether families engaged in FBT for AN are more or less impacted in their family wellbeing and caregiver burden, compared to families with a YP diagnosed with AN, who are not undergoing treatment with FBT. METHOD Computerized searches across six databases complemented by a manual search resulted in 30 papers being included in the scoping review. RESULTS The review identified 19 longitudinal studies on change in family wellbeing in families in FBT-like treatments, and 11 longitudinal studies on change in family wellbeing in treatment where parents are not in charge of refeeding. Only three randomized controlled studies directly compare FBT to treatment without parent-led refeeding. CONCLUSION The available research suggests no difference between intervention types regarding impact on family wellbeing. Approximately half of the studies find improvements in family wellbeing in both treatment with and without parent-led refeeding, while the same proportion find neither improvement nor deterioration. As parents play a pivotal role in FBT, there is a need for good quality studies to elucidate the impact of FBT on family wellbeing. Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
Collapse
Affiliation(s)
- Signe Holm Pedersen
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark.
| | - Dorthe Andersen Waage
- Center for Eating and Feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Denmark, Ballerup, Denmark
| | - Nadia Micali
- Center for Eating and Feeding Disorders Research, Mental Health Center Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Denmark, Ballerup, Denmark
| | - Mette Bentz
- Child and Adolescent Mental Health Center, Copenhagen University Hospital-Mental Health Services CPH, Copenhagen, Denmark
| |
Collapse
|
2
|
Lebow J, Sim L, Redmond S, Billings M, Mattke A, Gewirtz O'Brien JR, Partain P, Narr C, Breland R, Soma D, Schmit T, Magill S, Leonard A, Crane S, Le Grange D, Loeb K, Clark M, Phelan S, Jacobson RM, Enders F, Lyster-Mensh LC, Leppin A. Adapting Behavioral Treatments for Primary Care Using a Theory-Based Framework: The Case of Adolescent Eating Disorders. Acad Pediatr 2024; 24:208-215. [PMID: 37567443 DOI: 10.1016/j.acap.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/28/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
Evidence-based treatments have been developed for a range of pediatric mental health conditions. These interventions have proven efficacy but require trained pediatric behavioral health specialists for their administration. Unfortunately, the widespread shortage of behavioral health specialists leaves few referral options for primary care providers. As a result, primary care providers are frequently required to support young patients during their lengthy and often fruitless search for specialty treatment. One solution to this treatment-access gap is to draw from the example of integrated behavioral health and adapt brief evidence-based treatments for intra-disciplinary delivery by primary care providers in consultation with mental health providers. This solution has potential to expand access to evidence-based interventions and improve patient outcomes. We outline how an 8-step theory-based process for adapting evidence-based interventions, developed from a scoping review of the wide range of implementation science frameworks, can guide treatment development and implementation for pediatric behavioral health care delivery in the primary care setting, using an example of our innovative treatment adaptation for child and adolescent eating disorders. After reviewing the literature, obtaining input from leaders in eating disorder treatment research, and engaging community stakeholders, we adapted Family-Based Treatment for delivery in primary care. Pilot data suggest that the intervention is feasible to implement in primary care and preliminary findings suggest a large effect on adolescent weight gain. Our experience using this implementation framework provides a model for primary care providers looking to develop intra-disciplinary solutions for other areas where specialty services are insufficient to meet patient needs.
Collapse
Affiliation(s)
- Jocelyn Lebow
- Department of Psychiatry and Psychology (J Lebow, L Sim, M Clark), Mayo Clinic School of Medicine, Rochester, Minn; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (J Lebow, RM Jacobson, F Enders), Rochester, Minn; Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn.
| | - Leslie Sim
- Department of Psychiatry and Psychology (J Lebow, L Sim, M Clark), Mayo Clinic School of Medicine, Rochester, Minn
| | - Sarah Redmond
- Department of Quantitative Health Sciences (S Redmond, S Phelan, RM Jacobson, F Enders), Mayo Clinic School of Medicine, Rochester, Minn
| | - Marcie Billings
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Angela Mattke
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | | | - Paige Partain
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Cassandra Narr
- Department of Undergraduate Nursing (C Narr), Winona State University, Winona, Minn
| | - Renee Breland
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - David Soma
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Tammy Schmit
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Saraphia Magill
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Antoinette Leonard
- Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn
| | - Sarah Crane
- Department of Internal Medicine (S Crane), Mayo Clinic School of Medicine, Rochester, Minn
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences (D Le Grange), University of California, San Francisco; Department of Psychiatry and Behavioral Neuroscience (D Le Grange), The University of Chicago, Chicago, Ill
| | - Katharine Loeb
- Chicago Center for Evidence-Based Treatment (K Loeb), Chicago, Ill
| | - Matthew Clark
- Department of Psychiatry and Psychology (J Lebow, L Sim, M Clark), Mayo Clinic School of Medicine, Rochester, Minn
| | - Sean Phelan
- Department of Quantitative Health Sciences (S Redmond, S Phelan, RM Jacobson, F Enders), Mayo Clinic School of Medicine, Rochester, Minn
| | - Robert M Jacobson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (J Lebow, RM Jacobson, F Enders), Rochester, Minn; Department of Pediatric and Adolescent Medicine (J Lebow, M Billings, A Mattke, P Partain, R Breland, D Soma, T Schmit, S Magill, A Leonard, RM Jacobson), Mayo Clinic School of Medicine, Rochester, Minn; Department of Quantitative Health Sciences (S Redmond, S Phelan, RM Jacobson, F Enders), Mayo Clinic School of Medicine, Rochester, Minn
| | - Felicity Enders
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (J Lebow, RM Jacobson, F Enders), Rochester, Minn; Department of Quantitative Health Sciences (S Redmond, S Phelan, RM Jacobson, F Enders), Mayo Clinic School of Medicine, Rochester, Minn
| | | | - Aaron Leppin
- Department of Quantitative Health Sciences (S Redmond, S Phelan, RM Jacobson, F Enders), Mayo Clinic School of Medicine, Rochester, Minn
| |
Collapse
|
3
|
Frank B, Arnold S, Jaite C, Correll CU. Antipsychotic effects on anthropometric outcomes in anorexia nervosa: a retrospective chart review of hospitalized children and adolescents. J Eat Disord 2023; 11:151. [PMID: 37674209 PMCID: PMC10481458 DOI: 10.1186/s40337-023-00862-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Off-label antipsychotic use is not uncommon in youth with anorexia nervosa (AN), aiming to enhance suboptimal weight restoration, yet its efficacy remains debated, especially in youth. METHODS Retrospective chart review of consecutively admitted inpatients (ages 8-18 years) with restricting/binge-purge AN, comparing youth with versus without antipsychotic treatment regarding baseline factors, treatment, and anthropometric outcome characteristics including all patients and matched subgroups. Matched subsamples were also compared regarding faster versus slower weight change (median split). Furthermore, within-subject analyses compared weight gain trajectories before versus after antipsychotic use in antipsychotic-treated youth. These results were then compared in a pre-/post design with the matched control group without antipsychotic treatment, using the mean duration until antipsychotic use in the antipsychotic-treated group as the dividing timeline, controlling for a potential order effect, in that later rather than earlier antipsychotic treatment for AN may be more successful. RESULTS Of 294 youth with AN (median age = 15.2 (interquartile range = 14.0, 16.6) years, females = 96.6%, restricting subtype = 81.0%, hospitalization duration = 98.2 ± 43.2 days), 44 (15.0%) underwent 52 antipsychotic trials (olanzapine = 63.5%). In multivariable analyses, antipsychotic use was independently associated with younger age, childhood physical abuse history, comorbid borderline personality traits, and lower pre-antipsychotic weight gain (p < 0.0001). In unmatched groups, antipsychotic-treated versus non-treated youth had significantly lower discharge anthropometric parameters, longer inpatient treatment, and lower weight change/week (p < 0.001-p = 0.005), without significant differences between olanzapine and non-olanzapine antipsychotics (p = 0.27-0.44). Non-significant antipsychotic effects on weight outcomes were confirmed in (1) matched subgroups of antipsychotic-treated versus non-treated youth (n = 43 each), (2) youth with faster versus slower weight gain (n = 21 vs. n = 22), and (3) antipsychotic-treated youth when comparing weight change before versus after antipsychotic use (n = 31). Moreover, in antipsychotic-treated youth, weight change/week remained significantly lower versus matched non-antipsychotic-treated youth (n = 31) both before (p = 0.053) and after (p = 0.006) the median time (5 weeks) until antipsychotic use. CONCLUSIONS In this naturalistic study, clinician's antipsychotic choice, given to a more severely ill subgroup of adolescents with AN, did not significantly improve overall worse weight change trajectories during inpatient treatment, even in matched subgroups. Randomized trials in individuals reflecting real-world samples are needed to evaluate the utility of antipsychotic treatment in youth with AN.
Collapse
Affiliation(s)
- Bettina Frank
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitaetsmedizin Berlin, Campus Virchow, Corporate Member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Sabine Arnold
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitaetsmedizin Berlin, Campus Virchow, Corporate Member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitaetsmedizin Berlin, Campus Virchow, Corporate Member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany
- Department of Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Hildesheim, Hildesheim, Germany
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitaetsmedizin Berlin, Campus Virchow, Corporate Member of Freie Universitaet Berlin, Humboldt Universitaet zu Berlin, and Berlin Institute of Health, Augustenburger Platz 1, 13353, Berlin, Germany.
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA.
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
| |
Collapse
|
4
|
Joshua PR, Lewis V, Simpson S, Kelty SF, Boer DP. What role do early life experiences play in eating disorders? The impact of parenting style, temperament and early maladaptive schemas. Clin Psychol Psychother 2023. [PMID: 37654072 DOI: 10.1002/cpp.2904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/09/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE Given that most eating disorders develop in adolescence and early adulthood, early life experiences are said to play a key role in the aetiology of eating disorders. There are well-documented relationships between early maladaptive schemas and eating disorders, early maladaptive schemas and temperament and temperament and perceived parenting style. The present study aimed to test a hypothesis that perceived parenting style predicts temperament, which predicts early maladaptive schemas, which predict eating disorder symptoms in young people. METHOD An online survey measured perceived parenting style, temperament, early maladaptive schemas and eating disorder symptoms in 397 people with disordered eating between the ages of 18 and 29. Path analysis was used to investigate the relationship between these elements. RESULTS The results found support for this hypothesis. Perceived maladaptive parenting ratings for mothers were a stronger predictor of temperament, and only two temperament factors were adequate predictors of early maladaptive schemas. CONCLUSIONS Overall, the present study found preliminary support for a linear relationship where perceived parenting style predicts temperament, which predicts early maladaptive schema levels, which predicts eating disorder symptoms. The present study was the first to propose and test this model; however, further research is required to confirm the nature and extent of this relationship.
