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"FBT" and the "Maudsley Approach"
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Family-Based Treatment (FBT)* is now considered the first line of treatment for adolescent eating disorders around the world. While still not widely available, it is the most researched and has the highest rates of recovery compared to other approaches.

As one of the leaders in the field was quoted saying in October 2010, this approach: "should be the gold standard or first-line outpatient treatment for medically stable teens." In a field where there is very little data on what works, this research offers both optimism and strong results. 

The evidence has been mounting for decades, but the most recent studies confirm what has been a growing interest in this approach. Despite lingering skepticism in the field for this departure from usual treatment, a 2008 paper published in the Journal of Clinical Child & Adolescent Psychology said "At this time, the evidence base is strongest" for Family-Based Treatment.

The authors of another 2008 article (available by special permission on the FEAST site) describe published research on family-based interventions showing "at 4-5 year follow-up, the majority (60-90%) will have fully recovered while only 10-15% will still be seriously ill"... "Outpatient family therapy compares quite favorably to other treatment modalities such as inpatient care where full recovery rates vary between 33% - 55%."
Put simply, FBT sees the parents of the ill person as the best ally for recovery. The effects of dieting (or insufficient food for a person's activity level) are for many people a self-perpetuating cycle that requires intervention. In this evidence-based approach, parents are seen as the most committed and competent people in the patient's life and therefore best qualified to find ways to fight the illness, to regain healthy weight, and end unhealthy behaviors like compulsive exercise and purging. Normalizing eating is the first step toward recovery.

Without question, FBT represents a very different way of looking at eating disorders and treatment from traditional approaches. Some in the eating disorders community are shocked and even offended by the emphasis on nutrition and behaviors instead of insight and motivation. Still others remain skeptical of the role of parents in the treatment. Yet the results are clear: there is no other scientifically-validated treatment approach for adolescents with anorexia living at home who have been ill fewer than three years. The approach is also appropriate for bulimia and for older patients whose families are able to take on this role, according to leading researchers in the field.

In most cases, the treatment has three phases over a period of 6-12 months, led by a family-based therapist (some family therapists do Family-Based Treatment, most do not), and involve the entire family in hour-long weekly sessions. The parents are coached in how to help the patient eat (and/or stop purging and over-exercising) and siblings are encouraged to ally with the ill sibling. Patients are neither expected to nor asked to cooperate - in fact in the first session of Family-Based Treatment a family meal is eaten in the therapist's office and the ill person is asked to resist eating to demonstrate the difficulties and dynamics of the family around the meal.

(The treatment for bulimia is slightly different: the patients - usually older and more ready to engage in therapy - are more involved with the problem-solving phase of recovery.)

No one is blamed in FBT- the illness is not seen as anyone's fault. In fact, finding cause for the eating disorder is not part of the treatment at all.

The origins of Family-Based Treatment developed and was researched in the 1980s at the Maudsley Hospital in London. Initially used for anorexia nervosa, a modified version appropriate for bulimia nervosa is also in use. Clinical treatment manuals are available, published by Guilford Press (Anorexia manual / Bulimia manual ). The treatment and variations of the approach have spread to the United States, Australia, Canada, France, Germany, Israel and Poland. Modified versions of the original protocol have been used successfully with older patients, multi-family group trainings, and for couples.

Research is ongoing.

The three phases of treatment are:

  • Parents are given responsibility for decisions of what, when, and how much the ill patient eats as well as behaviors around food by the family therapist
  • After weight restoration is nearly achieved, control is carefully given back to the patient, guided by the family therapist
  • Finally, the therapist and family work to restore normal and age-appropriate lifestyle and relations between family members.

At this time it is still difficult to find clinicians trained in the Family-Based Treatment approach. Unfortunately, many parents will find that their local clinicians are either unfamiliar with or openly dismissive of the approach. It will take time for information and training to find its way into widespread practice, but parents can travel to evidence-based clinics for treatment or arrange for consultations between modern clinics and local resources. Clinicians interested in learning about or training in the approach can contact The Training Institute for Child and Adolescent Eating Disorders also lists clinicians who are certified in providing the treatment.

For more information on Eating Disorder treatment approaches, please see our Treating EDs page.

* sometimes referred to informally as "The Maudsley Approach," the word Maudsley refers to a London Hospital that pioneered family-based treatments. 

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