Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder: a non-randomized effectiveness trial

Daniel Le Grange; Sarah Eckhardt; Riccardo Dalle Grave; Ross D. Crosby; Carol B. Peterson; Helene Keery; Julie Lesser; Carolyn Martell

doi:10.1017/S0033291720004407

Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder: a non-randomized effectiveness trial

Daniel Le Grange, Sarah Eckhardt, Riccardo Dalle Grave, Ross D. Crosby, Carol B. Peterson, Helene Keery, Julie Lesser, Carolyn Martell

Psychiatry & Behavioral Sciences

Research output: Contribution to journal › Article › peer-review

33 Scopus citations

Abstract

Background. Family-based treatment (FBT) is an efficacious intervention for adolescents with an eating disorder. Evaluated to a lesser degree among adolescents, enhanced cognitive-behavior therapy (CBT-E) has shown promising results. This study compared the relative effectiveness of FBT and CBT-E, and as per manualized CBT-E, the sample was divided into a lower weight [<90% median body mass index (mBMI)], and higher weight cohort (≥90%mBMI). Method. Participants (N = 97) aged 12-18 years, with a DSM-5 eating disorder diagnosis (largely restrictive, excluding Avoidant Restrictive Food Intake Disorder), and their parents, chose between FBT and CBT-E. Assessments were administered at baseline, end-of-treatment (EOT), and follow-up (6 and 12 months). Treatment comprised of 20 sessions over 6 months, except for the lower weight cohort where CBT-E comprised 40 sessions over 9-12 months. Primary outcomes were slope of weight gain and change in Eating Disorder Examination (EDE) Global Score at EOT. Results. Slope of weight gain at EOT was significantly higher for FBT than for CBT-E (lower weight, est. = 0.597, S.E. = 0.096, p < 0.001; higher weight, est. = 0.495, S.E. = 0.83, p < 0.001), but not at follow-up. There were no differences in the EDE Global Score or most secondary outcome measures at any time-point. Several baseline variables emerged as potential treatment effect moderators at EOT. Choosing between FBT and CBT-E resulted in older and less well participants opting for CBT-E. Conclusions. Results underscore the efficiency of FBT to facilitate weight gain among underweight adolescents. FBT and CBT-E achieved similar outcomes in other domains assessed, making CBT-E a viable treatment for adolescents with an eating disorder.

Original language	English (US)
Pages (from-to)	2520-2530
Number of pages	11
Journal	Psychological medicine
Volume	52
Issue number	13
DOIs	https://doi.org/10.1017/S0033291720004407
State	Published - Oct 3 2022

Bibliographical note

Funding Information:
We would like to thank Christopher Fairburn, MD, and James Lock, MD, PhD, for their earlier support to CTED in providing therapy training prior to the onset of this study. We acknowledge the generous financial support from the Goven Family Foundation, who made it possible to conduct this effectiveness study.

Publisher Copyright:
© The Author(s), 2020. Published by Cambridge University Press.

Keywords

Enhanced cognitive-behavior therapy
family-based treatment
restrictive eating disorders
treatment effectiveness

PubMed: MeSH publication types

Journal Article

Access

10.1017/S0033291720004407

OpenUrl availability

Full text

Cite this

@article{39ed9237ffaa42d9aba6a05c1f1a4f35,

title = "Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder: a non-randomized effectiveness trial",

abstract = "Background. Family-based treatment (FBT) is an efficacious intervention for adolescents with an eating disorder. Evaluated to a lesser degree among adolescents, enhanced cognitive-behavior therapy (CBT-E) has shown promising results. This study compared the relative effectiveness of FBT and CBT-E, and as per manualized CBT-E, the sample was divided into a lower weight [<90% median body mass index (mBMI)], and higher weight cohort (≥90%mBMI). Method. Participants (N = 97) aged 12-18 years, with a DSM-5 eating disorder diagnosis (largely restrictive, excluding Avoidant Restrictive Food Intake Disorder), and their parents, chose between FBT and CBT-E. Assessments were administered at baseline, end-of-treatment (EOT), and follow-up (6 and 12 months). Treatment comprised of 20 sessions over 6 months, except for the lower weight cohort where CBT-E comprised 40 sessions over 9-12 months. Primary outcomes were slope of weight gain and change in Eating Disorder Examination (EDE) Global Score at EOT. Results. Slope of weight gain at EOT was significantly higher for FBT than for CBT-E (lower weight, est. = 0.597, S.E. = 0.096, p < 0.001; higher weight, est. = 0.495, S.E. = 0.83, p < 0.001), but not at follow-up. There were no differences in the EDE Global Score or most secondary outcome measures at any time-point. Several baseline variables emerged as potential treatment effect moderators at EOT. Choosing between FBT and CBT-E resulted in older and less well participants opting for CBT-E. Conclusions. Results underscore the efficiency of FBT to facilitate weight gain among underweight adolescents. FBT and CBT-E achieved similar outcomes in other domains assessed, making CBT-E a viable treatment for adolescents with an eating disorder.",

keywords = "Enhanced cognitive-behavior therapy, family-based treatment, restrictive eating disorders, treatment effectiveness",

author = "{Le Grange}, Daniel and Sarah Eckhardt and {Dalle Grave}, Riccardo and Crosby, {Ross D.} and Peterson, {Carol B.} and Helene Keery and Julie Lesser and Carolyn Martell",

note = "Funding Information: We would like to thank Christopher Fairburn, MD, and James Lock, MD, PhD, for their earlier support to CTED in providing therapy training prior to the onset of this study. We acknowledge the generous financial support from the Goven Family Foundation, who made it possible to conduct this effectiveness study. Publisher Copyright: {\textcopyright} The Author(s), 2020. Published by Cambridge University Press.",

year = "2022",

month = oct,

day = "3",

doi = "10.1017/S0033291720004407",

language = "English (US)",

volume = "52",

pages = "2520--2530",

journal = "Psychological medicine",

issn = "0033-2917",

publisher = "Cambridge University Press",

number = "13",

}

TY - JOUR

T1 - Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder

T2 - a non-randomized effectiveness trial

AU - Le Grange, Daniel

AU - Eckhardt, Sarah

AU - Dalle Grave, Riccardo

AU - Crosby, Ross D.