Collapse
Affiliation(s)
- Phoebe R Joshua
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Vivienne Lewis
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Susan Simpson
- University of South Australia, Adelaide, South Australia, Australia
- NHS Forth Valley, Stirling, UK
| | - Sally F Kelty
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Douglas P Boer
- Discipline of Psychology, Faculty of Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| |
Collapse
|
5
|
Kinnaird E, Nicholson M, Thomas A, Cooper M. Systematic review: Exploring the monitoring and reporting of unwanted events in psychotherapy trials for anorexia nervosa. Int J Eat Disord 2023. [PMID: 36872579 DOI: 10.1002/eat.23926] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/14/2023] [Accepted: 02/18/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE If a psychotherapeutic intervention has the capacity to produce positive change, the "deterioration effect" theory holds that it must also have the potential for negative effects. However, the definition, measurement, and reporting of unwanted events in psychotherapy is a topic of ongoing discussion. At present this area is under-explored in interventions for anorexia nervosa (AN), a severe mental illness associated with high medical and psychiatric risks. The aim of this article was to undertake a systematic review of published randomized controlled trials (RCTs) evaluating psychotherapeutic interventions for AN, and to assess how unwanted events were defined, monitored, and reported alongside the trial's key findings. METHOD Using a systematic review methodology, this article identified 23 RCTs through database searches meeting eligibility criteria. Results are presented using a narrative summary approach. RESULTS Unwanted event reporting varied widely, both regarding definitions of key unwanted events (such as non-compliance or symptom deterioration) and in the amount of detail captured in each paper. DISCUSSION The review identified two key issues: firstly, a lack of consistent definitions and unclear causality made it difficult to distinguish between unwanted events, and adverse events caused by the interventions. Secondly, it highlighted the difficulty of defining unwanted events where different studies have different populations and goals. Recommendations are made around how the area of defining, monitoring, and reporting unwanted events in RCTs for AN can be taken forward. PUBLIC SIGNIFICANCE Whilst psychotherapies can be effective in treating mental health conditions, negative or unwanted events can sometimes occur. This review explored how RCTs examining psychotherapy for AN report how they monitor the safety of participants, and how they report unwanted events. We found that the reporting was often inconsistent or hard to interpret, and we have made recommendations for how this can be improved in the future.
Collapse
Affiliation(s)
- Emma Kinnaird
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
| | - Meghan Nicholson
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
| | - Amelia Thomas
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Myra Cooper
- Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, UK
| |
Collapse
|
6
|
Godart N, Dorard G, Duclos J, Curt F, Kaganski I, Minier L, Corcos M, Falissard B, Eisler I, Jeammet P, Berthoz S. Long-term follow-up of a randomized controlled trial comparing systemic family therapy (FT-S) added to treatment as usual (TAU) with TAU alone in adolescents with anorexia nervosa. J Child Psychol Psychiatry 2022; 63:1368-1380. [PMID: 35178708 DOI: 10.1111/jcpp.13583] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/04/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Randomized controlled trials showed the efficacy of family therapy for anorexia nervosa during adolescence, but studies examining its long-term beneficial effect are still needed. This article presents the results of a 54-month post-randomization follow-up of a previously reported randomized controlled trial that compared two post-hospitalization outpatient treatment programs: Treatment As Usual alone versus Systemic Family Therapy added to Treatment As Usual. METHODS A consecutive series of 60 female adolescents with anorexia nervosa (DSM-IV) were randomized (30 per group). During the first 18 months, in the Treatment As Usual group, subjects received a multidisciplinary treatment. In the other group, Systemic Family Therapy sessions targeting intra-familial dynamics were added to Treatment As Usual. At 54 months, the primary outcome was defined using the Morgan and Russell global Outcome Categories (Good or Intermediate versus Poor). Secondary outcomes were the Global Outcome Assessment Schedule score, body mass index, amenorrhea, number of hospitalizations, eating disorder symptoms, psychopathological features, and family functioning. Analyses were carried out using an Intention-To-Treat with the Last Observation Carried Forward procedure. Data of 59/60 subjects were available. RESULTS At 54 months, significant effects in favor of adding Systemic Family Therapy to Treatment As Usual were shown for the Global Outcome Categories (60% of Good/Intermediate versus 31% in the control group, p = .026), mean body mass index (p = .048), resumption of menses (70.0% vs. 40% p = .020), and mental state score (p = .010). Family cohesion scores were lower in the Systemic Family Therapy group (p = .040). CONCLUSIONS Adding Systemic Family Therapy focusing on intra-familial dynamics to a multidimensional outpatient treatment program appeared to lead to a better long-term outcome in young women who suffered from severe anorexia nervosa during adolescence.
Collapse
Affiliation(s)
- Nathalie Godart
- CESP, INSERM, UMR 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France.,UFR des Sciences de la Santé Simone Veil (UVSQ), Versailles, France.,Fondation de Santé des Etudiants de France (FSEF), Paris, France
| | - Géraldine Dorard
- Laboratoire de Psychopathologie et Processus de Santé, Université de Paris, Boulogne-Billancourt, France
| | - Jeanne Duclos
- CNRS, CHU Lille, UMR 9193 - SCALab - Cognitive and Affective Sciences, Université de Lille, Lille, France.,Département de Psychiatrie, Hôpital Saint Vincent de Paul, GHICL, Lille, France
| | - Florence Curt
- Adolescents and Young Adults Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Irène Kaganski
- Adolescents and Young Adults Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Lisa Minier
- Fondation de Santé des Etudiants de France (FSEF), Paris, France.,Adolescents and Young Adults Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Maurice Corcos
- Adolescents and Young Adults Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France.,Department of Clinical Psychology, Psychopathology, Psychoanalysis - EA 4056 (PCPP), University of Paris Descartes, Paris, France
| | - Bruno Falissard
- CESP, INSERM, UMR 1018, Université Paris-Sud, UVSQ, Université Paris-Saclay, Villejuif, France
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, UK.,King's College London, London, UK
| | - Philippe Jeammet
- Adolescents and Young Adults Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France
| | - Sylvie Berthoz
- Adolescents and Young Adults Psychiatry Unit, Institut Mutualiste Montsouris, Paris, France.,CNRS, EPHE, INCIA, UMR 5287, Univ. Bordeaux, Bordeaux, France
| |
Collapse
|
7
|
Burnette CB, Luzier JL, Weisenmuller CM, Boutté RL. A systematic review of sociodemographic reporting and representation in eating disorder psychotherapy treatment trials in the United States. Int J Eat Disord 2022; 55:423-454. [PMID: 35288967 PMCID: PMC8988395 DOI: 10.1002/eat.23699] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 02/24/2022] [Accepted: 02/24/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating disorders (EDs) were once conceptualized as primarily affecting affluent, White women, a misconception that informed research and practice for many years. Abundant evidence now discredits this stereotype, but it is unclear if prevailing "evidence-based" treatments have been evaluated in samples representative of the diversity of individuals affected by EDs. Our goal was to evaluate the reporting, inclusion, and analysis of sociodemographic variables in ED psychotherapeutic treatment randomized controlled trials (RCTs) in the US through 2020. METHODS We conducted a systematic review of ED psychotherapeutic treatment RCTs in the US and examined the reporting and inclusion of gender identity, age, race/ethnicity, sexual orientation, and socioeconomic status (SES) of enrolled participants, as well as recruitment methods, power analyses, and discussion of limitations and generalizability. RESULTS Our search yielded 58 studies meeting inclusion criteria dating back to 1985. Reporting was at times incomplete, absent, or centered on the racial/gender majority group. No studies reported gender diverse participants, and men and people of color were underrepresented generally, with differences noted across diagnoses. A minority of papers considered sociodemographic variables in analyses or acknowledged limitations related to sample characteristics. Some progress was made across the decades, with studies increasingly providing full racial and ethnic data, and more men included over time. Although racial and ethnic diversity improved somewhat, progress appeared to stall in the last decade. DISCUSSION We summarize findings, consider context and challenges for RCT researchers, and offer suggestions for researchers, journal editors, and reviewers on improving representation, reporting, and analytic practices. PUBLIC SIGNIFICANCE Randomized controlled trials of eating disorder psychotherapeutic treatment in the US are increasingly reporting full race/ethnicity data, but information on SES is inconsistent and sexual orientation absent. White women still comprise the overwhelming majority of participants, with few men and people of color, and no gender-diverse individuals. Findings underscore the need to improve reporting and increase representation to ensure evidence-based treatments are effective across and within diverse groups.
Collapse
Affiliation(s)
- C. Blair Burnette
- Charleston Area Medical CenterCharlestonWest VirginiaUSA,Division of Epidemiology and Community Health, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Jessica L. Luzier
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA,Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
| | - Chantel M. Weisenmuller
- Department of Behavioral Medicine and PsychiatryWest Virginia University School of Medicine – Charleston DivisionCharlestonWest VirginiaUSA,Charleston Area Medical CenterInstitute for Academic MedicineCharlestonWest VirginiaUSA
| | | |
Collapse
|
8
|
Gan JKE, Wu VX, Chow G, Chan JKY, Klainin-Yobas P. Effectiveness of non-pharmacological interventions on individuals with anorexia nervosa: A systematic review and meta-analysis. PATIENT EDUCATION AND COUNSELING 2022; 105:44-55. [PMID: 34059364 DOI: 10.1016/j.pec.2021.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 03/15/2021] [Accepted: 05/19/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to synthesize the best available evidence regarding the effectiveness of non-pharmacological interventions on body mass index (BMI), body dissatisfaction, depression and anxiety among individuals with anorexia nervosa (AN). METHODS Published studies in English were searched using seven databases (such as PubMed). Grey literature was searched using ProQuest and Scopus. Studies were screened, appraised and extracted by two independent reviewers. Meta-analysis was performed and standardized mean difference was used as an effect measure. Heterogeneity was determined by I2 statistics and Cochran χ2 test. Publication bias was appraised using funnel plots. Sensitivity and subgroup analyses were also conducted. RESULTS Nineteen RCTs from eight different countries were included in this review. Behavioral family system therapy (BFST) was found to enhance BMI while conjoint family therapy (CFT) was more effective in ameliorating depression. Studies implementing combined family and individual therapy and those with longer therapeutic durations produced larger effect sizes. CONCLUSION This review provided evidence to support BSFT, CFT and combined family and individual therapy for adolescents with AN. PRACTICAL IMPLICATIONS Healthcare professionals may offer the two interventions to adolescents with AN in clinical settings. Future research may further investigate the effectiveness of BSFT and CFT on BMI and depression.
