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A pragmatic randomised multi-centre trial of multifamily and single family therapy for adolescent anorexia nervosa
Background
Considerable progress has been made in recent years in developing effective treatments for child and adolescent anorexia nervosa, with a general consensus in the field that eating disorders focussed family therapy (often referred to as Maudsley Family Therapy or Family Based Treatment) currently offers the most promising outcomes. Nevertheless, a significant number do not respond well and additional treatment developments are needed to improve outcomes. Multifamily therapy is a promising treatment that has attracted considerable interest and we report the results of the first randomised controlled trial of multifamily therapy for adolescent anorexia nervosa.
Methods
The study was a pragmatic multicentre randomised controlled superiority trial comparing two outpatient eating disorder focussed family interventions - multifamily therapy (MFT-AN) and single family therapy (FT-AN). A total of 169 adolescents with a DSM-IV diagnosis of anorexia nervosa or eating disorder not otherwise specified (restricting type) were randomised to the two treatments using computer generated blocks of random sizes to ensure balanced numbers in the trial arms. Independent assessors, blind to the allocation, completed evaluations at baseline, 3 months, 12 months (end of treatment) and 18 months.
Results
Both treatment groups showed clinically significant improvements with just under 60% achieving a good or intermediate outcome (on the Morgan-Russell scales) at the end of treatment in the FT-AN group and more than 75% in the MFT-AN group - a statistically significant benefit in favour of the multifamily intervention (OR = 2.55 95%; CI 1.17, 5.52;
p
= 0.019). At follow-up (18 months post baseline) there was relatively little change compared to end of treatment although the difference in primary outcome between the treatments was no longer statistically significant. Clinically significant gains in weight were accompanied by improvements in mood and eating disorder psychopathology. Approximately half the patients in FT-AN and nearly 60% of those in MFT-AN had started menstruating.
Conclusions
This study confirms previous research findings demonstrating the effectiveness of eating disorder focused family therapy and highlights the additional benefits of bringing together groups of families that maximises the use of family resources and mutual support leading to improved outcomes.
Trial Registration
Current Controlled Trials
ISRCTN11275465
; Registered 29 January 2007 (retrospectively registered)
Journal Article
The heart of the matter : music and art in family therapy
\"The Heart of the Matter invites therapists from all disciplines to consider the use of music and art in their work with families. It introduces systemic music and art ideas, giving clinical examples from practice, and a rationale for using each technique. Conversations with therapists who have explored and incorporated the techniques into their work are shared, and include both personal and professional responses to incorporating new methods in practice.\" -- Publisher's description.
Book
Handbook of Bowen Family Systems Theory and Research Methods
The Handbook of Bowen Family Systems Theory and Research Methods presents innovative approaches on a range of issues inherent in family research and discusses the links between theory, data collection, and data analysis based on Bowen family systems theory.
This multi-authored volume discusses core issues within family systems theory, including anxiety, stress, emotional cutoff, differentiation of self, multigenerational transmission process, and nuclear family emotional process. Chapters also examine related constructs in the research literature such as adaptation, resilience, social support, social networks, and intergenerational family relations. Readers will be able to view theoretical and methodological issues from the perspective of Bowen theory and develop a clearer knowledge of ways to navigate the challenges faced when studying individual, familial, and societal problems.
An essential resource for clinicians and researchers in the social and natural sciences, the Handbook of Bowen Family Systems Theory and Research Methods provides a comprehensive framework for understanding the application of Bowen theory to family practice and family research.
eBook
Human-Animal Bonds II: The Role of Pets in Family Systems and Family Therapy
The vast majority of pet owners regard their companion animals as family members, yet the role of pets in family systems and family therapy has received little attention in research, training, and practice. This article first notes the benefits of family pets and their importance for resilience. It then examines their role in couple and family processes and their involvement in relational dynamics and tensions. Next, it addresses bereavement in the loss of a cherished pet, influences complicating grief, and facilitation of mourning and adaptation. Finally, it explores the ways that clients' pets and the use of therapists' companion animals in animal‐assisted therapy can inform and enrich couple and family therapy as valuable resources in healing.
