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. 2019 May 1;5(5):CD004780.
doi: 10.1002/14651858.CD004780.pub4.

Family therapy approaches for anorexia nervosa

Caroline A Fisher  1 , Sonja Skocic, Kathleen A Rutherford, Sarah E Hetrick
Affiliations

Family therapy approaches for anorexia nervosa

Caroline A Fisher et al. Cochrane Database Syst Rev. .

Abstract

Background: Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010.

Objectives: To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN.

Search methods: We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016.

Selection criteria: Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa.

Data collection and analysis: Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures.

Main results: We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I2 = 37%) and at long-term follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up.

Authors' conclusions: There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or other psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted trials.

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Conflict of interest statement

Caroline Fisher: None known; Sonja Skocic: None known; Katheleen Rutherford: None known; Sarah Hetrick: None known.

Figures

1
1
Study flow diagram (from searches conducted to April 2016).
2
2
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1 Family therapy approaches vs standard care/treatment as usual, Outcome 1 Remission post‐intervention.
1.2
1.2. Analysis
Comparison 1 Family therapy approaches vs standard care/treatment as usual, Outcome 2 Remission long‐term follow‐up.
1.3
1.3. Analysis
Comparison 1 Family therapy approaches vs standard care/treatment as usual, Outcome 3 General Functioning.
1.4
1.4. Analysis
Comparison 1 Family therapy approaches vs standard care/treatment as usual, Outcome 4 Dropouts during therapy.
1.5
1.5. Analysis
Comparison 1 Family therapy approaches vs standard care/treatment as usual, Outcome 5 Eating disorder psychopathology post‐intervention.
1.6
1.6. Analysis
Comparison 1 Family therapy approaches vs standard care/treatment as usual, Outcome 6 Weight (BMI).
1.7
1.7. Analysis
Comparison 1 Family therapy approaches vs standard care/treatment as usual, Outcome 7 Relapse during treatment.
2.1
2.1. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 1 Remission post‐intervention.
2.2
2.2. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 2 Remission short‐term follow‐up.
2.3
2.3. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 3 Remission long‐term follow‐up.
2.4
2.4. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 4 Dropouts during treatment.
2.5
2.5. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 5 Eating disorder psychopathology post‐intervention.
2.6
2.6. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 6 Eating disorder psychopathology short‐term follow‐up.
2.7
2.7. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 7 Eating disorder psychopathology long‐term follow‐up.
2.8
2.8. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 8 Weight (BMI, BMI%ile, %ABW) post‐intervention.
2.9
2.9. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 9 Weight (BMI%ile) short‐term follow‐up.
2.10
2.10. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 10 Weight (BMI, BMI%ile, %ABW) long‐term follow‐up.
2.11
2.11. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 11 Relapse during treatment.
2.12
2.12. Analysis
Comparison 2 Family therapy approaches vs psychological interventions, Outcome 12 Relapse long‐term follow‐up.
3.1
3.1. Analysis
Comparison 3 Family therapy approaches vs educational interventions, Outcome 1 Remission long‐term follow‐up.
4.1
4.1. Analysis
Comparison 4 Family therapy approaches short‐term vs family therapy approaches long‐term, Outcome 1 Remission long‐term follow‐up (mean 3.96 years).
4.2
4.2. Analysis
Comparison 4 Family therapy approaches short‐term vs family therapy approaches long‐term, Outcome 2 Return to functioning (school or work) follow‐up.
4.3
4.3. Analysis
Comparison 4 Family therapy approaches short‐term vs family therapy approaches long‐term, Outcome 3 Dropouts during therapy.
4.4
4.4. Analysis
Comparison 4 Family therapy approaches short‐term vs family therapy approaches long‐term, Outcome 4 Eating disorder psychopathology long‐term follow‐up (EDE) note large dropout.
4.5
4.5. Analysis
Comparison 4 Family therapy approaches short‐term vs family therapy approaches long‐term, Outcome 5 Weight (BMI) post‐intervention.
4.6
4.6. Analysis
Comparison 4 Family therapy approaches short‐term vs family therapy approaches long‐term, Outcome 6 Weight (BMI) follow‐up.
4.7
4.7. Analysis