Collapse
Affiliation(s)
- Javeil Ke En Gan
- Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore.
| | - Vivien Xi Wu
- Alice Lee Centre for Nursing Studies, National University of Singapore, Level 2, Clinical Research Centre, 10 Medical Drive, Singapore 117597, Singapore.
| | - Gigi Chow
- Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828, Singapore.
| | | | - Piyanee Klainin-Yobas
- Alice Lee Centre for Nursing Studies, National University of Singapore, Level 2, Clinical Research Centre, 10 Medical Drive, Singapore 117597, Singapore.
| |
Collapse
|
9
|
Homan KJ, Crowley SL, Rienecke RD. Predictors of improvement in a family-based partial hospitalization/intensive outpatient program for eating disorders. Eat Disord 2021; 29:644-660. [PMID: 32174240 DOI: 10.1080/10640266.2020.1734410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The efficacy of family-based treatment (FBT) in outpatient settings has led to efforts to incorporate FBT principles into higher levels of care. The present study examined predictors of improvement in an FBT-based partial hospitalization program/intensive outpatient program (PHP/IOP) as measured by the Eating Disorder Examination-Questionnaire. Participants were 113 patients with anorexia nervosa (AN) or eating disorder not otherwise specified (EDNOS) consecutively participating in an FBT-based PHP/IOP. Multilevel modeling was used to investigate predictors for adolescents and young adults separately. Predictors considered included illness duration, previous hospitalization, hospitalization immediately prior to treatment, previous outpatient therapy, hospitalization during treatment, diagnosis, gaining 4 pounds in 4 weeks, and family status as time-invariant variables. Time-varying variables considered included depression symptoms and mothers'/fathers' ratings of parental self-efficacy and expressed emotion. For adolescents, depression by time and diagnosis by time interactions were statistically significant. At all levels of depression, adolescent patients with AN demonstrated greater reductions in eating disorder symptoms compared to patients with EDNOS. For young adults, depression and gaining 4 pounds in 4 weeks were significant predictors. The relationships for young adults were curvilinear such that, while lower eating disorder symptoms were found during treatment, these gains were not maintained at follow up.
Collapse
Affiliation(s)
- Kendra J Homan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Susan L Crowley
- Department of Psychology, Utah State University, Logan, Utah, USA
| | - Renee D Rienecke
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.,Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
10
|
Exploring alternatives for adolescent anorexia nervosa: adolescent and parent treatment (APT) as a novel intervention prospect. J Eat Disord 2021; 9:67. [PMID: 34108051 PMCID: PMC8191096 DOI: 10.1186/s40337-021-00423-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/24/2021] [Indexed: 12/26/2022] Open
Abstract
Recovery and remission rates of adolescent anorexia nervosa (AN) following Family Based Treatment (FBT) have seen a relative decline over recent years. While reasonably successful in achieving physical recovery (i.e. weight restoration), both empirical and anecdotal accounts highlight a lack of attention to the psychological recovery of the adolescent within manualised FBT. As such, there is a need for innovation to explore treatment variations and alternatives for the proportion of adolescents with AN who do not respond favourably to this first-line treatment. This paper introduces a new treatment framework to the field for clinical consideration and empirical assessment. Adolescent and Parent Treatment (APT) for adolescent AN draws from both family-based and individual treatment models, applying a developmental lens. APT attends to physical and psychological recovery simultaneously and from the start of treatment, with capacity to tailor individual psychological modules to the adolescent formulation. While clearly in its infancy, APT provides an exciting new avenue for exploration within the field, as we seek new avenues to support young people and their families to effectively combat this deadly illness.
Collapse
|
11
|
Midgley N, Mortimer R, Cirasola A, Batra P, Kennedy E. The Evidence-Base for Psychodynamic Psychotherapy With Children and Adolescents: A Narrative Synthesis. Front Psychol 2021; 12:662671. [PMID: 33986713 PMCID: PMC8110733 DOI: 10.3389/fpsyg.2021.662671] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/17/2021] [Indexed: 12/26/2022] Open
Abstract
Despite a rich theoretical and clinical history, psychodynamic child and adolescent psychotherapy has been slow to engage in the empirical assessment of its effectiveness. This systematic review aims to provide a narrative synthesis of the evidence base for psychodynamic therapy with children and adolescents. Building on two earlier systematic reviews, which covered the period up to 2017, the current study involved two stages: an updated literature search, covering the period between January 2017 and May 2020, and a narrative synthesis of these new studies with those identified in the earlier reviews. The updated search identified 37 papers (28 distinct studies). When combined with papers identified in the earlier systematic reviews, this resulted in a combined total of 123 papers (82 distinct studies). The narrative synthesis of findings indicates that there is evidence of effectiveness for psychodynamic therapy in treating a wide range of mental health difficulties in children and adolescents. The evidence suggests this approach may be especially effective for internalizing disorders such as depression and anxiety, as well as in the treatment of emerging personality disorders and in the treatment of children who have experience of adversity. Both the quality and quantity of empirical papers in this field has increased over time. However, much of the research demonstrates a range of methodological limitations (small sample sizes, lack of control groups etc.), and only 22 studies were Randomized Controlled Trials. Further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy for children and young people.
Collapse
Affiliation(s)
- Nick Midgley
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Rose Mortimer
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Antonella Cirasola
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.,Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Prisha Batra
- Child Attachment and Psychological Therapies Research Unit (ChAPTRe), Anna Freud National Centre for Children and Families, London, United Kingdom
| | - Eilis Kennedy
- Research and Development Unit, Tavistock and Portman NHS Trust, London, United Kingdom
| |
Collapse
|
12
|
Treatment and Discharge Planning for a Suicidal Adolescent with Complex Psychosocial and Family Stressors. Harv Rev Psychiatry 2021; 29:169-175. [PMID: 32732511 DOI: 10.1097/hrp.0000000000000265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
13
|
Abstract
PURPOSE OF REVIEW Our aim is to give an overview of the recent literature on psychological treatment for young adults and adults with anorexia nervosa and to discuss the implications of the findings for clinical practice. RECENT FINDINGS Three systematic reviews and meta-analyses have recently been published on psychological treatments for anorexia nervosa. Treatment outcomes are still modest and mainly focus on weight outcome, although outcomes for eating disorder disease and quality of life have also been reported. Adhering to a treatment protocol might lead to faster and better results. SUMMARY For children and adolescents with anorexia nervosa, the major guidelines recommend a family-based treatment. The treatments of choice for young adults and adults with anorexia nervosa are the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA), Cognitive Behaviour Therapy-Enhanced (CBT-E) and Specialist Supportive Clinical Management (SSCM), but none of these treatments seem to be superior. In search of other ways to improve outcome, shared decision making may be a way to help patients become more involved in their treatment, enhance their motivation and consequently improve the outcome.
Collapse
|
14
|
Couturier J, Isserlin L, Norris M, Spettigue W, Brouwers M, Kimber M, McVey G, Webb C, Findlay S, Bhatnagar N, Snelgrove N, Ritsma A, Preskow W, Miller C, Coelho J, Boachie A, Steinegger C, Loewen R, Loewen T, Waite E, Ford C, Bourret K, Gusella J, Geller J, LaFrance A, LeClerc A, Scarborough J, Grewal S, Jericho M, Dimitropoulos G, Pilon D. Canadian practice guidelines for the treatment of children and adolescents with eating disorders. J Eat Disord 2020; 8:4. [PMID: 32021688 PMCID: PMC6995106 DOI: 10.1186/s40337-020-0277-8] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline. METHODS Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders. RESULTS Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed. CONCLUSIONS Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Wendy Preskow
- National Initiative for Eating Disorders, Toronto, Canada
| | - Catherine Miller
- Canadian Mental Health Association - Waterloo, Wellington, Dufferin, Kitchener, Canada
| | | | | | | | | | | | | | - Catherine Ford
- 9Ontario Ministry of Health and Long-Term Care, Toronto, Canada
| | - Kerry Bourret
- 10St. Joseph's Care Group - Thunder Bay, Thunder Bay, Canada
| | | | - Josie Geller
- 6The Univeristy of British Columbia, Vancouver, Canada
| | | | | | - Jennifer Scarborough
- Canadian Mental Health Association - Waterloo, Wellington, Dufferin, Kitchener, Canada
| | | | | | | | | |
Collapse
|
15
|
Abstract
This article provides background information, descriptions, and evidential support for the more recent treatments for adolescents with anorexia nervosa, including family-based treatment, adolescent focused therapy, cognitive behavioral therapy, systemic family therapy, and psychopharmacologic treatments. At this time, family-based treatment has the best evidence of efficacy and cost-effectiveness. Future directions in treatment research for adolescent anorexia nervosa are discussed.
Collapse
Affiliation(s)
- James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA.
| |
Collapse
|
16
|
Le Grange D, Huryk KM, Murray SB, Hughes EK, Sawyer SM, Loeb KL. Variability in remission in family therapy for anorexia nervosa. Int J Eat Disord 2019; 52:996-1003. [PMID: 31318075 DOI: 10.1002/eat.23138] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 06/28/2019] [Accepted: 07/04/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The evolution toward more stringent conceptualizations of remission in family therapy for adolescent anorexia nervosa (AN) has, with time, introduced variability in outcomes across randomized controlled trials (RCTs). An examination of remission across the history of research on family therapy for AN shows that earlier studies adopted lenient definitions and generally yielded higher rates of remission than studies of the past decade that have used stricter definitions of remission. In this study, we investigate the reactivity of remission rates to the application of different definitions of remission used within the family therapy for AN literature, within a single RCT data set. METHOD We conducted a secondary analysis of data from a single-site RCT which compared the relative efficacy of two formats of family therapy in a sample of 106 Australian adolescents with AN. Using end-of-treatment data, we compared remission rates using 11 definitions of remission that have been used in studies of family therapy for AN spanning more than three decades. RESULTS We found wide variability in remission rates (21.7-87.7%; Cochran's Q χ2 (10, N = 106) = 303.55, p = .000], depending on which definition of remission was applied. As expected, more lenient criteria produced higher remission rates than more stringent definitions. DISCUSSION Applying different criteria of remission to a single data set illustrates the impact of changing how remission is defined. Failure to consider the greater stringency of remission criteria in recent studies could result in false inferences concerning the efficacy of family therapy for AN over time.