RESUMEN
Vínculos entre animales y humanos II: El rol de las mascotas en los sistemas familiares y en la terapia familiar
La gran mayoría de los dueños de mascotas consideran a sus animales de compañía como miembros de la familia, sin embargo, el rol de las mascotas en los sistemas familiares y en la terapia familiar ha recibido escasa atención tanto en la investigación como en la capacitación y la práctica. En este artículo se explican primero los beneficios de las mascotas familiares y su importancia para la capacidad de recuperación. Luego se analiza el rol que cumplen las mascotas en los procesos familiares y de pareja, y su intervención en la dinámica relacional y las tensiones. Posteriormente, se aborda el sufrimiento por la pérdida de una mascota querida, las influencias que complican el dolor, y la facilitación del duelo y la adaptación. Finalmente, se analizan las maneras en las que las mascotas de los pacientes y el uso de animales de compañía por terapeutas en la terapia asistida por animales pueden informar y enriquecer la terapia familiar y de pareja como recursos valiosos para la curación.
Palabras clave: animales de compañía; mascotas en sistemas familiares; mascotas en terapia familiar y/o terapia de pareja; terapia familiar asistida por animales; dolor por la pérdida o la muerte de una mascota
Journal Article
Multi-family Therapy for Eating Disorders Across the Lifespan
Purpose of Review
This review aims to report on recent evidence for multi-family therapy for eating disorders (MFT) across the lifespan. It is a narrative update of recent systematic, scoping and meta-analytic reviews.
Recent Findings
There has been a recent increase in published theoretical, quantitative and qualitative reports on MFT in the past few years. Recent and emerging data continues to confirm MFT can support eating disorder symptom improvement and weight gain, for those who may need to, for people across the lifespan. It has also been associated with improved comorbid psychiatric symptoms, self-esteem and quality of life. Data are also emerging regarding possible predictors, moderators and mediators of MFT outcomes, as well as qualitative data on perceived change processes. These data suggest families with fewer positive caregiving experiences at the start of treatment may particularly benefit from the MFT context. Additionally, early change in family functioning within MFT may lead to improved outcomes at end of treatment.
Summary
MFT is a useful adjunctive treatment across the lifespan for people with eating disorders. It helps to promote change in eating disorder and related difficulties. It has also been shown to support and promote broader family and caregiver functioning.
Journal Article
Exploring the Efficacy of Telehealth for Family Therapy Through Systematic, Meta-analytic, and Qualitative Evidence
There is a current escalating need for telehealth (TH) options in family mental health services. In the absence of replicated evidence, TH guidelines from peak bodies are largely based on assumptions of the effectiveness of TH methods. New investments in TH would optimally be based in evidence of clinical efficacy. To this end, we conducted three studies in which we (1) systematically reviewed eight professional guidelines for TH family therapy, (2) examined replicated evidence for the efficacy of TH family therapy through systematic review of 20 studies and meta-analyses of 13 effects, and (3) synthesised clinical accommodations to TH methodology from a study of 12 experienced TH family therapists. The studies found (1) a predominant focus in existing TH guidelines on operational matters pertaining to TH and relative neglect of therapeutic process; (2) meta-analyses of efficacy for child behavioural problems (k = 8) and parental depression (k = 5) showed equivalent outcomes in TH and face-to-face therapy and enhanced outcomes in TH relative to treatment as usual, resource provision (i.e. written materials), or wait-list control. Narrative review of 20 studies for a range of relational and mental health outcomes aligned with these findings; and (3) therapists defined clear conditions for enhanced engagement and therapeutic process via TH and reflected on cautions and accommodations for purposes of rapport building and mitigating risk. Given moderate-strong evidence for the efficacy of TH methods of family therapy for a range of conditions, we offer recommendations for future implementation of TH for family therapy.
Journal Article