Comparison 4 Family therapy approaches short‐term vs family therapy approaches long‐term, Outcome 7 Relapse during treatment.
5.1
5.1. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 1 Remission post‐intervention.
5.2
5.2. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 2 Remission short‐term follow‐up.
5.3
5.3. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 3 Remission long‐term follow‐up.
5.4
5.4. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 4 Dropouts during therapy.
5.5
5.5. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 5 Dropouts during follow‐up (5 years).
5.6
5.6. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 6 Eating disorder psychopathology post‐intervention (EAT).
5.7
5.7. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 7 Eating disorder psychopathology follow‐up (EAT).
5.8
5.8. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 8 Eating disorder psychopathology post‐intervention (MR).
5.9
5.9. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 9 Eating disorder psychopathology post‐intervention (EDI).
5.10
5.10. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 10 Eating disorder psychopathology follow‐up (EDI).
5.11
5.11. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 11 Eating disorder psychopathology post‐intervention (EDE).
5.12
5.12. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 12 Eating disorder psychopathology short‐term follow‐up (EDE).
5.13
5.13. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 13 Eating disorder psychopathology long‐term follow‐up (EDE).
5.14
5.14. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 14 Weight (%Median BMI) post‐intervention.
5.15
5.15. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 15 Weight (%Median BMI) short‐term follow‐up.
5.16
5.16. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 16 Weight (%Median BMI) long‐term follow‐up.
5.17
5.17. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 17 Weight (%ABW) post‐intervention.
5.18
5.18. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 18 Weight (%ABW) follow‐up (5 years).
5.19
5.19. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 19 Relapse post‐intervention.
5.20
5.20. Analysis
Comparison 5 Family therapy approaches conjoint vs family therapy approaches separated, Outcome 20 Relapse follow‐up (5 years).
6.1
6.1. Analysis
Comparison 6 Family therapy approaches vs family therapy approaches plus meal, Outcome 1 Remission post‐intervention.
6.2
6.2. Analysis
Comparison 6 Family therapy approaches vs family therapy approaches plus meal, Outcome 2 Remission short‐term follow‐up.
6.3
6.3. Analysis
Comparison 6 Family therapy approaches vs family therapy approaches plus meal, Outcome 3 Remission long‐term follow‐up.
6.4
6.4. Analysis
Comparison 6 Family therapy approaches vs family therapy approaches plus meal, Outcome 4 Family function post‐intervention Family Health Scale.
6.5
6.5. Analysis
Comparison 6 Family therapy approaches vs family therapy approaches plus meal, Outcome 5 Dropouts.
6.6
6.6. Analysis
Comparison 6 Family therapy approaches vs family therapy approaches plus meal, Outcome 6 Eating disorder psychopathology post‐intervention (MR).
6.7
6.7. Analysis
Comparison 6 Family therapy approaches vs family therapy approaches plus meal, Outcome 7 Eating disorder psychopathology short‐term follow‐up (MR).
6.8
6.8. Analysis
Comparison 6 Family therapy approaches vs family therapy approaches plus meal, Outcome 8 Eating disorder psychopathology long‐term follow‐up (MR).
6.9
6.9. Analysis
Comparison 6 Family therapy approaches vs family therapy approaches plus meal, Outcome 9 Weight (BMI, EBW%) post‐intervention.
6.10
6.10. Analysis
Comparison 6 Family therapy approaches vs family therapy approaches plus meal, Outcome 10 Weight (EBW%) short‐term follow‐up.
6.11
6.11. Analysis
Comparison 6 Family therapy approaches vs family therapy approaches plus meal, Outcome 11 Weight (BMI) long‐term follow‐up.
7.1
7.1. Analysis
Comparison 7 Individual family therapy approaches vs group family therapy approaches, Outcome 1 Family function post‐intervention (carers' LEE).
7.2
7.2. Analysis
Comparison 7 Individual family therapy approaches vs group family therapy approaches, Outcome 2 Family function follow‐up (carers' LEE).
7.3
7.3. Analysis
Comparison 7 Individual family therapy approaches vs group family therapy approaches, Outcome 3 Dropouts.
7.4
7.4. Analysis
Comparison 7 Individual family therapy approaches vs group family therapy approaches, Outcome 4 Eating disorder psychopathology post‐intervention (SEED‐AN).
7.5
7.5. Analysis
Comparison 7 Individual family therapy approaches vs group family therapy approaches, Outcome 5 Eating disorder psychopathology follow‐up (SEED‐AN).