Collapse
Affiliation(s)
- Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, California.,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago (Emeritus), Chicago, Illinois
| | - Kathryn M Huryk
- Department of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, California
| | - Elizabeth K Hughes
- The University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan M Sawyer
- The University of Melbourne, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Katharine L Loeb
- Department of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey
| |
Collapse
|
17
|
Abstract
BACKGROUND Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. OBJECTIVES To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa. DATA COLLECTION AND ANALYSIS Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures. MAIN RESULTS We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I2 = 37%) and at long-term follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up. AUTHORS' CONCLUSIONS There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or other psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted trials.
Collapse
Affiliation(s)
- Caroline A Fisher
- Royal Melbourne Hospital, Melbourne HealthAllied Health ‐ PsychologyParkvilleVictoriaAustralia3050
| | - Sonja Skocic
- HealthscopeThe Melbourne ClinicRichmondVictoriaAustralia
| | | | - Sarah E Hetrick
- University of AucklandDepartment of Psychological MedicineAucklandNew Zealand
- University of MelbourneThe Centre of Youth Mental HealthMelbourneVictoriaAustralia
| | | |
Collapse
|
18
|
Murray SB, Quintana DS, Loeb KL, Griffiths S, Le Grange D. Treatment outcomes for anorexia nervosa: a systematic review and meta-analysis of randomized-controlled trials - CORRIGENDUM. Psychol Med 2019; 49:701-704. [PMID: 30430952 DOI: 10.1017/s0033291718003185] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
19
|
Murray SB, Quintana DS, Loeb KL, Griffiths S, Le Grange D. Treatment outcomes for anorexia nervosa: a systematic review and meta-analysis of randomized controlled trials. Psychol Med 2019; 49:535-544. [PMID: 30101734 DOI: 10.1017/s0033291718002088] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND To determine the impact of specialized treatments, relative to comparator treatments, upon the weight and psychological symptoms of anorexia nervosa (AN) at end-of-treatment (EOT) and follow-up. METHODS Randomized controlled trials (RCTs) between January 1980 and December 2017 that reported the effects of at least two treatments on AN were screened. Weight and psychological symptoms were analyzed separately for each study. PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed, and studies were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) criteria and Cochrane risk of bias tool. RESULTS We identified 35 eligible RCTs, comprising data from 2524 patients. Meta-analyses revealed a significant treatment effect on weight outcomes at EOT [g = 0.16, 95% CI (0.05-0.28), p = 0.006], but not at follow-up [g = 0.11, 95% CI (-0.04 to 0.27), p = 0.15]. There was no significant treatment effect on psychological outcomes at either EOT [g = -0.03, 95% CI (-0.14 to 0.08), p = 0.63], or follow-up [g = -0.001, 95% CI (-0.11 to 0.11), p = 0.98]. There was no strong evidence of publication bias or significant moderator effects for illness duration, mean age, year of publication, comparator group category, or risk of bias (all p values > 0.05). CONCLUSIONS Current specialized treatments are more adept than comparator interventions at imparting change in weight-based AN symptoms at EOT, but not at follow-up. Specialized treatments confer no advantage over comparator interventions in terms of psychological symptoms. Future precision treatment efforts require a specific focus on the psychological symptoms of AN.
Collapse
Affiliation(s)
- Stuart B Murray
- Department of Psychiatry,University of California,San Francisco, CA,USA
| | - Daniel S Quintana
- NORMENT,KG Jebsen Centre for Psychosis Research,Division of Mental Health and Addiction,University of Oslo, and Oslo University Hospital,Oslo,Norway
| | - Katharine L Loeb
- School of Psychology, Fairleigh Dickinson University,Teaneck, NJ,USA
| | - Scott Griffiths
- School of Psychology, University of Melbourne,Melbourne, VIC,Australia
| | - Daniel Le Grange
- Department of Psychiatry,University of California,San Francisco, CA,USA
| |
Collapse
|
20
|
Kästner D, Löwe B, Gumz A. The role of self-esteem in the treatment of patients with anorexia nervosa - A systematic review and meta-analysis. Int J Eat Disord 2019; 52:101-116. [PMID: 30488479 DOI: 10.1002/eat.22975] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to provide a comprehensive overview of the role of self-esteem in the treatment of patients with anorexia nervosa (AN). Specifically, our objectives were to investigate the differences in self-esteem between individuals with AN and healthy controls, or individuals with other eating disorders, and to examine self-esteem as an outcome, predictor, moderator, and mediator in AN treatment. METHOD The databases PsycINFO, PSYNDEXplus, Ovid MEDLINE®, and ProQuest were searched for studies published from 1990 to 2018. To estimate aggregated effect sizes, we performed random-effects meta-analyses. RESULTS A screening of 1,596 abstracts and 203 full-texts identified 68 relevant publications. Results suggest a significantly lower global self-esteem in individuals with AN than in healthy controls (d = -1.90, p < .001). In contrast, global self-esteem of AN and bulimia nervosa (BN) patients was found to be comparable (d = 0.05, p = .529). It might be specific to AN patients that negative self-evaluations may not affect scholastic and professional abilities. Significantly moderate self-esteem increases were observed in treated AN patients at the end of treatment (d = 0.56, p < .001), short-term (d = 0.50, p < .001), and long-term (d = 0.75, p < .001) follow-up. Self-esteem did not predict end of treatment remission-or weight-related outcome and treatment dropout. However, small to moderate predictive effects were detected on short-term (r = .15, p = .007) and long-term remission or weight (r = .33, p = .017). Finally, first indications point to self-esteem as a mediator in adult AN inpatient treatment. DISCUSSION The review provides insights relevant for theory, research, and practice. Implications concern the overall support for transdiagnostic approaches and the recommendation to consider low initial self-esteem for decisions on after-care.
Collapse
Affiliation(s)
- Denise Kästner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf & Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf & Schön Clinic Hamburg Eilbek, Hamburg, Germany
| | - Antje Gumz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre, Hamburg-Eppendorf & Schön Clinic Hamburg Eilbek, Hamburg, Germany
| |
Collapse
|
21
|
Abstract
BACKGROUND Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. OBJECTIVES To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa. DATA COLLECTION AND ANALYSIS Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures. MAIN RESULTS We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I2 = 37%) and at long-term follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up. AUTHORS' CONCLUSIONS There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted trials.
Collapse
Affiliation(s)
- Caroline A Fisher
- Royal Melbourne Hospital, Melbourne HealthAllied Health ‐ PsychologyParkvilleAustralia3050
| | - Sonja Skocic
- HealthscopeThe Melbourne ClinicRichmondAustralia
| | | | | |
Collapse
|
22
|
Wallis A, Miskovic-Wheatley J, Madden S, Alford C, Rhodes P, Touyz S. Does continuing family-based treatment for adolescent anorexia nervosa improve outcomes in those not remitted after 20 sessions? Clin Child Psychol Psychiatry 2018; 23:592-600. [PMID: 29781302 DOI: 10.1177/1359104518775145] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Our aim was to investigate the benefit of ongoing family-based treatment (FBT) sessions for adolescent anorexia nervosa if remission criteria were not met at session 20. METHOD Participants were 69 medically unstable adolescents with Diagnostic and Statistical Manual of Mental Disorders (4th ed; DSM-IV) anorexia nervosa from a randomized controlled trial investigating length of hospital admission prior to outpatient FBT. Participants were divided post hoc into those meeting remission criteria at session 20 ( n = 16), those that had not remitted but continued with FBT ( n = 39) and those who ceased FBT undertaking alternative treatments ( n = 14). Outcome was assessed as remission and hospital readmission days at 12 months after FBT session 20. RESULTS There were no differences between groups at baseline. There was a significant difference in the use of hospital admission days with those in the Alternate Treatment Group who did not continue with FBT using 71.93 days compared to those in Additional FBT Group with only 12.51 days ( F(2, 66) = 13.239, p < .01). At 12 months after FBT session 20, the Additional FBT Group had a 28.2% increase in remission rate, significantly higher than those in the Alternate Treatment Group (χ2(2) = 17.68, p < .001). DISCUSSION Continuing FBT after session 20 if remission is not achieved can significantly reduce hospital readmission days and improve remission rates.
Collapse
Affiliation(s)
- Andrew Wallis
- 1 Eating Disorder Service, The Sydney Children's Hospital Network, Australia.,2 School of Psychology, The University of Sydney, Australia
| | | | - Sloane Madden
- 1 Eating Disorder Service, The Sydney Children's Hospital Network, Australia
| | - Colleen Alford
- 1 Eating Disorder Service, The Sydney Children's Hospital Network, Australia
| | - Paul Rhodes
- 2 School of Psychology, The University of Sydney, Australia
| | - Stephen Touyz
- 2 School of Psychology, The University of Sydney, Australia
| |
Collapse
|
23
|
Lebow J, Sim LA, Accurso EC. Is there clinical consensus in defining weight restoration for adolescents with anorexia nervosa? Eat Disord 2018; 26:270-277. [PMID: 29087249 DOI: 10.1080/10640266.2017.1388664] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Successful outcome for adolescent anorexia nervosa includes achieving weight restoration. Despite the importance of this measurement, there are significant discrepancies in the field on how to quantify expected body weight (EBW). A survey was sent to 113 child and adolescent eating disorder treatment providers inquiring about the methods used to determine weight restoration in their clinical practice. Although 40.7% used growth curve data, the remaining employed a diverse range of approaches. Providers who specialize in Family-Based Treatment were significantly more likely to use an individualized approach versus considering adolescent preference. Although there is a modicum of endorsement for using growth curves to predict EBW, this is not universal practice and is inconsistent with methods used in treatment studies. The lack of an evidence-based method to calculate EBW-or even a best practice consensus for calculating this number-is a major oversight in the field that requires empirical attention.
