Pro’s and Con’s of Family-Based Treatment for Eating Disorders
Written by ‘Ai Pono Hawaii Staff Writer
Eating disorders affect people of all ages, devastatingly, including children and teens. When a parent or caretaker has an adolescent struggling with an eating disorder, they often feel overwhelmed deciding what course of action and treatment is best suited for their child and family. While the support and involvement of parents is highly recommended, the level of involvement may differ depending on the treatment course taken. One option that may be considered is “Family-Based Treatment”, sometimes called “FBT” or known as “The Maudsley Approach.”
In this article we will cover:
What Family-Based Treatment is
The different phases of FBT
The pros & cons of FBT to help you determine if it is a good fit for your loved one
What is “Family-Based Treatment”
In simple terms, FBT is evidenced-based psychotherapy for adolescents with eating disorders, originally mainly anorexia nervosa, that puts the patient's parents at the forefront of the battle with the illness and encourages the entire family, including siblings, to be a part of the recovery journey. FBT is a manualized treatment delivered by trained professionals in an outpatient setting. The FBT approach is rooted in aspects of behavioral therapy, narrative therapy, and structural family therapy
Treatment involves three different phases:
Weight Restoration
Returning control over eating to adolescent
Establishing healthy adolescent identity
In phase one, the main focus is on nourishing the patient by having the parents take control of the child's eating and exercise. Meals will be prepared and supervised by parents during this phase.
In phase two, control is gradually reestablished to the child. This may mean having a meal unsupervised at school or going out to dinner with friends or relatives outside of the immediate family involved in the FBT process.
In phase three, the goal is to transition from solely eating disorder focus to a general adolescent parental-child relationship where developmentally appropriate struggles and growth.
As with any eating disorder treatment approach, there are always different advantages and disadvantages to consider. Choosing the best modality and team for your loved one and family is an important decision.
Advantages of FBT in treating eating disorders
Research finds FBT to be effective in treating Anorexia Nervosa
In one study, Family-Based Treatment showed that approximately two-thirds of adolescents with anorexia nervosa recovered at the end of FBT treatment and 75-90% maintained full weight recovery at five years following treatment. In addition to physical recovery, they also demonstrated similar progress in terms of psychological factors. FBT appears to be most effective for families in which the length of illness is less than three years. An early positive response to the treatment (commonly by week four) is prognostic of a long-term successful outcome.
Cost-effective alternative
While higher levels of care such as intensive outpatient, residential or inpatient programming may be helpful, many families struggle to afford or access these programs both with or without insurance. FBT can be an effective method to support your loved one on the recovery journey if medically appropriate.
Treats eating disorder as an illness
In FBT, the eating disorder is treated as a condition in which food is the medicine. Inadvertently this also allows for the family to accept that eating disorders are not caused by one sole thing, especially the family itself. In fact, genetic studies indicate that approximately 50% to 80% of a person's risk of an eating disorder is due to genetic factors.
Addresses eating disorder immediately
Many people with eating disorders, no matter their age, will struggle with a lack of awareness that one is ill. This is called anosognosia and is often caused by brain starvation. This consequently can cause a lack of motivation or insight to maintain recovery. In FBT, waiting for motivation and to take actions on their own is taken off the table and efforts to recover are addressed immediately.
Lessens eating disorder impact on health
FBT assigns the work of behavioral change and full nutrition to the parents and gives them skills and coaching to meet these goals. As a result, it helps the child to recover even before they have the capacity to do so on their own.Because it tends to work faster than other treatments, FBT reduces medical repercussions and increases the chances of a complete recovery.
Possible drawbacks of utilizing FBT in treating eating disorders
It is not evidenced-based for all eating disorders
While evidence shows FBT is effective for adolescents under 19 years old, there is limited studies or research to see its impact on treatment for bulimia nervosa, avoidant/restrictive food intake disorder (ARFID), binge eating disorder or other unspecified eating disorders. The FBT model can be modified and clients may succeed in recovery no matter what behaviors are being engaged in, but it is best to consult an FBT professional to help you determine if this modality is appropriate for your family.
Nutritional guidance from a dietitian is not a part of the FBT model
In traditional treatment plans, the involvement of an eating disorder dietitian is usually recommended or required. This allows for nutritional guidance and a space to address and unlearn food rules created by the eating disorder. In FBT, the parents are relied on to make nutrition choices. While parents can consult an eating disorder dietitian, it is not necessary or recommended. If there is already a rigid or disordered eating happening within the family unit, this can be particularly unhelpful in establishing a neutral relationship with food.
Family sessions vs individual sessions
In FBT, the entire family meets with the FBT trained therapist to address concerns and discuss progress. While in most treatment programs family sessions are an important part of the recovery process, FBT mainly focuses on family sessions without any individual processing. While this may not be an issue for some adolescents, for others, having the space and time to process and talk alone with a therapist can be a critical step to owning recovery, acknowledging frustrations about recovery, and identifying underlying issues.
Supervision of all meals
While higher levels of care also may disrupt school for children, FBT does take a high level of coordination and supervision from the parents to prepare and monitor all meals. Children may need to stay home from school during the initial stage of treatment and parents may need to coordinate working from home or taking a leave of absence. Once the child transitions back to school, a trusted counselor, nurse or teacher may need to be available to supervise lunch. In a residential, inpatient, or outpatient setting, meals and snacks are monitored by trained professionals which can be a positive benefit for both the child and family.
Underlying conditions and contributing factors
In FBT, the approach is agnostic, meaning therapists do not try to analyze why the eating disorder developed and the focus is on avoiding higher levels of care. While this may be a suitable option for some, in certain cases addressing underlying conditions and contributing factors may be incredibly important especially if the family dynamic is contributing to the use of behaviors or there are co-occurring mood disorders such as depression or bipolar disorder or maladaptive behaviors that need to be addressed.
No matter what treatment approach you decide is right for you and your family, playing a role in the recovery of your loved ones can be a challenging but rewarding experience.
Here are additional resources that may be helpful for you and your family:
If you would like to learn more about residential treatment programs or alternative treatment options, our team at ‘Ai Pono would be happy to answer your questions. Learn more about our holistic programs by reaching out to us today.