Open Trial of Family Based Treatment of Anorexia Nervosa

Review by Elizabeth Easton

Dimitropoulos, G., Landers, A. L., Freeman, V. E., Novick, J., Garber, A. K., & Le Grange, D. (2018). Open trial of family-based treatment of anorexia nervosa for transition age youth. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 27(1), 50-61.

http://www.cacapacpea.org/uploads/documents//Open_Trial_of_Family_Based_Treatment_of_Anorexia_Nervosa.pdf

The young adult age group, now often deemed ‘emerging adult,’ appears to bring unique challenges to the already complex approach of eating disorder treatment. Bridging the gap between ‘dependent’ adolescents and ‘independent’ adults are the ‘interdependent’ young adults who are still often intertwined with their families of origin yet striving to create a life and support system beyond their parents. This treatment approach and subsequent paper honor the complexities of a developmental approach to eating disorder treatment by targeting what they refer to as “transition age youth.”

A manualized adaptation of Family-Based Treatment for Transition Age Youth (FBT-TAY) was examined, specifically for participants with anorexia nervosa, aiming to study: 1) acceptability and feasibility of FBT in the age group and 2) effect sizes for weight restoration and eating disorder psychopathology. Study participants (between the ages of 16.5-25) were recruited from treatment programs, medically stable to receive outpatient treatment and willing to involve their support system directly in care. FBT-TAY was adapted from the traditional approach throughout all three of the FBT phases, most notably by allowing the individual to choose who they considered ‘family’ for involvement in sessions and the integration of individual session time (20- to 30-minutes) from the beginning of the 25-session approach. Other notable differences throughout the phases were: 1) family collaboration through monitoring symptoms during and outside of meals with age-appropriate patient direction (e.g. encouraged to identify how they wanted the support from loved ones), 2) symptom management was handed back to the individual as they increased their exposure to developmentally appropriate situations (e.g. eating on campus, independent meal preparation), and 3) age-appropriate transition concerns (e.g. transitions to school, living in dorms) and recovery maintenance planning, including sharing that plan with supports. Of note, a majority of participants (>95%) chose to participate with their family of origin despite being given the option to invite peers or partners. The study outcomes demonstrated that FBT-TAY was found to be acceptable and feasible to clinicians and participants, as well as effective for participants. At end of treatment and 3-months post-treatment, participants demonstrated significant improvements from baseline on EDE-Q Global Score (p< .001; ES = 0.34) and achieved and maintained weight restoration when compared to baseline (p< .0001; ED = 0.54). It was noted that these results are congruent with weight outcomes of prior FBT studies with adolescents.

Why Does this Matter?

At a time in which ‘Millennials’ and ‘Generation Z’ are increasingly influencing education and hiring practices, developmentally-adapted approaches to psychotherapy are growing in popularity and importance. We are far from the time in which adolescents were deemed ‘miniature adults’, yet the emerging adult population is still being forced into the molds of child versus adult approaches throughout the field. Studies and treatment models like FBT-TAY are essential to this age group’s treatment outcomes by individualizing, while also standardizing, psychotherapy approaches. In addition, the role and empowerment of the family, specifically family of origin caregivers, proves to remain vital in this interdependent patient population.