Collapse
Affiliation(s)
- Jocelyn Lebow
- a Department of Psychiatry and Psychology , Mayo Clinic College of Medicine , Rochester , MN , USA
| | - Leslie A Sim
- a Department of Psychiatry and Psychology , Mayo Clinic College of Medicine , Rochester , MN , USA
| | - Erin C Accurso
- b Department of Psychiatry , UCSF Weill Institute for Neurosciences, University of California , San Francisco , CA , USA
| |
Collapse
|
24
|
Alckmin-Carvalho F, Vega JB, Cobelo AW, Fabbri AD, Pinzon VD, Melo MHDS. Evidence-based psychotherapy for treatment of anorexia nervosa in children and adolescents: systematic review. ACTA ACUST UNITED AC 2018. [DOI: 10.1590/0101-60830000000154] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
25
|
Mann SE, Erford BT, Minnich A. Meta-Analysis of Anorexia Nervosa Counseling Outcome Studies From 1990 to 2015. JOURNAL OF COUNSELING AND DEVELOPMENT 2018. [DOI: 10.1002/jcad.12176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Sara E. Mann
- Education Specialties Department; Loyola University Maryland
| | - Bradley T. Erford
- Education Specialties Department; Loyola University Maryland
- Now at Department of Human and Organizational Development; Vanderbilt University
| | - Amelia Minnich
- Education Specialties Department; Loyola University Maryland
| |
Collapse
|
26
|
Abstract
The family and therapyThe term family therapy can be misleading. ‘Family’ is open to many interpretations, if not attacks, because it is frequently read as implying a two-parent, heterosexual couple with two children, with the woman primarily the ‘homemaker’ and the man the ‘breadwinner’, with occasional backup from the grandparents. Such a picture would seem to marginalise or exclude other family forms, such as childless couples, single parents with children, gay or lesbian couples and unattached elderly persons. However, the reality is that family therapists treat many different forms of committed relationships and friendships. As to the term therapy, it tends to imply the presence of illness or dysfunction, located in the family rather than one of its individual members, and may thus be quite unacceptable to families who often believe that it is the patient and not them whom requires help. Being at the receiving end of family therapy can have strong connotations of blame. Practitioners therefore increasingly use the term systemic therapy, which is also more informative because some of the work often involves the wider system. The systemic approach is essentially a contextual approach – seeing and treating people in context.
Collapse
|
27
|
Le LKD, Barendregt JJ, Hay P, Sawyer SM, Hughes EK, Mihalopoulos C. The modeled cost-effectiveness of family-based and adolescent-focused treatment for anorexia nervosa. Int J Eat Disord 2017; 50:1356-1366. [PMID: 29044637 DOI: 10.1002/eat.22786] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 09/05/2017] [Accepted: 09/19/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is a prevalent, serious mental disorder. We aimed to evaluate the cost-effectiveness of family-based treatment (FBT) compared to adolescent-focused individual therapy (AFT) or no intervention within the Australian healthcare system. METHOD A Markov model was developed to estimate the cost and disability-adjusted life-year (DALY) averted of FBT relative to comparators over 6 years from the health system perspective. The target population was 11-18 year olds with AN of relatively short duration. Uncertainty and sensitivity analyses were conducted to test model assumptions. Results are reported as incremental cost-effectiveness ratios (ICER) in 2013 Australian dollars per DALY averted. RESULTS FBT was less costly than AFT. Relative to no intervention, the mean ICER of FBT and AFT was $5,089 (95% uncertainty interval (UI): dominant to $16,659) and $51,897 ($21,591 to $1,712,491) per DALY averted. FBT and AFT are 100% and 45% likely to be cost-effective, respectively, at a threshold of AUD$50,000 per DALY averted. Sensitivity analyses indicated that excluding hospital costs led to increases in the ICERs but the conclusion of the study did not change. CONCLUSION FBT is the most cost-effective among treatment arms, whereas AFT was not cost-effective compared to no intervention. Further research is required to verify this result.
Collapse
Affiliation(s)
- Long Khanh-Dao Le
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Jan J Barendregt
- School of Public Health, The University of Queensland, Herston, Queensland, Australia.,Epigear International Pty Ltd, Sunrise Beach, Queensland, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, New South Wales, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Elizabeth K Hughes
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Australia
| |
Collapse
|
28
|
Allan E, Le Grange D, Sawyer SM, McLean LA, Hughes EK. Parental Expressed Emotion During Two Forms of Family-Based Treatment for Adolescent Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2017; 26:46-52. [PMID: 29105211 DOI: 10.1002/erv.2564] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 10/04/2017] [Accepted: 10/11/2017] [Indexed: 11/09/2022]
Abstract
High parental expressed emotion (EE), reflected by criticism or emotional over-involvement, has been related to poorer outcome in family-based treatment (FBT) for adolescent anorexia nervosa. This study assessed EE in 89 mothers and 64 fathers at baseline and end of treatment in a randomised trial comparing conjoint FBT to parent-focused FBT (PFT). Compared with conjoint FBT, PFT was associated with a decrease in maternal criticism, regardless of adolescent remission. Furthermore, an increase in maternal criticism was more likely to be observed in conjoint FBT (80%) than PFT (20%, p = 0.001). Adolescents of mothers who demonstrated an increase in EE, or remained high in EE, were less likely to remit compared with adolescents for whom EE decreased or remained low (33% and 0% vs. 43% and 50%, p = 0.03). There were no significant effects for paternal EE. The results highlight the importance of considering EE when implementing FBT for adolescents with anorexia nervosa. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
Collapse
Affiliation(s)
- Erica Allan
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia.,Faculty of Education, Monash University, VIC, Australia
| | - Daniel Le Grange
- Department of Psychiatry, University of California, San Francisco, CA, USA.,Psychiatry and Behavioral Neuroscience, The University of Chicago, IL, USA (Emeritus)
| | - Susan M Sawyer
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Department of Adolescent Medicine, Royal Children's Hospital, Melbourne, VIC, Australia
| | | | - Elizabeth K Hughes
- Murdoch Children's Research Institute, Melbourne, VIC, Australia.,Centre for Adolescent Health, Royal Children's Hospital, Melbourne, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,School of Psychological Sciences, Monash University, VIC, Australia
| |
Collapse
|
29
|
Rienecke RD. Family-based treatment of eating disorders in adolescents: current insights. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2017; 8:69-79. [PMID: 28615982 PMCID: PMC5459462 DOI: 10.2147/ahmt.s115775] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Eating disorders are serious illnesses associated with significant morbidity and mortality. Family-based treatment (FBT) has emerged as an effective intervention for adolescents with anorexia nervosa, and preliminary evidence suggests that it may be efficacious in the treatment of adolescents with bulimia nervosa. Multifamily therapy for anorexia nervosa provides a more intensive experience for families needing additional support. This review outlines the three phases of treatment, key tenets of family-based treatment, and empirical support for FBT. In addition, FBT in higher levels of care is described, as well as challenges in the implementation of FBT and recent adaptations to FBT, including offering additional support to eating-disorder caregivers. Future research is needed to identify families for whom FBT does not work, determine adaptations to FBT that may increase its efficacy, develop ways to improve treatment adherence among clinicians, and find ways to support caregivers better during treatment.
Collapse
Affiliation(s)
- Renee D Rienecke
- Department of Pediatrics.,Department of Psychiatry and Behavioral Sciences, College of Medicine, Medical University of South Carolina, Charleston, SC.,Department of Psychiatry, University of Michigan Health System, Ann Arbor, MI, USA
| |
Collapse
|
30
|
Gusella JL, Campbell AG, Lalji K. A shift to placing parents in charge: Does it improve weight gain in youth with anorexia? Paediatr Child Health 2017; 22:269-272. [PMID: 29479232 DOI: 10.1093/pch/pxx063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Family-based treatment (FBT) has emerged as a promising approach for medically stable youth with anorexia nervosa (AN). While there is evidence that therapists embrace the core principles of FBT, most face barriers in implementing the model with fidelity. Little research has been conducted to determine whether adhering to the core methods of placing parents in charge are sufficient in restoring weight in youth with AN. This study involved a chart review of youth under 16 years of age, treated by a Canadian tertiary care health centre-based eating disorders team (EDT). The purpose was to compare the weight gain of youth treated before and after the team was trained in FBT and shifted to empowering parents to be in charge of weight gain. As predicted, youth who participated in family sessions adhering to the 'parents in charge' approach (PIC, N=32) made greater gains in percentage of ideal body weight (%IBW) and were more likely to reach body weights within a healthy range as compared with youth (N=14) who participated in a 'non-specific therapy' (NST) involving expert driven psycho-educational family sessions. Youth whose parents were placed in charge of weight gain were also significantly less likely to be hospitalized on the psychiatry unit for weight restoration, had significantly shorter mean duration of stays on this unit, and required tube-feeding less frequently than youth who participated in NST. Collectively, the results suggest that placing parents in charge of refeeding promotes efficient weight gain, while decreasing the need for more intensive intervention.
Collapse
Affiliation(s)
- Joanne L Gusella
- Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | - Anna G Campbell
- Community Mental Health, IWK Health Centre, Halifax, Nova Scotia
| | - Kristin Lalji
- Child and Adolescent Mental Health Specialized Services, Alberta Health Services, Calgary, Alberta
| |
Collapse
|
31
|
Rith-Najarian LR, Park AL, Wang T, Etchison AI, Chavira DA, Chorpita BF. Applying new evidence standards to youth cognitive behavioral therapies - A review. Behav Res Ther 2017; 90:147-158. [PMID: 28061375 DOI: 10.1016/j.brat.2016.12.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 11/11/2016] [Accepted: 12/16/2016] [Indexed: 12/19/2022]
Abstract
This review included 136 published randomized controlled trials (RCTs) of youth cognitive behavioral therapy (CBT) treatments. We aimed to test the premise that evidence-based youth treatments can be better differentiated from each other by applying more nuanced standards of evidence. Accordingly, we applied three standards to this article sample to determine how many treatments produced significant results: (a) on multiple target symptom measures, (b) at follow-up, and/or (c) against an active comparison group. We identified how many trials met standards individually and in combination. Although 87 of the 136 articles produced at least one significant treatment result at post-assessment, the subsets of "passing" articles were smaller and varied for any one of our three standards, with only 11 articles (8%) meeting all three standards simultaneously. Implications are discussed regarding the definition of "evidence-based," the need for multi-parameter filtering in treatment selection and clinical decision making, and future directions for research. We ultimately argue the value in assessing youth treatments for different types of evidence, which is better achieved through dynamic sets of standards, rather than a single approach to assessing general strength of evidence.
