Family-based treatment for adolescent anorexia nervosa: outcomes of a stepped-care model
Daniel Le Grange, Martin Pradel, Danielle Pogos, Michele Yeo, Elizabeth K. Hughes, Alicia Tompson, Andrew Court, Ross D. Crosby & Susan M. Sawyer[Work done by Dr Le Grange (UCSF) and his colleagues at the Royal Children’s Hospital in Melbourne, Australia]
A considerable body of literature underscores family-based treatment (FBT) as the most efficacious intervention for adolescents with anorexia nervosa (AN). However, enthusiasm for FBT should be tempered, as typically at the end of a course of standard FBT (i.e., 16-18 sessions over 6-9 months), and on average, about 40% of adolescents are remitted. That is, when remission is defined as weight at >95% of median Body Mass Index (%mBMI) plus within one standard deviation (SD) of the community norms of the Eating Disorder Examination (EDE) global score.
To improve treatment outcomes for adolescents with AN, we developed an FBT-based stepped-care model that is consistent with family/parent preference (i.e., tailored) and responsive to adolescent needs (i.e., intensity). The aim of our study was to evaluate the effectiveness of this model in terms of remission at the end-of-treatment, i.e., when remission is defined in the same way as described above (weight >95% of %mBMI + within 1SD of the EDE global score). Eighty-two adolescents aged 12-18 years (average 15.1), meeting DSM-5 criteria for AN, were assessed at the beginning of treatment, at Week 24 and again at Week 48. FBT was tailored to family preference and adolescent clinical need, with a dose of 16-18 treatment sessions provided by Week 24. This was followed by three FBT booster sessions, or an extension of FBT plus booster sessions by Week 48.
We found remission rates to be an impressive 45.1% at Week 24 and 52.4% at Week 48. Commensurable improvements were also evident across secondary outcomes (e.g., EDE subscale scores). These findings should be considered quite encouraging as a wider comparison of our stepped-care model with the only three prior randomized clinical trials (i.e., Le Grange et al., 2016; Lock et al., 2010; Madden et al., 2015) that used the same definition of remission that we used here, showed that at the same time points, our stepped-care model achieved remission rates exceeding those of these prior RCTs by between 10 and 30 percentage points.
To wrap up, our stepped-care model, designed to be responsive to parents’ preference and the needs of adolescents and their families, achieved very encouraging rates of remission. This study provides an important signal that supports future clinical trials of stepped-care models for adolescents with AN.
Here is the complete article in the International Journal of Eating Disorders.
Le Grange, D., Hughes, E. K., Court, A., Yeo, M., Crosby, R. D., & Sawyer, S. M. (2016). Randomized Clinical Trial of Parent-Focused Treatment and Family-Based Treatment for Adolescent Anorexia Nervosa. Journal of the American Academy of Child & Adolescent Psychiatry, 55(8), 683–692. https://doi.org/10.1016/j.jaac.2016.05.007
Le Grange, D., Pradel, M., Pogos, D., Yeo, M., Hughes, E., Tompson, A., Court, A., Crosby, R.D.,
& Sawyer, S.M. Family-based treatment for adolescent anorexia nervosa: outcomes of a
stepped-care model. International Journal of Eating Disorders, 2021 Oct 22. doi.org/ 10.1002/ eat.23629. https://doi.org/10.1002/eat.23629
Lock, J., Le Grange, D., Agras, W. S., Moye, A., Bryson, S. W., & Jo, B. (2010). Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia Nervosa. Archives of General Psychiatry, 67(10), 1025. https://doi.org/10.1001/archgenpsychiatry.2010.128
Madden, S., Miskovic-Wheatley, J., Wallis, A., Kohn, M., Lock, J., Le Grange, D., Jo, B., Clarke, S., Rhodes, P., Hay, P., & Touyz, S. (2015). A randomized controlled trial of in-patient treatment for anorexia nervosa in medically unstable adolescents. Psychological Medicine, 45(2), 415–427. https://doi.org/10.1017/S0033291714001573