Family-Based Treatment for Transition Age Youth

Review by Allison Chase

Dimitropoulos, G., Landers, A. L., Freeman, V. E., Novick, J., Cullen, O., Engelberg, M. J., . . . Le Grange, D. (2018). Family-based treatment for transition age youth: parental self-efficacy and caregiver accommodation. Journal of Eating Disorders, 6, 13.

There is evidence that effective interventions are needed to prevent the severe physical and emotional consequences of anorexia nervosa. Among the evidence-based treatment modalities, family-based therapies have been shown to be an impactful intervention. The inclusion of the family or caregiver can help to provide the necessary support to challenge the enduring and pervasive pattern of eating disorder symptomatology. Among the family therapy approaches, manualized Family-Based Treatment (FBT) has been shown to be the most effective treatment approach for medically stable adolescents for anorexia nervosa. While the data has supported FBT for adolescents, for the young adult population, also known as transition age youth (TAY), there is limited research on the impact of family-based therapy. In recognizing the developmental and transitional realities for this young adult populations, a recent intervention FBT-TAY was developed for this population. Consideration was taken to balance the need for support and autonomy in this age group.

While the treatment outcomes for FBT have overall been positive, it is important to better understanding which mechanisms are promoting the positive change. The core principles of FBT assume the active role of the parent to re-nourish and implement behavioral strategies to eliminate eating disorder behaviors. Research has indicated that parental confidence plays a key role in the reduction of eating disorder behaviors, as well as re-nourishing their child. Conversely, it is believed that the feelings of hopelessness and increased anxiety experienced by some parents family-based eating disorder treatment result in inadvertently accommodating the unhealthy behaviors, impacting self-efficacy and treatment success.

The aim of this study was to determine if self-efficacy and caregiver accommodation were impacted during implementation of FBT-TAY. The study was conducted at one adult and two pediatric hospital sites in Canada. The participants self-selected at least one caregiver, defined broadly to include family or friends, to participate in treatment. A total of 26 participants, with a mean age of 18.15 years, were assessed for caregiver accommodation, parental self-efficacy, eating disorder behavior and weight restoration at pre-, post- and 3-month post-treatment. Assessment measures included height and weight measurements, the Eating Disorder Examination Questionnaire, Parents vs Anorexia (PvA) scale to measure parental self-efficacy, and the Accommodation and Enabling Scale for Eating Disorders (AESED). Results indicated that parental self-efficacy did show an increase throughout treatment; however, only from baseline to 3-month follow-up was it statistically significant. Caregiver accommodation decreased significant during treatment, but results were not sustained at 3-month follow-up. Furthermore, neither parental self-efficacy not caregiver accommodation changes predicted weight restoration or eating disorder behaviors among the transition age youth.

Why is this important?

The study illuminates the importance of further understanding the mechanisms by which treatment interventions can promote change of those transition age youth suffering from an eating disorder. More specifically, eating disorders among this age group provide a unique challenge, marked by the desire for developmentally appropriate independence, yet the presence of an illness that requires more supervision and support. FBT-TAY is a promising treatment and the increased self-efficacy from baseline to 3-month post treatment in caregivers was encouraging, despite the lack of statistical significance. This study acknowledged the limitations with not only sample size but the broad definition of “caregiver”, lacking consistency on how the self-efficacy measure was interpreted by the caregivers. Increasing caregiver confidence and decreasing accommodation during treatment has been shown in prior studies to promote more significant change. Therefore, continued research on how to utilize and improve the impact of caregiver support remains important in enhancing the treatment outcome of transition age youth with eating disorders.