Collapse
Affiliation(s)
- Leslie R Rith-Najarian
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA.
| | - Alayna L Park
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Tina Wang
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Ana I Etchison
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Denise A Chavira
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles 1285 Franz Hall, Los Angeles, CA, 90095, USA
| |
Collapse
|
32
|
How does family functioning effect the outcome of family based treatment for adolescents with severe anorexia nervosa? J Eat Disord 2017; 5:55. [PMID: 29255605 PMCID: PMC5729267 DOI: 10.1186/s40337-017-0184-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 11/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this research was to investigate the relationship between family functioning, adolescent-parent attachment and remission, as well as changes in these variables over time for adolescents with severe anorexia nervosa treated with family based treatment (FBT). Understanding how families respond to treatment is important because the family will be the ongoing context for psychosocial development in the longer term. The relationship between family functioning and outcome is also an important variable because it is potentially modifiable during treatment and this may improve outcome. METHODS Fifty-seven female adolescents treated with FBT in a randomised controlled trial were assessed at baseline, FBT session 20 and 12-months post FBT session 20. Data on family functioning and adolescent-parent attachment was collected from patients and their parents at each time point. A series of regression analyses were used to determine the relationship between family functioning and comorbidity at baseline, and the relationship with remission status over time. Repeat measure mixed-effects models were used to assess changes in family functioning and attachment quality over time. RESULTS Greater adolescent perceived family functioning impairment was positively related to psychiatric comorbidity at the start of treatment. Conversely, better family functioning predicted higher self-esteem and stronger attachment quality. Adolescent's reporting better general family functioning, communication and problem solving were more likely to be remitted at session 20, but not at 12-month follow-up. There was no overall improvement in family functioning for any respondent either during treatment or at follow-up, and no significant relationship between change and remission at either session 20 or follow-up. CONCLUSIONS The adolescent's perspective on family functioning at the start of treatment impacts on a positive outcome. Addressing family issues earlier in FBT may be important for some patients. Further research is needed in this area to determine how these findings could be integrated into the current FBT model. TRIAL REGISTRATION Australian Clinical Trials Register number: ACTRN012607000009415 (www.anzctr.org.au).
Collapse
|
33
|
Gisladottir M, Treasure J, Svavarsdottir EK. Effectiveness of therapeutic conversation intervention among caregivers of people with eating disorders: quasi-experimental design. J Clin Nurs 2016; 26:735-750. [PMID: 27239974 DOI: 10.1111/jocn.13412] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2016] [Indexed: 01/03/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to evaluate the effectiveness of therapeutic conversation intervention in group and caregiver sessions on the supporting role of caregivers. BACKGROUND Caregivers of people with eating disorders are known to suffer major difficulties and are in great need of support. Unhelpful parental support strategies can delay the recovery of an individual with an eating disorder. Skill training interventions can equip parents with skills, guidance and techniques by helping them to be a support person and making them one of the most important links in the treatment process. DESIGN The therapeutic conversation intervention consisted of five group and caregiver sessions and three booster sessions. The Calgary Family Assessment and Calgary Family Intervention Models, the Illness Beliefs Model and the New Maudsley Method were used as theoretical frameworks. The content of the intervention consisted of work on difficult behaviours, feelings and helpful strategies. The participants (n = 58) included primary and secondary caregivers of 12- to 24-year-old patients with eating disorders. Eight caregivers dropped out of treatment. METHODS This study had a quasi-experimental design with one pre- and two post-test measures. RESULTS Between 90-96% of caregivers rated the therapeutic conversation intervention as supportive. Furthermore, the study revealed significant differences in caregiver emotional and cognitive support, illness beliefs, disruptive behaviour and quality of life, negative aspects of care giving demands and caregiver and patient behavioural difficulties after the intervention and/or at follow-up. CONCLUSIONS Therapeutic conversation intervention with caregivers in group and private sessions proved to be beneficial. RELEVANCE TO CLINICAL PRACTICE This outcome provides information for healthcare professionals on how they can help primary caregivers in their supporting role, which can, in turn, improve services in healthcare centres and psychiatric hospitals.
Collapse
Affiliation(s)
- Margret Gisladottir
- Child and Adolescent Psychiatry Unit, Landspitali National University Hospital, Reykjavik, Iceland
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK
| | | |
Collapse
|
34
|
Abbate-Daga G, Marzola E, Amianto F, Fassino S. A comprehensive review of psychodynamic treatments for eating disorders. Eat Weight Disord 2016; 21:553-580. [PMID: 26980319 DOI: 10.1007/s40519-016-0265-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 02/17/2016] [Indexed: 01/28/2023] Open
Abstract
PURPOSE To comprehensively review the existing literature on the effectiveness of psychodynamic psychotherapies in eating disorders (EDs) and to stimulate both debate and research on this topic. METHODS Online and hand searches were conducted to identify papers published between 1980 and 2015 on psychodynamic treatments delivered to adults with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). RESULTS A total of 47 studies were finally included in this review. Fifteen studies were available for AN, 9 for BN, 12 for BED, and 11 for samples with mixed diagnoses. Several methodological flaws emerged, but overall psychodynamic interventions showed promising results at the end of treatment and follow-up, when available. CONCLUSIONS The body of literature on psychodynamic treatments is sparse and sometimes methodologically questionable; nevertheless, current data provide support to the effectiveness of these interventions, particularly for AN. However, both a defined approach (focus, themes, and techniques) and randomized controlled trials (RCTs) are warranted to clarify the effectiveness of psychodynamic psychotherapies.
Collapse
Affiliation(s)
- Giovanni Abbate-Daga
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy.
| | - Enrica Marzola
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Federico Amianto
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| | - Secondo Fassino
- Department of Neuroscience, Eating Disorders Center for Treatment and Research, University of Turin, Via Cherasco 15, 10126, Turin, Italy
| |
Collapse
|
35
|
Eisler I, Simic M, Hodsoll J, Asen E, Berelowitz M, Connan F, Ellis G, Hugo P, Schmidt U, Treasure J, Yi I, Landau S. A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa. BMC Psychiatry 2016; 16:422. [PMID: 27881106 PMCID: PMC5122159 DOI: 10.1186/s12888-016-1129-6] [Citation(s) in RCA: 120] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 11/15/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa, with a general consensus in the field that eating disorders focussed family therapy (often referred to as Maudsley Family Therapy or Family Based Treatment) currently offers the most promising outcomes. Nevertheless, a significant number do not respond well and additional treatment developments are needed to improve outcomes. Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first randomised controlled trial of multifamily therapy for adolescent anorexia nervosa. METHODS The study was a pragmatic multicentre randomised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy (MFT-AN) and single family therapy (FT-AN). A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified (restricting type) were randomised to the two treatments using computer generated blocks of random sizes to ensure balanced numbers in the trial arms. Independent assessors, blind to the allocation, completed evaluations at baseline, 3 months, 12 months (end of treatment) and 18 months. RESULTS Both treatment groups showed clinically significant improvements with just under 60% achieving a good or intermediate outcome (on the Morgan-Russell scales) at the end of treatment in the FT-AN group and more than 75% in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention (OR = 2.55 95%; CI 1.17, 5.52; p = 0.019). At follow-up (18 months post baseline) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant. Clinically significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology. Approximately half the patients in FT-AN and nearly 60% of those in MFT-AN had started menstruating. CONCLUSIONS This study confirms previous research findings demonstrating the effectiveness of eating disorder focused family therapy and highlights the additional benefits of bringing together groups of families that maximises the use of family resources and mutual support leading to improved outcomes. TRIAL REGISTRATION Current Controlled Trials ISRCTN11275465 ; Registered 29 January 2007 (retrospectively registered).
Collapse
Affiliation(s)
- Ivan Eisler
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, London, UK. .,Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Mima Simic
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - John Hodsoll
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, London, UK
| | - Eia Asen
- University College London, London, UK ,Marlborough Family Service, Central and North West London NHS Foundation Trust, London, UK
| | - Mark Berelowitz
- Child and Adolescent Eating Disorders Service, Royal Free Hospital London, NHS Foundation Trust, London, UK
| | - Frances Connan
- Vincent Square Eating Disorders Service, Central and North West London NHS Foundation Trust, University of London, London, UK
| | - Gladys Ellis
- Child and Adolescent Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Pippa Hugo
- St George’s, University of London, London, UK
| | - Ulrike Schmidt
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, London, UK ,Adult Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, London, UK ,Adult Eating Disorders Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Irene Yi
- Child and Adolescent Mental Health Service, Surrey and Borders Partnership NHS Foundation Trust, Frimley, UK
| | - Sabine Landau
- Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, London, UK
| |
Collapse
|
36
|
Peterson CM, Fischer S, Loiselle K, Shaffer A. FBT With Adjunctive Parent Emotion Coaching in an Adolescent Male With Anorexia Nervosa. Clin Case Stud 2016. [DOI: 10.1177/1534650116664586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Family-based therapy (FBT) is the gold standard of treatment for adolescents with anorexia nervosa (AN) and has shown to be more effective than other forms of treatment in several randomized controlled trials. However, FBT is a behaviorally based intervention that does not explicitly address emotional distress often exhibited by patients and their parents. This case study describes the treatment of a 14-year-old adolescent male with AN using FBT as the primary treatment modality. We also implemented an adjunctive treatment designed to address parents’ emotion communication skills (ECSs) to reduce emotion dysregulation and family conflict in the implementation of FBT and in the process of AN recovery. Over the course of 29 sessions, the adolescent has evidenced an increase in weight from 84 pounds to 110.25 pounds and significant decreases in weight and shape concerns. This case provides preliminary support for the feasibility and effectiveness of an adjunct parent emotion coaching intervention combined with FBT for an adolescent male with AN.
