2015 EST Status: Treatment pending re-evaluation Very strong: High-quality evidence that treatment improves symptoms and functional outcomes at post-treatment and follow-up; little risk of harm; requires reasonable amount of resources; effective in non-research settings

Strong: Moderate- to high-quality evidence that treatment improves symptoms OR functional outcomes; not a high risk of harm; reasonable use of resources

Weak: Low or very low-quality evidence that treatment produces clinically meaningful effects on symptoms or functional outcomes; Gains from the treatment may not warrant resources involved

Insufficient Evidence: No meta-analytic study could be identified

Insufficient Evidence: Existing meta-analyses are not of sufficient quality

Treatment pending re-evaluation

1998 EST Status: Strong Research Support Strong: Support from two well-designed studies conducted by independent investigators.

Modest: Support from one well-designed study or several adequately designed studies.

Controversial: Conflicting results, or claims regarding mechanisms are unsupported.

Brief Summary

• Basic premise: Active and structured family involvement in the treatment of adolescents suffering from anorexia nervosa significantly increases the likelihood of positive treatment outcomes.
• Essence of therapy: Family-Based Treatment (FBT) for anorexia nervosa is an outpatient intervention for adolescents who are medically stable, and consists of three phases: (1) parents take charge of the process of nutritional rehabilitation and weight restoration with the help of the therapist; (2) control over eating is returned to the adolescent in an age appropriate fashion; (3) issues of psychosocial development in the absence of an eating disorder are addressed. FBT also aims to correct misperceptions and misattributions of blame for the patient’s illness. That is, neither the parents nor the adolescent is responsible for the eating disorder. Therefore, FBT takes a theoretically agnostic approach to the etiology of this disorder. [Note: Family therapy for adolescents with anorexia nervosa (AN) was developed at the Maudsley Hospital in London, United Kingdom, in the 1980’s by a team of clinicians lead by Ivan Eisler, PhD, and Christopher Dare, MD. Family-based treatment (FBT) for adolescents with AN is an adaptation of this London-based approach. It was through the collective work of Daniel Le Grange, PhD, a psychologist who trained with the Maudsley team in the 1980’s, and then moved to The University of Chicago, and James Lock, MD, PhD, a Stanford University Child and Adolescent Psychiatrist, that a clinician’s manual of FBT was written. FBT is not the same as family therapy for adolescents with AN, but is a very close ‘relative’, and has now been utilized in several randomized clinical trials.]
• Length: Approximately 15-20 sessions conducted over 6-12 months

 

Treatment Resources

Editors: David Albert, PhD; Alexandra Greenfield, MS

Note: The resources provided below are intended to supplement not replace foundational training in mental health treatment and evidence-based practice

Treatment Manuals / Outlines

Treatment Manuals

Books Available for Purchase Through External Sites

• Treatment Manual for Anorexia Nervosa, Second Edition: A Family-Based Approach (Lock & Le Grange)

Training Materials and Workshops

• Family therapy for anorexia nervosa (Dare & Eisler, 1997)
• Treating adolescents with anorexia nervosa using behavioral family systems therapy (Robin & Le Grange, 2010; In Evidence-Based Psychotherapies for Children and Adolescents)
• Treating adolescents with eating disorders in the family context: Empirical and theoretical considerations (Lock, 2002)

Video Descriptions

• Family-Based Treatment for Anorexia Nervosa: The Maudsley Approach (maudsleyparents.org)
  
• Family-Based Treatment for Young Adults with Anorexia Nervosa (maudsleyparents.org)

• The Role of Siblings in Family-Based Treatment (maudsleyparents.org)

Clinical Trials

• Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa (Lock et al., 2010)
• Evaluation of family treatments in adolescent anorexia nervosa: A pilot study (Le Grange et al., 1992)
• Family therapy for adolescent anorexia nervosa: The results of a controlled comparison of two family interventions (Eisler et al., 2000)
• Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa (Lock et al., 2010)
• A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa (Robin et al., 1999)
• Clinical effectiveness of treatments for anorexia nervosa in adolescents: Randomised controlled trial (Gowers et al., 2007)
• A comparison of short- and long-term family therapy for adolescent anorexia nervosa (Lock et al., 2005)
• An evaluation of family therapy in anorexia nervosa and bulimia nervosa (Russell et al., 1987)
• A randomized controlled trial of inpatient treatment for anorexia nervosa in medically unstable adolescents (Madden et al., 2014)

Meta-analyses and Systematic Reviews

• Anorexia nervosa treatment: a systematic review of randomized controlled trials (Bulik et al., 2007)
• Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis (Couturier et al., 2013)

Other Treatment Resources

• Relapse from remission at two- to four-year follow-up in two treatments for adolescent anorexia nervosa (Le Grange et al., 2014)
• Moderators and mediators of remission in family-based treatment and adolescent focused therapy for anorexia nervosa (Le Grange et al., 2012)
• Family therapy for adolescent anorexia nervosa (Le Grange, 1999)