7.6
7.6. Analysis
Comparison 7 Individual family therapy approaches vs group family therapy approaches, Outcome 6 Weight (BMI) post‐intervention.
7.7
7.7. Analysis
Comparison 7 Individual family therapy approaches vs group family therapy approaches, Outcome 7 Weight (BMI) follow‐up.
8.1
8.1. Analysis
Comparison 8 Family‐based therapy vs systemic family therapy, Outcome 1 Remission post‐intervention.
8.2
8.2. Analysis
Comparison 8 Family‐based therapy vs systemic family therapy, Outcome 2 Remission short‐term follow‐up.
8.3
8.3. Analysis
Comparison 8 Family‐based therapy vs systemic family therapy, Outcome 3 Dropouts during therapy.
9.1
9.1. Analysis
Comparison 9 Inpatient family therapy approaches vs day‐patient family therapy approaches, Outcome 1 Remission short‐term follow‐up.
9.2
9.2. Analysis
Comparison 9 Inpatient family therapy approaches vs day‐patient family therapy approaches, Outcome 2 Dropouts.
9.3
9.3. Analysis
Comparison 9 Inpatient family therapy approaches vs day‐patient family therapy approaches, Outcome 3 Eating disorder psychopathology short‐term follow‐up (EDI).
9.4
9.4. Analysis
Comparison 9 Inpatient family therapy approaches vs day‐patient family therapy approaches, Outcome 4 Weight (%EBW) short‐term follow‐up.
9.5
9.5. Analysis
Comparison 9 Inpatient family therapy approaches vs day‐patient family therapy approaches, Outcome 5 Relapse at short‐term follow‐up.
10.1
10.1. Analysis
Comparison 10 Family‐based therapy vs family‐based therapy plus parent coaching, Outcome 1 Remission post‐intervention.
10.2
10.2. Analysis
Comparison 10 Family‐based therapy vs family‐based therapy plus parent coaching, Outcome 2 Dropouts.
10.3
10.3. Analysis
Comparison 10 Family‐based therapy vs family‐based therapy plus parent coaching, Outcome 3 Eating disorder psychopathology post‐intervention (EDE).
10.4
10.4. Analysis
Comparison 10 Family‐based therapy vs family‐based therapy plus parent coaching, Outcome 4 Weight (BMI) post‐intervention.
11.1
11.1. Analysis
Comparison 11 Family‐based therapy plus medical stabilisation vs family‐based therapy plus weight restoration, Outcome 1 Remission post‐intervention.
11.2
11.2. Analysis
Comparison 11 Family‐based therapy plus medical stabilisation vs family‐based therapy plus weight restoration, Outcome 2 Remission short‐term follow‐up.
11.3
11.3. Analysis
Comparison 11 Family‐based therapy plus medical stabilisation vs family‐based therapy plus weight restoration, Outcome 3 Remission long‐term follow‐up.
11.4
11.4. Analysis
Comparison 11 Family‐based therapy plus medical stabilisation vs family‐based therapy plus weight restoration, Outcome 4 Dropouts.
11.5
11.5. Analysis
Comparison 11 Family‐based therapy plus medical stabilisation vs family‐based therapy plus weight restoration, Outcome 5 Eating disorder psychopathology (EDE) long‐term follow‐up.
11.6
11.6. Analysis
Comparison 11 Family‐based therapy plus medical stabilisation vs family‐based therapy plus weight restoration, Outcome 6 Weight (%EBW change) long‐term follow‐up.
11.7
11.7. Analysis
Comparison 11 Family‐based therapy plus medical stabilisation vs family‐based therapy plus weight restoration, Outcome 7 Relapse at long‐term follow‐up.
12.1
12.1. Analysis
Comparison 12 Family‐based therapy vs family‐based therapy plus consultation, Outcome 1 Remission post‐intervention.
13.1
13.1. Analysis
Comparison 13 Family therapy approaches vs standard care/treatment as usual (subgroup by age), Outcome 1 Remission post‐intervention (subgroup by age).
13.2
13.2. Analysis
Comparison 13 Family therapy approaches vs standard care/treatment as usual (subgroup by age), Outcome 2 Remission long‐term follow‐up.
13.3
13.3. Analysis
Comparison 13 Family therapy approaches vs standard care/treatment as usual (subgroup by age), Outcome 3 General Functioning.
13.4
13.4. Analysis
Comparison 13 Family therapy approaches vs standard care/treatment as usual (subgroup by age), Outcome 4 Dropouts during therapy.
13.5
13.5. Analysis
Comparison 13 Family therapy approaches vs standard care/treatment as usual (subgroup by age), Outcome 5 Eating disorder psychopathology post‐intervention.
13.6
13.6. Analysis
Comparison 13 Family therapy approaches vs standard care/treatment as usual (subgroup by age), Outcome 6 Weight (BMI).
13.7
13.7. Analysis
Comparison 13 Family therapy approaches vs standard care/treatment as usual (subgroup by age), Outcome 7 Relapse during treatment.
14.1
14.1. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 1 Remission post‐intervention.
14.2
14.2. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 2 Remission short‐term follow‐up.
14.3
