Behavioral Health - Main Line Center For Eating Disorders

Behavioral
Health

Family-Based Treatment

Family-based treatment (FBT) is considered the gold standard outpatient treatment and is the recommended first line treatment for medically stable children and adolescents with eating disorders. Compared to individual treatment, children and adolescents who engage in FBT are more likely to achieve full recovery, avoid hospitalization and have a reduced risk of relapse.

The goal of FBT is to reverse medical and psychological complications associated with weight loss and malnutrition. Early and complete weight restoration via nutritional rehabilitation is the cornerstone of this treatment method. FBT aims to restore the child or adolescent to a healthful weight based on age, previous growth trends, and current and/or expected height. Because there is no conclusive agreement regarding the use of medication for the treatment of AN, food remains the most successful “medicine” for its treatment. Once total weight restoration has been achieved, cognitive and emotional issues can be addressed.

Family-based treatment is intended to be a short term treatment, typically lasting 9 to 12 months. Treatment consists of three phases. Phase I involves rapid and complete weight restoration. Physical activities are limited and parents are completely responsible for all meals and snacks, while the child’s only responsibilities are eating and resting. Phase II slowly transitions age-appropriate responsibility back to the adolescent, and Phase III addresses any remaining issues that may interfere with achievement and maintenance of recovery.

FBT considers parents (who are the true experts on their child) an essential component of the multidisciplinary treatment team. Therapists serve as supportive consultants to parents. Supervision by a physician is essential to ensure medical stability. Registered dietitians can often offer helpful adjunctive support.

5 Key Tenets of FBT

Agnostic view of the illness

Family-based Treatment does not focus on why someone has developed an eating disorder because there is NO one answer and we don’t need to know WHY in order to engage in successful treatment. Eating disorders often occur as the result of a “perfect storm” of genetic vulnerabilities and psychosocial and environmental stressors. Someone may intentionally lose weight and develop an eating disorder

Parent empowerment

Therapist as consultant

Externalize the illness

Pragmatic approach to treatment

Cognitive-Behavioral Therapy-Enhanced

Cognitive-Behavioral Therapy-Enhanced (CBT-E) is the leading, evidence-based treatment for young adults and adults with bulimia nervosa, binge eating disorder, and anorexia nervosa. CBT-E is short-term, goal-oriented, individual treatment designed to stabilize and structure eating behaviors and weight, and subsequently target current factors contributing to the onset and maintenance of disordered eating (i.e., perfectionism, low self-esteem, the importance of one’s weight/shape to one’s self-esteem and self-evaluation). Treatment is collaborative, with clients taking an active role in their recovery and the treatment planning process.

Cognitive Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder

Cognitive-Behavioral Therapy for Avoidant Restrictive Food Intake Disorder (CBT-AR) is a goal-oriented, structured approach designed to treat children, adolescents, and adults with avoidant/restrictive food intake disorder (ARFID). Treatment may be delivered in individual or family-involved formats depending on the client’s age, presentation, and circumstances. CBT-AR assists individuals in achieving/maintaining an appropriate weight (and when indicated, continued age appropriate growth), correcting nutritional deficiencies, increasing food flexibility and variety, and social eating. CBT-AR focuses on current factors maintaining selective eating and subsequent consequences, which may include sensory sensitivity, a fear of aversive outcomes of eating, and low appetite. Treatment is short-term, collaborative and individualized to the client and their specific symptom presentation, needs, and goals.

Multi-family Groups

To overcome the illness-related isolation of the family
To take on responsibility for managing the illness-specific symptoms and everyday situations.
To connect with other parents/guardians to share experiences and strategies.
To improve intra-familial conflict management.
To strengthen parental/caregiver bonds with children and develop conciliation skills.
To change problematic interactions and relationship patterns around their child's eating.
To highlight personal psychological issues if these affect the child's specific problems adversely.