maudsley parents san diego conference, renee hoste and daniel le grange

Family-based treatment: Innovations and new directions

Renee Hoste, Ph.D.Assistant Professor of Psychiatry

Daniel Le Grange, Ph.D. Professor of Psychiatry

Anorexia NervosaAnorexia Nervosa

FBT = 1st line treatment

FBT = 1st line treatment

??

Where are we today after 25 years of research?

Where are we today after 25 years of research?

Young Adults with

AN

Young Adults with

AN

Bulimia Nervosa

Adolescent Overweight

Some signals in favor of FBT

and CBT

?

???

Adolescent Anorexia Nervosa(Lock & Le Grange, 2011)

Part 1

4

Family-Based Treatment for AN

Developed in London at the Maudsley Hospital (1980s), continued refinement there, the US, Canada, and Australia

First line treatment for medically stable children and adolescents with AN

Outpatient treatment to restore weight and return adolescent to developmental track

Team approach, i.e., parents, therapist, pediatrician and psychiatrist

Three Phases of FBT-AN

Anorexia NervosaAnorexia Nervosa

FBT = 1st line treatment

FBT = 1st line treatment

Non-responders?Non-responders?

Where are we today after 25 years of research for AN?

Where are we today after 25 years of research for AN?

Parent/Sibling Role?Parent/Sibling Role?

Role of Medication?Role of Medication?

More intensive FBTMore intensive FBT

MGFT, Reg FT, PFTMGFT, Reg FT, PFT

Olanzapine or other meds?Olanzapine or other meds?

Adolescent Bulimia Nervosa(Le Grange & Lock, 2007)

Part 2

Family-Based Treatment for BN

Adapted from AN treatment manual (Lock, Le Grange, et al., 2001)

Twenty sessions over six months

Concomitant management of medical and comorbidity needs

Three Phases of FBT-BN

Specific Challenges in FBT-BN

Developmental stage of BN adolescents

Secretiveness (shame and guilt) of BN

Bulimic symptoms can elicit criticism

Ego-dystonic nature of BN

Comorbidity and BN

Heterogeneity of BN

How is FBT different for BN?

Treatment is more collaborative (developmental stage + egodystonic)

Focus on bulimic symptoms can be a challenge (comorbidity)

Greater flexibility/creativity on the part of the therapist required (heterogeneity)

Emphasis on regulating food intake, and curtailing binge/purge behavior (secretiveness)

How is FBT different for BN?(continue)

Family meal in BN Help adolescent eat regular meal Include food that typically triggers

binge Explore adolescent’s feelings around

urges to binge and purge

FBT-Y for young adults with AN

Chicago Treatment Development(Le Grange & Chen)

Part 3

How does FBT-Y differ from FBT-AN?

Collaborative approach Family of choice Developmental issues Time with patient

Operational Mechanisms for FBT and FBT-Y

FBT-Young Adults

Case series (Chen, Le Grange et al., 2010)

Treatment development

Two iterations of 6 patients (N=12)

Open trial (N=20)

FBT for Pediatric Overweight

Chicago & Mt Sinai Treatment Development

(Loeb & Le Grange)

Part 4

Adolescent Anorexia Nervosa

Phase 1 Phase 2 Phase 3

Very underweight Healthy weight

All ages

Weight Status

ParentalControl

Very underweight Healthy weight

Pediatric Overweight

Child

Pre-Adolescent

Adolescent

WeightStatus

ParentControl

Overweight Healthy weight

Phase 1 Phase 2 Phase 3

Anorexia NervosaAnorexia Nervosa

FBT = 1st line treatment

FBT = 1st line treatment

Non-respondersNon-responders

Where are we today?Where are we today?

Young Adults with

AN

Young Adults with

AN

Bulimia Nervosa

Adolescent Overweight

Signals in favor of FBT and

CBT

Multi-Site Study

Treatment Dev Study

Treatment Dev StudyTreatment Dev Study

Parent/Sib RoleParent/Sib Role

MedicationMedication

Recruitment at Chicago

www.eatingdisorders.uchicago.edu

773-834-5677

legrange@uchicago.edu