Collapse
|
37
|
Jewell T, Blessitt E, Stewart C, Simic M, Eisler I. Family Therapy for Child and Adolescent Eating Disorders: A Critical Review. FAMILY PROCESS 2016; 55:577-594. [PMID: 27543373 DOI: 10.1111/famp.12242] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Eating disorder-focused family therapy has emerged as the strongest evidence-based treatment for adolescent anorexia nervosa, supported by evidence from nine RCTs, and there is increasing evidence of its efficacy in treating adolescent bulimia nervosa (three RCTs). There is also emerging evidence for the efficacy of multifamily therapy formats of this treatment, with a recent RCT demonstrating the benefits of this approach in the treatment of adolescent anorexia nervosa. In this article, we critically review the evidence for eating disorder-focused family therapy through the lens of a moderate common factors paradigm. From this perspective, this treatment is likely to be effective as it provides a supportive and nonblaming context that: one, creates a safe, predictable environment that helps to contain anxiety generated by the eating disorder; two, promotes specific change early on in treatment in eating disorder-related behaviors; and three, provides a vehicle for the mobilization of common factors such as hope and expectancy reinforced by the eating disorder expertise of the multidisciplinary team. In order to improve outcomes for young people, there is a need to develop an improved understanding of the moderators and mediators involved in this treatment approach. Such an understanding could lead to the refining of the therapy, and inform adaptations for those families who do not currently benefit from treatment.
Collapse
Affiliation(s)
- Tom Jewell
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | | | - Catherine Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mima Simic
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ivan Eisler
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
38
|
van Langenberg T, Sawyer SM, Le Grange D, Hughes EK. Psychosocial Well-being of Siblings of Adolescents with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2016; 24:438-445. [PMID: 27501269 DOI: 10.1002/erv.2469] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 07/15/2016] [Accepted: 07/17/2016] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Anorexia nervosa (AN) is often first diagnosed in the adolescent years. The treatment with the greatest evidence during this time is family-based treatment (FBT). In FBT, siblings are expected to attend treatment sessions; however, sibling well-being during this time has not been well researched. This study aimed to explore sibling well-being when the ill child was initially diagnosed with AN and after FBT had been completed. METHOD Eighty-five parents and 55 siblings of adolescents with AN completed the Strengths and Difficulties Questionnaire at diagnosis. In addition, 88 parents and 46 siblings completed the Strengths and Difficulties Questionnaire after finishing treatment. RESULTS Mothers and fathers reported siblings to have lower levels of conduct problems in comparison with population norms. Mothers also reported lower levels of prosocial behaviours. Siblings reported higher levels of emotional difficulties and hyperactivity in comparison with their peers. There were no differences in reported psychosocial well-being of siblings between diagnosis and following FBT. CONCLUSIONS Siblings of adolescents with AN have poorer psychosocial adjustment than their peers, both before and after FBT. Clinicians and parents are encouraged to be aware of sibling difficulties and seek additional support if required. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.
Collapse
Affiliation(s)
| | - Susan M Sawyer
- Department of Paediatrics, The University of Melbourne, Australia.,The Royal Children's Hospital Centre for Adolescent Health, Parkville, VIC, Australia.,Murdoch Childrens Research Institute, Parkville, VIC, Australia
| | - Daniel Le Grange
- Department of Paediatrics, The University of Melbourne, Australia.,Department of Psychiatry, Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Elizabeth K Hughes
- School of Psychological Sciences, Monash University, Clayton, VIC, Australia. .,Department of Paediatrics, The University of Melbourne, Australia. .,The Royal Children's Hospital Centre for Adolescent Health, Parkville, VIC, Australia. .,Murdoch Childrens Research Institute, Parkville, VIC, Australia.
| |
Collapse
|
39
|
Pisetsky EM, Utzinger LM, Peterson CB. Incorporating Social Support in the Treatment of Anorexia Nervosa: Special Considerations for Older Adolescents and Young Adults. COGNITIVE AND BEHAVIORAL PRACTICE 2016; 23:316-328. [PMID: 27429544 DOI: 10.1016/j.cbpra.2015.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Currently, research support is strongest for family-based treatment (FBT) for the treatment of anorexia nervosa (AN) in adolescents. However, a strong evidence base for treatments for older adolescents and young adults with AN is lacking. Emphasizing social support in the treatment of AN may be beneficial for older adolescents and young adults with AN. This paper provides a brief review of the literature on FBT for adolescent AN and provides a case example of adolescent AN treated with FBT. We then discuss novel treatments that have incorporated social support for older adolescents and young adults with AN, such as modified FBT and couples-based interventions. We provide case studies of each of these novel treatment approaches as well. Additionally, this paper highlights and discusses developmental considerations and challenges in working with older adolescents and young adults with AN.
Collapse
Affiliation(s)
- Emily M Pisetsky
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | | | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| |
Collapse
|
40
|
Abstract
This article reports on the treatment of an adolescent girl with anorexia nervosa using a manualized family therapy approach. The therapy used proceeds through three phases. The first phase encourages parents to take charge of refeeding their daughter while separating the illness from the patient. The second phase promotes the adolescent once again eating on her own, and the third phase aims at general adolescent issues that have been affected by anorexia nervosa. The family therapy reported on her has been shown to be effective in clinical trials and this case illustrates the basic therapeutic processes and outcomes that can be expected.
Collapse
|
41
|
Stein RI, Saelens BE, Dounchis JZ, Lewczyk CM, Swenson AK, Wilfley DE. Treatment of Eating Disorders in Women. COUNSELING PSYCHOLOGIST 2016. [DOI: 10.1177/0011000001295004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article reviews the most recent treatment literature for anorexia nervosa, bulimia nervosa, and binge eating disorder and serves as a guide for recommended readings and therapist resources. The primary focus is on empirically tested treatment modalities; for each of these approaches reviewed, the theoretical background, nature of the intervention, and existing empirical support are summarized. The article also presents less researched, albeit promising, approaches to eating disorder treatment, describing the rationale and available research. A focus on multicultural issues, including the paucity of eating disorder treatment research among participants of color, and suggestions for building research and enhancing treatment effectiveness with ethnic minority clients, is incorporated throughout. Recommendations concerning pressing research needs are made, and a summary of clinical recommendations for each disorder is formulated.
Collapse
Affiliation(s)
- Richard I. Stein
- San Diego State University and University of California, San Diego,
| | | | - Jennifer Zoler Dounchis
- San Diego State University; University of California, San Diego; and Minneapolis Veterans Affairs Medical Center, Minnesota
| | | | | | | |
Collapse
|
42
|
Sala M, Heard A, Black EA. Emotion-focused treatments for anorexia nervosa: a systematic review of the literature. Eat Weight Disord 2016; 21:147-64. [PMID: 26886827 DOI: 10.1007/s40519-016-0257-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Accepted: 01/29/2016] [Indexed: 10/22/2022] Open
Abstract
PURPOSE The present review explores emotion-focused treatments for anorexia nervosa (AN). METHODS We conducted a systematic literature search across key databases (PsychINFO, PubMed/Medline, and Web of Science) prior to September 2015. Twenty studies were selected for systematic review. RESULTS The present review found initial evidence supporting the acceptability and feasibility of emotion-focused treatments for AN. Although preliminary results are promising, further controlled studies are necessary to establish the efficacy of emotion-focused treatments for AN. CONCLUSIONS Future controlled trials should compare emotion-focused treatments against each other and against other AN treatments. Future studies should also examine the mechanisms of action for the emotion-focused treatments and treatment moderators.
Collapse
Affiliation(s)
- Margarita Sala
- Department of Psychology, Southern Methodist University, Dallas, TX, 75275, USA.
| | - Amy Heard
- Department of Psychology, Loyola University Chicago, Chicago, USA
| | - Elizabeth A Black
- Department of Psychology, Southern Methodist University, Dallas, TX, 75275, USA
| |
Collapse
|
43
|
Byrne CE, Accurso EC, Arnow KD, Lock J, Le Grange D. An exploratory examination of patient and parental self-efficacy as predictors of weight gain in adolescents with anorexia nervosa. Int J Eat Disord 2015; 48:883-8. [PMID: 25808269 PMCID: PMC4845658 DOI: 10.1002/eat.22376] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine whether increases in adolescent or parental self-efficacy predicted subsequent weight gain in two different therapies for adolescent anorexia nervosa (AN). METHOD Participants were 121 adolescents with AN (M = 14.4 years, SD = 1.6), from a two-site randomized clinical trial for family-based treatment (FBT) and individual adolescent focused therapy (AFT). Both adolescent and parental self-efficacy were assessed at baseline and sessions 2, 4, 6, and 8. Adolescent self-efficacy was assessed using a generic measure of self-efficacy, while parental self-efficacy was assessed using a measure specific to the recovery of an eating disorder. Weight was assessed at baseline, sessions 1 through 8, and end of treatment. Mixed-effects models were used to evaluate the relation between patient and parent self-efficacy and subsequent weight gain, controlling for weight at the previous time point. RESULTS For families who received FBT, greater within-treatment increases in parental self-efficacy predicted greater subsequent adolescent weight gain compared to those who received FBT with lesser change in parental self-efficacy and those who received AFT. Interestingly, adolescent self-efficacy did not significantly predict subsequent weight gain. DISCUSSION Greater increases in parental self-efficacy predicted significantly greater subsequent weight gain for adolescents who received FBT, but the same was not true for adolescents who received AFT. Neither overall level nor change in adolescent self-efficacy significantly predicted subsequent weight gain in either treatment group. These findings emphasize the importance of increasing parental self-efficacy in FBT in order to impact adolescent weight outcomes.