14.3. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 3 Remission long‐term follow‐up.
14.4
14.4. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 4 Dropouts during treatment.
14.5
14.5. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 5 Eating disorder psychopathology post‐intervention.
14.6
14.6. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 6 Eating disorder psychopathology short‐term follow‐up (Lock 2010‐EDE).
14.7
14.7. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 7 Eating disorder psychopathology long‐term follow‐up.
14.8
14.8. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 8 Weight (BMI, BMI%ile, %ABW) post‐intervention.
14.9
14.9. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 9 Weight (BMI%ile) short‐term follow‐up.
14.10
14.10. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 10 Weight (BMI, BMI%ile, %ABW) long‐term follow‐up.
14.11
14.11. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 11 Relapse during treatment.
14.12
14.12. Analysis
Comparison 14 Family therapy approaches vs psychological interventions (sugroup by age), Outcome 12 Relapse long‐term follow‐up.
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    1. Grange D, Hughes EK, Court A, Yeo M, Crosby RD, Sawyer SM. Randomized clinical trial of parent‐focused treatment and family‐based treatment for adolescent anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry 2016;55(8):683‐92. [ACTRN12610000216011] - PubMed
Li 2006 {published data only}
    1. Li Y, Wang J, Ma J. A controlled clinical trial of citalopram and citalopram combined with family therapy in the treatment of anorexia nervosa. Shanghai Archives of Psychiatry 2006;18(3):158‐6.
Lock 2005 {published data only (unpublished sought but not used)}
    1. Grange D, Hoste RR, Lock J, Bryson SW. Parental expressed emotion of adolescents with anorexia nervosa: outcome in family‐based treatment. International Journal of Eating Disorders 2011;44(8):731‐4. - PMC - PubMed
    1. Lee HY, Lock J. Anorexia nervosa in Asian‐American adolescents: Do they differ from their non‐Asian peers. International Journal of Eating Disorders 2007;40(3):227‐31. - PubMed
    1. Lock J, Agras WS, Bryson S, Kraemer HC. A comparison of short‐ and long‐term family therapy for adolescent anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry 2005;44(7):632‐9. - PubMed
    1. Lock J, Couturier J, Agras WS. Comparison of long‐term outcomes in adolescents with anorexia nervosa treated with family therapy. Journal of the American Academy of Child and Adolescent Psychiatry 2006;45(6):666‐72. - PubMed
    1. Lock J, Couturier J, Bryson S, Agras S. Predictors of dropout and remission in family therapy for adolescent anorexia nervosa in a randomized clinical trial. International Journal of Eating Disorders 2006;39(8):639‐47. - PubMed
Lock 2010 {published data only}
    1. Accurso EC, Ciao AC, Fitzsimmons‐Craft EE, Lock JD, Grange D. Is weight gain really a catalyst for broader recovery?: The impact of weight gain on psychological symptoms in the treatment of adolescent anorexia nervosa. Behaviour Research and Therapy 2014;56:1‐6. - PMC - PubMed
    1. Accurso EC, Fitzsimmons‐Craft EE, Ciao AC, Grange D. From efficacy to effectiveness: Comparing outcomes for youth with anorexia nervosa treated in research trials versus clinical care. Behaviour Research and Therapy 2015;65:36‐41. - PMC - PubMed
    1. Brownstone L, Anderson K, Beenhakker J, Lock J, Grange D. Recruitment and retention in an adolescent anorexia nervosa treatment trial. International Journal of Eating Disorders 2012;45(6):812‐5. - PMC - PubMed
    1. Byrne CE, Accurso EC, Arnow KD, Lock J, Grange D. An exploratory examination of patient and parental self‐efficacy as predictors of weight gain in adolescents with anorexia nervosa. International Journal of Eating Disorders 2015;48:883‐8. [DOI: 10.1002/eat.22376] - DOI - PMC - PubMed
    1. Byrne CE, Kass AE, Accurso EC, Fischer S, O'Brien S, Goodyear A, et al. Overvaluation of shape and weight in adolescents with anorexia nervosa: does shape concern or weight concern matter more for treatment outcome?. Journal of Eating Disorders 2015;3(49):1‐5. [DOI 10.1186/s40337‐015‐0086‐7] - PMC - PubMed
Lock 2015 {published data only}
    1. Lock J, Grange D, Agras WS, Fitzpatrick KK, Jo B, Accurso E, et al. Can adaptive treatment improve outcomes in family‐based therapy for adolescents with anorexia nervosa? Feasibility and treatment effects of a multi‐site treatment study. Behaviour Research and Therapy 2015;73:90‐95. - PMC - PubMed
Madden 2015 {published data only}
