James Lock1, Daniel Le Grange2, W Stewart Agras3, Kathleen Kara Fitzpatrick3, Booil Jo3, Erin Accurso2, Sarah Forsberg3, Kristen Anderson4, Kate Arnow3, Maya Stainer4. 1. Department of Psychiatry and Behavioral Sciences, University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA. Electronic address: jimlock@stanford.edu. 2. Department of Psychiatry, UCSF, USA. 3. Department of Psychiatry and Behavioral Sciences, University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA. 4. Department of Psychiatry& Behavioral Neuroscience, The University of Chicago, USA.
Abstract
OBJECTIVE:Adolescents with Anorexia Nervosa (AN), treated with family-based treatment (FBT) who fail to gain 2.3 kg by the fourth week of treatment have a 40-50% lower chance of recovery than those who do. Because of the high risk of developing enduring AN, improving outcomes in this group of poor responders is essential. This study examines the feasibility and effects of a novel adaptive treatment (i.e., Intensive Parental Coaching-IPC) aimed at enhancing parental self-efficacy related to re-feeding skills in poor early responders to FBT. METHOD: 45 adolescents (12-18 years of age) meeting DSM TR IV criteria for AN were randomized in an unbalanced design (10 to standard FBT; 35 to the adaptive arm). Attrition, suitability, expectancy rates, weight change, and psychopathology were compared between groups. OUTCOMES: There were no differences in rates of attrition, suitability, expectancy ratings, or most clinical outcomes between randomized groups. However, the group of poor early responders that received IPC achieved full weight restoration (>95% of expected mean BMI) by EOT at similar rates as those who had responded early. CONCLUSIONS: The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT. The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early. A sufficiently powered study is needed to confirm these promising findings.
RCT Entities:
OBJECTIVE: Adolescents with Anorexia Nervosa (AN), treated with family-based treatment (FBT) who fail to gain 2.3 kg by the fourth week of treatment have a 40-50% lower chance of recovery than those who do. Because of the high risk of developing enduring AN, improving outcomes in this group of poor responders is essential. This study examines the feasibility and effects of a novel adaptive treatment (i.e., Intensive Parental Coaching-IPC) aimed at enhancing parental self-efficacy related to re-feeding skills in poor early responders to FBT. METHOD: 45 adolescents (12-18 years of age) meeting DSM TR IV criteria for AN were randomized in an unbalanced design (10 to standard FBT; 35 to the adaptive arm). Attrition, suitability, expectancy rates, weight change, and psychopathology were compared between groups. OUTCOMES: There were no differences in rates of attrition, suitability, expectancy ratings, or most clinical outcomes between randomized groups. However, the group of poor early responders that received IPC achieved full weight restoration (>95% of expected mean BMI) by EOT at similar rates as those who had responded early. CONCLUSIONS: The results of this study suggest that it is feasible to use an adaptive design to study the treatment effect of IPC for those who do not gain adequate weight by session 4 of FBT. The results also suggest that using IPC for poor early responders significantly improves weight recovery rates to levels comparable to those who respond early. A sufficiently powered study is needed to confirm these promising findings.
Authors: James Lock; Harry Brandt; Blake Woodside; Stewart Agras; W Katherine Halmi; Craig Johnson; Walter Kaye; Denise Wilfley Journal: Int J Eat Disord Date: 2011-04-14 Impact factor: 4.861
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Authors: Alison M Darcy; Susan W Bryson; W Stewart Agras; Kathleen Kara Fitzpatrick; Daniel Le Grange; James Lock Journal: Behav Res Ther Date: 2013-09-15
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Authors: Erin C Accurso; Ellen Astrachan-Fletcher; Setareh O'Brien; Susan F McClanahan; Daniel Le Grange Journal: Eat Disord Date: 2017-06-01 Impact factor: 3.222
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Authors: Kelsey E Hagan; Brittany E Matheson; Nandini Datta; Alexa M L'Insalata; Z Ayotola Onipede; Sasha Gorrell; Sangeeta Mondal; Cara M Bohon; Daniel Le Grange; James D Lock Journal: Psychol Med Date: 2021-05-06 Impact factor: 7.723