Collapse
Affiliation(s)
- Catherine E. Byrne
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Erin C. Accurso
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| | - Katherine D. Arnow
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - James Lock
- Stanford University, Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Daniel Le Grange
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL
| |
Collapse
|
44
|
Hay PJ, Claudino AM, Touyz S, Abd Elbaky G. Individual psychological therapy in the outpatient treatment of adults with anorexia nervosa. Cochrane Database Syst Rev 2015; 2015:CD003909. [PMID: 26212713 PMCID: PMC6491116 DOI: 10.1002/14651858.cd003909.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anorexia nervosa is a disorder with high morbidity and significant mortality. It is most common in young adult women, in whom the incidence may be increasing. The focus of treatment has moved to an outpatient setting, and a number of differing psychological therapies are presently used in treatment. This is an update of a Cochrane review which was last published in 2008. OBJECTIVES To assess the effects of specific individual psychological therapies for anorexia nervosa in adults or older adolescents treated in an outpatient setting. SEARCH METHODS We searched the Cochrane Depression, Anxiety and Neurosis Review Group Specialised Register (CCDANCTR) (16 July 2014). This register includes relevant randomised controlled trials from: the Cochrane Library (all years), MEDLINE (1950 to date), EMBASE (1974 to date), and PsycINFO (1967 to date). We screened reference lists of all included studies and sent letters to identified, notable researchers requesting information on unpublished or ongoing studies. SELECTION CRITERIA All randomised controlled trials of one or more individual outpatient psychological therapies for adults with anorexia nervosa, as defined by DSM-5 or similar international criteria. DATA COLLECTION AND ANALYSIS We selected a range of outcome variables, including physical state, severity of eating disorder attitudes and beliefs, interpersonal function, and general psychiatric symptom severity. Continuous outcome data comparisons used the mean or standardised mean difference (MD or SMD), and binary outcome comparisons used the risk ratio (RR). Two review authors (PH and AC or ST) extracted data independently. MAIN RESULTS We identified 10 trials from the search, with a total of 599 anorexia nervosa participants, and included them in the review. Seven had been identified in the previous versions of this review and we now include three new trials. We now deem one previously identified ongoing trial to be ineligible, and six ongoing trials are new for this update. Two of the 10 trials included children. Trials tested diverse psychological therapies and comparability was poor. Risks of bias were mostly evident through lack of blinded outcome assessments (in 60% of studies) and incomplete data reporting (attrition bias).The results suggest that treatment as usual (TAU) when delivered by a non-eating-disorder specialist or similar may be less efficacious than focal psychodynamic therapy. This was suggested for a primary outcome of recovery by achievement of a good or intermediate outcome on the Morgan and Russell Scale (RR 0.70, 95% confidence interval (CI) 0.51 to 0.97; 1 RCT, 40 participants; very low-quality evidence). However there were no differences between cognitive analytic therapy and TAU for this outcome (RR 0.78, 95% CI 0.61 to 1.00; 2 RCTs, 71 participants; very low-quality evidence), nor for body mass index (BMI). There were no differences in overall dropout rates between individual psychological therapies and TAU.Two trials found a non-specific specialist therapy (Specialist Supportive Clinical Management) or an Optimised TAU delivered by therapists with eating disorder expertise was similar in outcomes to cognitive behaviour therapy (BMI MD -0.00, 95% CI -0.91 to 0.91; 197 participants, low-quality evidence). When comparing individual psychological therapies with each other, no specific treatment was consistently superior to any other specific approach. Dietary advice as a control arm had a 100% non-completion rate in one trial (35 participants). None of the trials identified any adverse effects. Insufficient power was problematic for the majority of trials. AUTHORS' CONCLUSIONS There was a suggestion in one trial that focal psychodynamic therapy might be superior to TAU, but this is in the context of TAU performing poorly. An alternative control condition of dietary advice alone appeared to be unacceptable, but again this is based on just one trial. Owing to the risk of bias and limitations of studies, notably small sample sizes, we can draw no specific conclusions about the effects of specific individual psychological therapies for anorexia nervosa in adults or older adolescents. Larger RCTs of longer treatment duration and follow-up are needed.
Collapse
Affiliation(s)
- Phillipa J Hay
- Western Sydney UniversityCentre for Health ResearchPenrithNew South WalesAustralia2751
- James Cook UniversityTownsvilleQueenslandAustralia
| | - Angélica M Claudino
- Federal University of São Paulo (UNIFESP)Department of Psychiatry and Psychological MedicineRua Borges Lagoa 570 conj. 71São PauloSão PauloBrazil04038‐000
| | - Stephen Touyz
- University of SydneySchool of Psychology and Boden Institute School of MedicineSydneyNSWAustralia2006
| | - Ghada Abd Elbaky
- Campbelltown Hospital, South Western Sydney Local Health DistrictDepartment of PsychiatryTherry RoadCampbelltownNSWAustralia2560
| | | |
Collapse
|
45
|
Rienecke RD, Accurso EC, Lock J, Le Grange D. Expressed Emotion, Family Functioning, and Treatment Outcome for Adolescents with Anorexia Nervosa. EUROPEAN EATING DISORDERS REVIEW 2015. [PMID: 26201083 DOI: 10.1002/erv.2389] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The current study examined the relation between parental expressed emotion (EE) and treatment outcome among adolescents participating in a treatment study for adolescent anorexia nervosa, as well as its impact on family functioning. One hundred and twenty-one families were assigned to family-based treatment or adolescent-focused therapy. Paternal criticism predicted lesser improvement in eating disorder psychopathology at end of treatment. There was also a significant interaction between maternal hostility and treatment, indicating that adolescents whose mothers displayed hostility had greater increases in percent of expected body weight in adolescent-focused therapy than family-based treatment. In addition, maternal hostility predicted less improvement in general family functioning and family communication at the end of treatment. Findings suggest that maternal and paternal EE may differentially impact treatment outcome and should be directly attended to in clinical settings. Future research is needed to further explore ways in which parental EE can be effectively modified in treatment.
Collapse
Affiliation(s)
- Renee D Rienecke
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Erin C Accurso
- Department of Psychiatry, University of California, San Francisco, USA
| | - James Lock
- Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Daniel Le Grange
- Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| |
Collapse
|
46
|
Abstract
Best-practice guidelines for the treatment of child and adolescent eating disorders recommend the inclusion of parents. Family-based treatment (FBT) posits that families are not only important in supporting their children but are critical change agents in the recovery process. As originally developed for anorexia nervosa, parents take a central role in managing and disrupting eating disorder symptoms. The most evidence-based treatment model for adolescent anorexia nervosa, FBT has also recently been found to be useful in the treatment of adolescent bulimia nervosa. This article provides a summary of the theoretic model, evidence base, and application of FBT.
Collapse
Affiliation(s)
- Sarah Forsberg
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA.
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| |
Collapse
|
47
|
Abstract
This paper provides a comprehensive review of outcome studies and meta-analyses of effectiveness studies of psychodynamic therapy (PDT) for the major categories of mental disorders. Comparisons with inactive controls (waitlist, treatment as usual and placebo) generally but by no means invariably show PDT to be effective for depression, some anxiety disorders, eating disorders and somatic disorders. There is little evidence to support its implementation for post-traumatic stress disorder, obsessive-compulsive disorder, bulimia nervosa, cocaine dependence or psychosis. The strongest current evidence base supports relatively long-term psychodynamic treatment of some personality disorders, particularly borderline personality disorder. Comparisons with active treatments rarely identify PDT as superior to control interventions and studies are generally not appropriately designed to provide tests of statistical equivalence. Studies that demonstrate inferiority of PDT to alternatives exist, but are small in number and often questionable in design. Reviews of the field appear to be subject to allegiance effects. The present review recommends abandoning the inherently conservative strategy of comparing heterogeneous "families" of therapies for heterogeneous diagnostic groups. Instead, it advocates using the opportunities provided by bioscience and computational psychiatry to creatively explore and assess the value of protocol-directed combinations of specific treatment components to address the key problems of individual patients.
Collapse
Affiliation(s)
- Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, and The Anna Freud Centre, London, UK
| |
Collapse
|
48
|
Rienecke RD, Lebow J, Lock J, Le Grange D. Family Profiles of Expressed Emotion in Adolescent Patients With Anorexia Nervosa and Their Parents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2015; 46:428-436. [PMID: 25945418 DOI: 10.1080/15374416.2015.1030755] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The current study examined expressed emotion (EE) among families of adolescents with anorexia nervosa (AN) participating in a treatment study. EE ratings were made from 110 adolescents toward their parents and from parents toward their children using videotaped family interviews. Participants were 92% female and 75% Caucasian with a mean age of 14.41 years. Four family profiles were created (low patient EE/low parent EE, high patient EE/high parent EE, low patient EE/high parent EE, high patient EE/low parent EE). Family EE profile was not related to full remission at end of treatment. Groups were then combined according to EE level of parent. The low parent group (defined as low on criticism, hostility, and emotional overinvolvement) had significantly lower scores on a measure of eating disorder psychopathology than the high parent group at the end of treatment. Patients with AN in low EE families do better in treatment than those patients belonging to high EE families. These findings are true regardless of the EE status of the patient.
Collapse
Affiliation(s)
| | - Jocelyn Lebow
- b Department of Psychiatry & Behavioral Sciences , University of Miami.,c Department of Psychiatry and Psychology , Mayo Clinic
| | - James Lock
- d Department of Psychiatry & Behavioral Sciences , Stanford University
| | - Daniel Le Grange
- e Department of Psychiatry , University of California , San Francisco
| |
Collapse
|
49
|
Lock J, La Via MC. Practice parameter for the assessment and treatment of children and adolescents with eating disorders. J Am Acad Child Adolesc Psychiatry 2015; 54:412-25. [PMID: 25901778 DOI: 10.1016/j.jaac.2015.01.018] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 01/31/2015] [Indexed: 10/23/2022]
Abstract
This Practice Parameter reviews evidence-based practices for the evaluation and treatment of eating disorders in children and adolescents. Where empirical support is limited, clinical consensus opinion is used to supplement systematic data review. The Parameter focuses on the phenomenology of eating disorders, comorbidity of eating disorders with other psychiatric and medical disorders, and treatment in children and adolescents. Because the database related to eating disorders in younger patients is limited, relevant literature drawn from adult studies is included in the discussion.
Collapse
|
50
|
Johnston JAY, O'Gara JSX, Koman SL, Baker CW, Anderson DA. A pilot study of maudsley family therapy with group dialectical behavior therapy skills training in an intensive outpatient program for adolescent eating disorders. J Clin Psychol 2015; 71:527-43. [PMID: 25867492 DOI: 10.1002/jclp.22176] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The goal of this study was to provide pilot clinical data on the effectiveness of an intensive outpatient treatment model for adolescent eating disorders that combines Maudsley-based family therapy and group dialectical behavior therapy skills training. METHOD Measures of physical and psychological status were gathered upon admission, discharge, and at 3 follow-up intervals. RESULTS Adolescents who completed the program gained a significant amount of weight and experienced a significant decrease in eating disorder psychopathology. At the 1-year follow-up, 64% of adolescents were weight restored and menstruating normally. Measures of eating disorder psychopathology continued to improve up to a year after treatment. CONCLUSIONS This pilot, multimodal program warrants further investigation and may be an effective intermediate level of care treatment option for adolescent eating disorders.
Collapse
|