Family Based Therapy for Eating Disorders

6 days ago
3 min read

By Ben Segal

Maudsley Family Based Therapy for eating disorders

The Maudsley Model of family-based treatment (FBT) is an evidence-based therapy for children and adolescents with eating disorders (ED) initially developed in London during the 1980s. Currently FBT is acknowledged worldwide as a first-line therapy for young people with EDs. Additionally, the Royal Australian and New Zealand College of Psychiatrists and the Australia and New Zealand Academy for Eating Disorders have indicated FBT is an effective treatment for children and adolescents struggling with EDs.

FBT Research

Research supports the use of FBT, with studies (Datta et al., 2022; Lock, 2015) indicating it is a gold-standard approach for supporting people younger than 19. Furthermore, studies have reported that over 80% of young people complete FBT and that treatment satisfaction rates are as high as 78%.

Additionally, research suggests that FBT supports faster weight restoration compared to individual therapy treatments (such as CBT-E). Efficient weight restoration is important in adolescent ED treatment because young people are more impacted by starvation syndrome.

Starvation Syndrome

The term starvation syndrome describes the physical and psychological consequences that inadequate eating causes. These may include increased anxiety, impaired concentration, decreased heart rate and blood pressure, social withdrawal, intensification of obsessive thinking, and in severe cases mortality.

As the brains and bodies of adolescents and children with EDs have not yet completed all developmental milestones, they are more vulnerable to starvation syndrome. This means that compared to an adult, young people with starvation syndrome will experience more impairment. As a result, adolescents with EDs may struggle with individual therapy approaches that require them to independently work towards recovery on their own. The added difficulty of individual therapy increases the risk of young people becoming so affected by starvation syndrome they require hospitalisation.

FBT addresses these risks by passing responsibility from the young person to the parents. Instead of requiring adolescents to handle therapy tasks by themselves, their parents support them by taking control over food and eating. This relieves the burden of responsibility from the child, decreasing distress and enhancing the speed of ED recovery.

What does FBT involve?

FBT has three phases:

Weight Restoration (10-12 weekly sessions): After an initial assessment, parents receive clinician coaching focused on learning practical problem-solving strategies used to contain the ED. This assists the family in creating an effective weight restoration plan to address starvation syndrome.
Transitioning Control (6-8 fortnightly sessions): FBT proceeds to phase two after fulfilling several criteria, which include a successful weight restoration and reduction in ED symptoms. At this stage the young person is no longer as impacted by starvation syndrome. Consequently, the goal of treatment shifts to assisting the child in reasserting age-appropriate control over food and eating. This transition is made in a collaborative and methodological manner to reduce the risk of ED symptom lapse or relapse.
Return to Normal (2-4 sessions 4-6 weeks apart): In the final phase of FBT, the family is supported in relaxing and refocusing on their lives. Any adolescent challenges that remain after addressing the ED may be examined if needed. Additionally, a long-term relapse/lapse prevention plan is developed to assist the family in maintaining recovery.

How are sessions structured?

After an initial assessment, sessions will involve your clinician checking in with the young person for 5-10 minutes, after which 40-45 minutes are spent with the family. As adolescent EDs impact the whole household, effective FBT requires the attendance of all parents and siblings living in the home. If you have any questions or concerns about this aspect of FBT, please discuss this with your clinician.

Resources:

References:

Lock, J. (2015). An update on evidence-based psychosocial treatments for eating disorders in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 44(5), 707–721. https://doi.org/10.1080/15374416.2014.971458

Datta, N., Matheson, B. E., Citron, K., Van Wye, E. M., & Lock, J. D. (2022). Evidence based update on psychosocial treatments for eating disorders in children and adolescents. Journal of Clinical Child & Adolescent Psychology, 52(2), 1–12. https://doi.org/10.1080/15374416.2022.2109650