    1. Madden S, Miskovic‐Wheatley J, Wallis A, Kohn M, Lock J, Grange D, et al. A randomized controlled trial of in‐patient treatment for anorexia nervosa in medically unstable adolescents. Psychological Medicine 2015;45(2):415‐27. - PMC - PubMed
    1. Madden S, Miskovic‐Wheatley J, Wallis A, Kohn M, Hay P, Touyz S. Early weight gain in family‐based treatment predicts greater weight gain and remission at the end of treatment and remission at 12‐month follow‐up in adolescent anorexia nervosa. International Journal of Eating Disorders 2015;48(7):919‐22. - PubMed
    1. Wallis A. Family Based Treatment for Young People with Severe Anorexia Nervosa: An Investigation of Outcome, Family Functioning and Relationship Change [thesis]. Sydney: University of Sydney, Faculty of Science, School of Psychology, 2017.
    1. Wallis A, Miskovic‐Wheatley J, Madden S, Rhodes P, Crosby RD, Cao L, et al. How does family functioning effect the outcome of family based treatment for adolescents with severe anorexia nervosa?. Journal of Eating Disorders 2017;5:55. - PMC - PubMed
Onnis 2012 {published data only}
    1. Onnis L, Barbara E, Bernardini M, Caggese A, Giacomo S, Giambartolomei A, et al. Family relations and eating disorders. The effectiveness of an integrated approach in the treatment of anorexia and bulimia in teenagers: Results of a case‐control systemic research. Eating and Weight Disorders 2012;17(1):e36‐e48. - PubMed
Rausch Herscovici 2006 {published data only (unpublished sought but not used)}
    1. Rausch Herscovici C. Lunch session, weight gain and their interaction with the psychopathology of anorexia nervosa in adolescents. Vertex: Revista Argentina de Psiquiatria 2006;17(65):7‐15. - PubMed
Rhodes 2008 {published data only}
    1. Rhodes P, Baillee A, Brown J, Madden S. Can parent‐to‐parent consultation improve the effectiveness of the Maudsley model of family‐based treatment for anorexia nervosa? A randomized control trial. Journal of Family Therapy 2008;30(1):96‐108.
    1. Rhodes P, Brown J, Madden S. The Maudsley model of family‐based treatment for anorexia nervosa: a qualitative evaluation of parent‐to‐parent consultation. Journal of Marital and Family Therapy 2009;35(2):181‐92. - PubMed
Robin 1999 {published and unpublished data}
    1. Robin AL. Behavioral family systems therapy for adolescents with anorexia nervosa. In: Kazdin, AE editor(s). Evidence‐based Psychotherapies for Children and Adolescents. New York: Guilford Press, 2003:358‐73.
    1. Robin AL, Siegel P. The limited effectiveness of short‐term therapy for anorexia nervosa. 155th Annual Meeting of the American Psychiatric Association; Philadelphia PA; 18‐23 May 2002. 2002:10C.
    1. Robin AL, Siegel PT, Koepke T, Moye AW, Tice S. Family therapy versus individual therapy for adolescent females with anorexia nervosa. Journal of Developmental and Behavioral Pediatrics 1994;15(2):111‐6. - PubMed
    1. Robin AL, Siegel PT, Moye A. Family versus individual therapy for anorexia: Impact on family conflict. International Journal of Eating Disorders 1995;17(4):313‐22. - PubMed
    1. Robin AL, Siegel PT, Moye AW, Gilroy M, Dennis AB, Sikand A. A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. Journal of the American Academy of Child and Adolescent Psychiatry 1999;38(12):1482‐9. - PubMed
Russell 1987 {published and unpublished data}
    1. Dare C, Eisler I, Russell GF, Szmukler GI. The clinical and theoretical impact of a controlled trial of family therapy in anorexia nervosa. Journal of Marital and Family Therapy 1990;16(1):39‐57.
    1. Eisler I [pers comm]. Data sent for post‐intervention outcomes by subgroup [personal communication]. Letter to Caroline Fisher 13 October 2008.
    1. Eisler I, Dare C, Russell GF, Szmukler G, Grange D, Dodge E. Family and individual therapy in anorexia nervosa. A 5‐year follow‐up. Archives of General Psychiatry 1997;54(11):1025‐30. - PubMed
    1. Hewell K, Hoste RR, Grange D. Recruitment for an adolescent bulimia nervosa treatment study. International Journal of Eating Disorders 2006;39(7):594‐7. - PubMed
    1. Russell GF, Szmukler GI, Dare C, Eisler I. An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Archives of General Psychiatry 1987;44(12):1047‐56. - PubMed
Whitney 2012 {published and unpublished data}
    1. Todd G, Gavan K, Murphy T. Family work in the treatment of patients with anorexia nervosa. 29th Annual Conference of the British Association for Behavioural and Cognitive Psychotherapies; 20‐23 June 2001, Glasgow UK. 2001.
    1. Whitney J, Murphy T, Landau S, Gavan K, Todd G, Whitaker W, et al. Exploratory RCT of family day workshops and individual family work as a supplement to inpatient care for anorexia nervosa. International Journal of Eating Disorders 2012;20(2):142‐50. - PubMed

