Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa.
This randomized controlled trial found that family based treatment (FBT) was more effective in facilitating long-lasting full remission of anorexia nervosa in adolescents, when compared with adolescent-focused individual therapy (AFT). Full remission at 12-month follow-up was 49% for FBT compared with 23% for AFT (P=0.02).
- Randomized controlled trial.
- N=121 participants, 91% female, ages 12-18, with DSM-IV anorexia nervosa (excluding amenorrhea requirement), randomized to receive 24 hours of outpatient treatment, over 12 months, in:
- Family based treatment (FBT, n=61)
- Adolescent-focused individual therapy (AFT, n=60)
- Family based treatment occurred in 3 phases:
- Phase 1 involved trying to absolve patients of being the cause of the disorder, identifying positive aspects of their parenting, and encouraging the families to develop a strategy to restore the weight of their adolescent.
- Phase 2 involved helping shift control of eating and weight gain back to their adolescent.
- Phase 3 involved establishing a healthy relationship between the adolescent and their parents.
- Adolescent-focused individual therapy involved development of a therapeutic relationship, active encouragement of eating and weight gain with the patient taking responsibility for these, with measurable goals. The therapist helped the patient distinguish bodily needs from emotional states, and encouraged individuation and increased tolerance of negative affect.
- Assessments at baseline, end of treatment, 6-month follow-up, 12 month follow-up.
- Primary outcomes: Full remission (weight ≥95% of expected for sex, age, height), and Eating Disorder Examination score within 1 standard deviation of published means.
- Secondary outcomes: Partial remission (weight >85% of expected for height, plus those in full remission), changes in body mass index percentile, and eating-related psychopathology.
- Setting: Stanford University and The University of Chicago, 2005-2009.
- Full remission rates at end of treatment (did not differ significantly, P=0.055):
- FBT: 42%
- AFT: 23%
- Full remission rates at 6-month follow-up (P=0.03):
- FBT: 40%
- AFT: 18%
- Full remission rates at 12-month follow-up (P=0.02):
- FBT: 49%
- AFT: 23%
- Partial remission rates at end of treatment (P=0.02):
- FBT: 89%
- AFT: 67%
- Partial remission rates did not differ significantly at follow-up.
- BMI percentile was an average of 8.0 higher in FBT than AFT (95% CI, 0.1-15.9, P=0.048) at end of treatment, but not a follow-up.
Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry. 2010;67(10):1025-1032. doi:10.1001/archgenpsychiatry.2010.128.