Family therapy for anorexia: short course sufficient for most

Short-term family therapy for adolescents with anorexia nervosa is as effective as long-term family therapy, say the authors of a US study.Previous research has suggested that family therapy that begins by promoting parental control over re-feeding may be effective in adolescents with anorexia nervosa.The researchers conducted a study involving 86 medically stable adolescents (12-18 years) with anorexia nervosa to determine the optimal length of family therapy. Study participants were randomised to short-term family therapy (6 months, 10 sessions, n=44) or long-term family therapy (12 months, 20 sessions, n=42). Therapy sessions in both groups comprised a 10- to 15-minute check-in with the adolescent followed by a 45- to 50-minute meeting with the whole family.Participants' height, weight and severity of the characteristic psychopathology of eating disorders were measured at baseline and at six and 12 months using the adult version of the Eating Disorder Examination (EDE). Body mass index (BMI) was also measured.Severity of obsessionality and compulsiveness about eating behaviours weight and exercise was measured after each EDE assessment using the Yale-Brown-Cornell Eating Disorder Scale (YBC-ED).No statistically significant difference between the two therapy groups was observed in terms of the primary outcomes (BMI and EDE) or on any of the secondary outcomes.The researchers state that while a non-significant difference does not prove the null hypothesis, even in an adequately powered study such as this, all of the confidence intervals for the effect sizes indicate that the true effect size is unlikely to be anywhere near moderate (d=0.5)."In short there is no evidence supporting that, in general, long-term treatment will produce more favourable results than the short-term treatment."Examination of possible moderators of outcome for both BMI and global EDE revealed that participants with more severe and persistent eating-related obsessive-compulsive thinking on the YBC-ED or those from non-intact families did significantly better in long-term treatment.The researchers suggest that clinicians should consider the possibility that a short-term course of family therapy will benefit adolescents with anorexia nervosa but that it is probably more likely that a longer-course will be required if patients exhibit very high levels of eating-related obsessive-compulsive thinking or come from non-intact families.Reference...