CBT-E

Family-Based Therapy for Anorexia Nervosa

Having just returned from the 2-day training on FBT-AN, I thought now would be a good time to write a bit about this treatment. Originally developed at the Maudsley Hospital in London, Family-Based Therapy for Anorexia Nervosa (FBT-AN) is considered a first-line treatment for adolescents with AN. Some people find the treatment controversial and the topic certainly generates intense discussion among researchers and providers. However, I think that what makes it controversial is also what makes it so effective. The basic premise of FBT-AN is that inpatient hospitalization is traumatic, disruptive and has not proven to be very effective in treating AN over the long-term. It also makes the argument that most current treatment approaches disempower parents by removing them from the re-feeding process. The approach that FBT takes is that parents should be responsible for re-feeding their child, and the entire family should be involved in the treatment process. It is well documented in research literature that it is critical to achieve weight restoration as quickly as possible to reduce the risk of the illness becoming chronic. Furthermore, because cognition is severely impaired when an individual is dangerously underweight, traditional insight-oriented therapy is of no use. Cognitive difficulties and other symptoms that accompany low-weight anorexia (obsessionality, anxiety, depression) typically resolve once weight is restored. The underlying message in FBT-AN is “food is the medicine” and until the child is weight-restored and able to handle the responsibility of eating, it is up to the parents to ensure that this occurs. FBT also takes an agnostic view of AN; it does not delve into what might have caused the illness but rather on ensuring the child gets weight-restored as quickly as possible. The therapist is the expert consultant, always guiding and refocusing the family on the task at hand.

It should be noted here that FBT-AN is not a self-help approach, and parents should never attempt to implement the treatment without a qualified FBT therapist. Anorexia Nervosa is a serious illness with the highest mortality rate of any psychiatric disorder and required qualified medical and mental health providers to be effectively treated. FBT also recognizes that there are times when hospitalization is necessary due to acute medical risks and suicidality. To learn more about FBT-AN, please visit maudsleyparents.org. The developers of FBT also maintain a list of certified FBT therapists.

As with any new treatment approach that challenges current thinking, FBT has generated much discussion and debate regarding the approach and its effectiveness. Having had the opportunity to hear Daniel Le Grange discuss FBT-AN in comparison to CBT-E with Chris Fairburn at ICED 2013, and then to attend the intensive training, it is clear that no one is suggesting that FBT-AN is the only treatment option. However, with remission rates as high as 60% and long-term follow-up showing similar rates, the evidence indicates that is extremely effective for many individuals, and should be a first-line treatment for adolescents with AN.

If you or a loved one is suffering from an eating disorder and needs treatment, please contact Ascent Counseling today to schedule your initial consultation phone call.