AU - Peterson, Carol B.

AU - Keery, Helene

AU - Lesser, Julie

AU - Martell, Carolyn

N1 - Funding Information: We would like to thank Christopher Fairburn, MD, and James Lock, MD, PhD, for their earlier support to CTED in providing therapy training prior to the onset of this study. We acknowledge the generous financial support from the Goven Family Foundation, who made it possible to conduct this effectiveness study. Publisher Copyright: © The Author(s), 2020. Published by Cambridge University Press.

PY - 2022/10/3

Y1 - 2022/10/3

N2 - Background. Family-based treatment (FBT) is an efficacious intervention for adolescents with an eating disorder. Evaluated to a lesser degree among adolescents, enhanced cognitive-behavior therapy (CBT-E) has shown promising results. This study compared the relative effectiveness of FBT and CBT-E, and as per manualized CBT-E, the sample was divided into a lower weight [<90% median body mass index (mBMI)], and higher weight cohort (≥90%mBMI). Method. Participants (N = 97) aged 12-18 years, with a DSM-5 eating disorder diagnosis (largely restrictive, excluding Avoidant Restrictive Food Intake Disorder), and their parents, chose between FBT and CBT-E. Assessments were administered at baseline, end-of-treatment (EOT), and follow-up (6 and 12 months). Treatment comprised of 20 sessions over 6 months, except for the lower weight cohort where CBT-E comprised 40 sessions over 9-12 months. Primary outcomes were slope of weight gain and change in Eating Disorder Examination (EDE) Global Score at EOT. Results. Slope of weight gain at EOT was significantly higher for FBT than for CBT-E (lower weight, est. = 0.597, S.E. = 0.096, p < 0.001; higher weight, est. = 0.495, S.E. = 0.83, p < 0.001), but not at follow-up. There were no differences in the EDE Global Score or most secondary outcome measures at any time-point. Several baseline variables emerged as potential treatment effect moderators at EOT. Choosing between FBT and CBT-E resulted in older and less well participants opting for CBT-E. Conclusions. Results underscore the efficiency of FBT to facilitate weight gain among underweight adolescents. FBT and CBT-E achieved similar outcomes in other domains assessed, making CBT-E a viable treatment for adolescents with an eating disorder.

AB - Background. Family-based treatment (FBT) is an efficacious intervention for adolescents with an eating disorder. Evaluated to a lesser degree among adolescents, enhanced cognitive-behavior therapy (CBT-E) has shown promising results. This study compared the relative effectiveness of FBT and CBT-E, and as per manualized CBT-E, the sample was divided into a lower weight [<90% median body mass index (mBMI)], and higher weight cohort (≥90%mBMI). Method. Participants (N = 97) aged 12-18 years, with a DSM-5 eating disorder diagnosis (largely restrictive, excluding Avoidant Restrictive Food Intake Disorder), and their parents, chose between FBT and CBT-E. Assessments were administered at baseline, end-of-treatment (EOT), and follow-up (6 and 12 months). Treatment comprised of 20 sessions over 6 months, except for the lower weight cohort where CBT-E comprised 40 sessions over 9-12 months. Primary outcomes were slope of weight gain and change in Eating Disorder Examination (EDE) Global Score at EOT. Results. Slope of weight gain at EOT was significantly higher for FBT than for CBT-E (lower weight, est. = 0.597, S.E. = 0.096, p < 0.001; higher weight, est. = 0.495, S.E. = 0.83, p < 0.001), but not at follow-up. There were no differences in the EDE Global Score or most secondary outcome measures at any time-point. Several baseline variables emerged as potential treatment effect moderators at EOT. Choosing between FBT and CBT-E resulted in older and less well participants opting for CBT-E. Conclusions. Results underscore the efficiency of FBT to facilitate weight gain among underweight adolescents. FBT and CBT-E achieved similar outcomes in other domains assessed, making CBT-E a viable treatment for adolescents with an eating disorder.

KW - Enhanced cognitive-behavior therapy

KW - family-based treatment

KW - restrictive eating disorders

KW - treatment effectiveness

UR - http://www.scopus.com/inward/record.url?scp=85097243124&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85097243124&partnerID=8YFLogxK

U2 - 10.1017/S0033291720004407

DO - 10.1017/S0033291720004407

M3 - Article

C2 - 33267919

AN - SCOPUS:85097243124

SN - 0033-2917

VL - 52

SP - 2520

EP - 2530

JO - Psychological medicine

JF - Psychological medicine

IS - 13

ER -

Enhanced cognitive-behavior therapy and family-based treatment for adolescents with an eating disorder: a non-randomized effectiveness trial

Abstract

Bibliographical note

Keywords

PubMed: MeSH publication types

Access

OpenUrl availability

Other files and links

Fingerprint

Cite this