Stephanie Jacobs1,2, Lauren Muhlheim3, Renee D Rienecke4,5. 1. Private Practice, New York, NY, USA. 2. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA. 3. Private Practice, Los Angeles, CA, USA. 4. Eating Recovery Center and Pathlight Mood and Anxiety Centers, 333 N. Michigan Avenue, Ste. 1900, Chicago, IL, 60601, USA. renee.rienecke@ercpathlight.com. 5. Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA. renee.rienecke@ercpathlight.com.
Abstract
PURPOSE: In manualized family-based treatment (FBT) for eating disorders, phase 1 of the 3-phase treatment-during which parents are put in control of eating-related issues-is perhaps the most critical phase, and is comprehensively addressed in the manual. Phase 2, during which control over eating is gradually returned to the patient, is more variable and the manual dedicates less space to this phase. The purpose of the current exploratory study was to assess Phase 2 practices of clinicians providing FBT and to compare these practices to the guidance offered in the manual. METHODS: In the current study, a survey assessing Phase 2 practices was sent to clinicians. Twenty-seven providers responded. Two providers reported that they did not provide FBT in an outpatient setting. One reported not currently providing outpatient FBT but had in the past. The remaining providers were currently providing FBT in an outpatient setting. RESULTS: No items addressing the core interventions of Phase 2, including encouraging age-appropriate independent eating, were endorsed by 100% of respondents as being addressed 100% of the time in Phase 2. CONCLUSION: Responses reflected some adherence to the manual, along with examples of therapist drift and incorporation of therapeutic interventions that are not described in the FBT manual. Adherence to manualized treatments may improve outcome for some patients, while allowing for flexibility to address clinical situations that are not addressed in the manual. LEVEL OF EVIDENCE: V. Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
PURPOSE: In manualized family-based treatment (FBT) for eating disorders, phase 1 of the 3-phase treatment-during which parents are put in control of eating-related issues-is perhaps the most critical phase, and is comprehensively addressed in the manual. Phase 2, during which control over eating is gradually returned to the patient, is more variable and the manual dedicates less space to this phase. The purpose of the current exploratory study was to assess Phase 2 practices of clinicians providing FBT and to compare these practices to the guidance offered in the manual. METHODS: In the current study, a survey assessing Phase 2 practices was sent to clinicians. Twenty-seven providers responded. Two providers reported that they did not provide FBT in an outpatient setting. One reported not currently providing outpatient FBT but had in the past. The remaining providers were currently providing FBT in an outpatient setting. RESULTS: No items addressing the core interventions of Phase 2, including encouraging age-appropriate independent eating, were endorsed by 100% of respondents as being addressed 100% of the time in Phase 2. CONCLUSION: Responses reflected some adherence to the manual, along with examples of therapist drift and incorporation of therapeutic interventions that are not described in the FBT manual. Adherence to manualized treatments may improve outcome for some patients, while allowing for flexibility to address clinical situations that are not addressed in the manual. LEVEL OF EVIDENCE: V. Opinions of respected authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.
Authors: Mandy Goldstein; Stuart B Murray; Scott Griffiths; Kathryn Rayner; Jessica Podkowka; Joel E Bateman; Andrew Wallis; Christopher E Thornton Journal: Int J Eat Disord Date: 2016-06-08 Impact factor: 4.861
Authors: Katharine L Loeb; B Timothy Walsh; James Lock; Daniel le Grange; Jennifer Jones; Sue Marcus; James Weaver; Ilyse Dobrow Journal: J Am Acad Child Adolesc Psychiatry Date: 2007-07 Impact factor: 8.829
Authors: Gina Dimitropoulos; James D Lock; William Stewart Agras; Harry Brandt; Katherine A Halmi; Booil Jo; Walter H Kaye; Leora Pinhas; Denise E Wilfley; D Blake Woodside Journal: Eur Eat Disord Rev Date: 2019-07-11