References to studies excluded from this review

Attia 2012 {published data only}
    1. Attia E. In the Clinic. Eating disorders. Annals of Internal Medicine 2012;156(7):1‐16. - PubMed
Buddeberg 1979 {published data only}
    1. Buddeberg B, Buddeberg C. Family therapy of anorexia nervosa. Praxis der Kinderpsychologie und Kinderpsychiatrie 1979;28(2):37‐43. - PubMed
Ciao 2015 {published data only}
    1. Ciao AC, Accurso EC, Fitzsimmons‐Craft EE, Grange D. Predictors and moderators of psychological changes during the treatment of adolescent bulimia nervosa. Behaviour Research and Therapy 2015;69:48‐53. - PMC - PubMed
Dalle Grave 2010 {published data only}
    1. Dalle Grave R. Inpatient cognitive behavior therapy for severe eating disorders. Psychological Topics 2010;19(2):323‐40.
Fettes 1992 {published data only}
    1. Fettes PA, Peters JM. A meta‐analysis of group treatments for bulimia nervosa. International Journal of Eating Disorders 1992;11(2):97‐110.
George 1997 {published data only}
    1. George L. The psychological characteristics of patients suffering from anorexia nervosa and the nurse’s role in creating a therapeutic relationship. Journal of Advanced Nursing 1997;26:899‐908. - PubMed
Gilbert 2008 {published data only}
    1. Gilbert G. Inpatient treatment equals outpatient treatment for anorexia. Journal of the National Medical Association 2008;100(7):869‐70.
Goddard 2013 {published data only}
    1. Goddard E, Raenker S, Macdonald P, Todd G, Beecham J, Naumann U, et al. Carers' assessment, skills and information sharing: theoretical framework and trial protocol for a randomised controlled trial evaluating the efficacy of a complex intervention for carers of inpatients with anorexia nervosa. European Eating Disorders Review 2013;21(1):60‐71. - PubMed
    1. ISRCTN06149665. A randomised pragmatic trial comparing the cost effectiveness of supplementing standard care with an intervention for carers (Carers Assessment, Skills and Information Sharing [CASIS]) of people with eating disorders. www.isrctn.com/ISRCTN06149665 (first recieved 19 August 2008).
    1. Macdonald P, Rhind C, Hibbs R, Goddard E, Raenker S, Todd G, et al. Carers' assessment, skills and information sharing (CASIS) trial: A qualitative study of the experiential perspective of caregivers and patients. European Eating Disorders Review 2014;22(6):430‐8. - PubMed
    1. Macdonald P, Rhind C, Hibbs R, Goddard E, Raenker S, Todd G, et al. Carers' assessment, skills and information sharing: Theoretical framework and trial protocol for a randomised controlled trial evaluating the efficacy of a complex intervention for carers of inpatients with anorexia nervosa. European Eating Disorders Review 2013;21(1):60‐71. - PubMed
    1. Macdonald P, Rhind C, Hibbs R, Goddard E, Raenker S, Todd G, et al. Two‐year follow‐up of a pragmatic randomised controlled trial examining the effect of adding a carer's skill training intervention in inpatients with anorexia nervosa. European Eating Disorders Review 2015;24(2):122‐30. - PubMed
Gowers 2010 {published data only}
    1. Byford S, Barrett B, Roberts C, Clark A, Edwards V, Smethurst N, et al. Economic evaluation of a randomised controlled trial for anorexia nervosa in adolescents. British Journal of Psychiatry 2007;191:436‐40. - PubMed
    1. Gowers S. Evidence based decision making in adolescent anorexia nervosa. 33rd Annual Conference of the British Association for Behavioural and Cognitive Psychotherapies, July 21‐23 2005, Canterbury UK. Canterbury, 2005:87.
    1. Gowers SG, Clark A, Robert C, Griffiths A, Edwards V, Bryan C, et al. Clinical effectiveness of treatments for anorexia nervosa in adolescents: randomised controlled trial. British Journal of Psychiatry 2009;191:427‐35. - PubMed
    1. Gowers SG, Clark AF, Roberts C, Byford S, Barrett B, Griffiths A, et al. A randomised controlled multicentre trial of treatments for adolescent anorexia nervosa including assessment of cost‐effectiveness and patient acceptability ‐ The TOuCAN trial. Health Technology Assessment 2010;14(15):1‐98. - PubMed
Karwautz 2015 {published data only}
    1. Karwautz A, Wagner G. Supporting carers of children and adolescents with eating disorders in Austria (SUCCEAT). clinicaltrials.gov/show/NCT02480907 (first received 25 June 2015).
Keshen 2013 {published data only}
    1. Keshen A. Effectiveness of the ECHOs Approach for Patients With Eating Disorders and Their Carers (ECHO). clinicaltrials.gov/show/NCT01927042 (first received 22 August 2013). [NCT01927042]
Le Grange 2005a {published data only}
