Family Based Therapy for Adolescents with Anorexia
Jack and Susannah Pierce (names changed) are caring, supportive parents. They have been on a rollercoaster since their daughter Wendi, now 15, was diagnosed with anorexia almost a year ago. “It was a vicious cycle,” says Jack. “She was hospitalized twice due to very low weight. As soon as she was discharged from the hospital she’d lose all the weight and we’d be back to square one.”
In researching treatment options, the couple heard about Family Based Treatment (FBT) also known as the Maudsley approach. Their outpatient therapist, who was equally concerned with the Wendi’s lack of progress, had also heard about FBT, and a partnership began. They abandoned traditional individual therapy and began to work together in a radically different way. Jack and Susannah supervised all of Wendi’s meals and snacks. This included daily trips to Wendi’s school to eat with her at lunchtime. Their therapist helped coach them in interacting with Wendi in a firm yet supportive way.
“It wasn’t easy,” Susannah says. “There were some nights when I was ready to give up. Many times Wendi refused to eat. There were times when we spent hours at the table. “I think that when she finally was able to see that we were serious, and were not about to let her die, she began to eat.”
FBT has been around since the 1990s but is still relatively underutilized. This may change with the publication of another study supporting its efficacy.
The research, published on October 4 in the Archives of General Psychiatry by James Lock and Daniel LeGrange, followed 121 young men and women with anorexia, ages 12-18. The teens were randomly assigned to receive individual psychotherapy or FBT. Patients were considered in full remission if they reached 95 percent of normal body weight. At the conclusion of the study, 49.3 percent of FBT patients were in full remission, whereas 23.2 percent of individual psychotherapy patients were in full remission. The two treatments were equally effective in helping patients achieve partial remission, defined as a body weight of 85 percent of normal.
Dr. Ellen Davis, cofounder of Woodland Forge in Phoenixville, Pa., is a strong advocate for FBT. “I used to practice traditional psychotherapy with patients with anorexia,” she says, “The recovery time for most adolescents was between 2-3 years. It’s much quicker with FBT. With a younger adolescent I can move them to the point where a parent will say ‘I have my kid back’ in 9-10 months. It’s an amazing approach.”
There are three stages to FBT. The first stage focuses on weight restoration. In this stage parents are solely responsible for food preparation, and eat every meal and snack with the adolescent. When weight begins to reach a healthier level and there is no resistance around eating, control over meals is gradually returned to the teen (phase two). Phase three is more akin to traditional therapy and addresses the psychological, environmental or family issues that contributed to the eating disorder.
FBT is a relatively new treatment and families often have to be proactive in searching for treatment providers familiar with FBT. That said, there are a number of outpatient therapists who are skilled in FBT, and most are identifiable with a simple phone call.
FBT has shown to be a “Gold Standard” for adolescents with anorexia, but not necessarily those with bulimia, EDNOS or binge eating disorder. For older patients, or those struggling with other eating disorders, a combination of treatment strategies; including CBT (Cognitive Behavioral Therapy), DBT (Diabolical Behavioral Therapy), FBT (Family Based Therapy), Experiential Therapies, 12-Step based treatment, are well worth looking into to suit each patient’s specific needs. What works for one person or family, doesn’t necessarily work for all!
This guest post provided by Heidi_PsyD re-posted from the Examiner.