    1. Grange D, Binford R, Loeb KL. Manualized family‐based treatment for anorexia nervosa: A case series. Journal of the American Academy of Child and Adolescent Psychiatry 2005;44(1):41‐6. - PubMed
Loeb 2007 {published data only}
    1. Loeb L, Walsh TB, Lock, J, Grange D, Jones, J, Marcus S, et al. Open trial of family‐based treatment for full and partial anorexia nervosa in adolescence: Evidence of successful dissemination. Journal of the American Academyof Child and Adolescent Psychiatry 2007;46(7):792‐800. - PubMed
    1. NCT00418977. Early identification and treatment of anorexia nervosa. ClinicalTrials.gov/show/NCT00418977 (first received 28 April 2014).
Perkins 2005 {published data only}
    1. Perkins S, Schmidt U, Eisler I, Treasure J, Yi I, Winn S, et al. Why do adolescents with bulimia nervosa choose not to involve their parents in treatment?. European Child and Adolescent Psychiatry 2005;14(7):376‐85. - PubMed
    1. Schmidt U, Lee S, Beecham J, Perkins S, Treasure J, Yi I, et al. A randomized controlled trial of family therapy and cognitive behavior therapy guided self‐care for adolescents with bulimia nervosa and related disorders. American Journal of Psychiatry 2007;164(4):591‐8. - PubMed
Reyes‐Rodriguez 2011 {published data only}
    1. Reyes‐Rodriguez ML. Engaging Latino families in eating disorders treatment (PAS). ClinicalTrials.gov/show/NCT01470508 (first received 11 November 2011).
Salbach 2006 {published data only}
    1. Salbach H, Bohnekamp I, Lehmkuhl U, Pfeiffer E, Korte A. Family‐oriented group therapy in the treatment of female patients with anorexia and bulimia nervosa ‐ a pilot study. Zeitschrift fur Kinder‐und Jugendpsychiatrie und Psychotherapie 2006;34:267‐74. - PubMed
Schmidt 2005 {published data only}
    1. Schmidt U. A pilot randomised controlled trial of the CD‐ROM based intervention for carers of people with anorexia nervosa (AN). www.isrctn.com/ISRCTN33652725 (first received 13 May 2005). [DOI: 10.1186/ISRCTN33652725] - DOI
Schmidt 2013 {published data only}
    1. Schmidt U, Renwick B, Lose A, Kenyon M, DeJong H, Broadbent H, et al. The MOSAIC study ‐ comparison of the Maudsley Model of Treatment for Adults with Anorexia Nervosa (MANTRA) with Specialist Supportive Clinical Management (SSCM) in outpatients with anorexia nervosa or eating disorder not otherwise specified, anorexia nervosa type: Study protocol for a randomized controlled trial. Trials 2013; Vol. 14, issue 1:160. - PMC - PubMed
Slagerman 1989 {published data only}
    1. Slagerman M, Yager J. Multiple family group treatment for eating disorders: A short term program. Psychiatric Medicine 1989;7(4):269‐83. - PubMed
Spettigue 2015 {published data only}
    1. Spettigue W, Maras D, Obeid N, Henderson KA, Buchholz A, Gomez R, et al. A psycho‐education intervention for parents of adolescents with eating disorders: a randomized controlled trial. Eating Disorders 2015;23(1):60‐75. - PubMed
Treasure 2006 {published data only}
    1. Treasure J. Collaborative caring project: working with parents at treatment and secondary prevention of eating disorders. isrctn.com/ISRCTN56376745 (first received 4 October 2005). [DOI: 10.1186/ISRCTN56376745] - DOI
Treasure 2007 {published data only}
    1. Treasure J, Sepulveda AR, Whitaker W, Todd G, Lopez C, Whitney J. Collaborative care between professionals and non‐professionals in the management of eating disorders: A description of workshops focused on interpersonal maintaining factors. European Eating Disorders Review 2007;15:24‐34. - PubMed
Vandereycken 1977 {published data only}
    1. Vandereycken W, Pierloot R. Anorexia nervosa: weight recovery with behaviour therapy. Feuillets Psychiatrique de Liege 1977;10:47‐58.
Vandereycken 1978 {published data only}
    1. Vandereycken W, Pieters G. Short‐term weight restoration in anorexia nervosa through operant conditioning. Scandinavian Journal of Behaviour Therapy 1978;7(4):221‐36.
Wallin 2000 {published data only}
    1. Wallin U, Kronovall P, Majewski M. Body awareness therapy in teenage anorexia nervosa: outcome after 2 years. European Eating Disorders Review 2000;8(1):19‐30.
Whitney 2012b {published data only}
    1. Whitney J, Currin L, Murray J, Treasure J. Family work in anorexia nervosa: A qualitative study of carers' experiences of two methods of family intervention. European Eating Disorders Review 2012;20(2):132‐41. - PubMed
Woidislawsky 1996 {published data only}
    1. Woidislawsky R. A comparison of two types of group psychotherapy for eating disordered daughters and their mothers. Dissertation Abstracts International 1996;56(9‐B):5192.

References to studies awaiting assessment

Bulik 2009 {published data only}
    1. Bulik C. UCAN: Uniting Couples in the Treatment of Anorexia Nervosa (UCAN). clinicaltrials.gov/ct2/show/NCT00928109 (first received 25 June 2009).
Dimitropoulos 2014 {published data only}
    1. Dimitropoulos G. Multi‐family group therapy for adult eating disorders (MFGT). clinicaltrials.gov/show/NCT02106728 (first received 8 April 2014).
Eisler 2006 {published data only}
    1. Eisler I. A multi‐centre randomised trial of the outcome, acceptability and cost‐effectiveness of family therapy and multi‐family day treatment compared with inpatient care and outpatient family therapy for adolescent anorexia nervosa. www.isrctn.com/ISRCTN11275465 (first received 5 April 2006).
    1. Eisler I, Simic M, Hodsoll J, Asen E, Berelowitz M, Connan F, et al. A pragmatic randomised multi‐centre trial of multifamily and single family therapy for adolescent anorexia nervosa. BMC Psychiatry 2016;16(1):422. - PMC - PubMed
Gore‐Rees 2001 {published data only}
    1. Gore‐Rees, P. A randomised controlled multicentre treatment of adolescent anorexia nervosa including assessment of cost and patient acceptability. National Research Register [Archived].
Jacobi 2012 {published data only}
    1. Jacobi C. Early detection and intervention of anorexia nervosa in adolescent girls: a randomized controlled trial comparing a family‐oriented, internet‐based intervention with a control group without intervention. www.isrctn.com/ISRCTN18614564 (first received 6 January 2012).
Le Grange 2005 {published data only}
    1. Grange D. Treatment for adolescent anorexia nervosa. clinicaltrials.gov/ct2/show/NCT00183586 (first received 16 September 2005). [NCT00183586]
Lock 2014 {published data only}
    1. Lock J. Feasibility of combining family and cognitive therapy to prevent chronic anorexia. clinicaltrials.gov/ct2/show/NCT02054364 (first received 4 February 2014).
    1. Lock J, Fitzpatrick KK, Agras WS, Weinbach N, Jo B. Feasibility study combining art therapy or cognitive remediation therapy with family‐based treatment for adolescent anorexia nervosa. European Eating Disorders Review 2018;26(1):62‐8. [DOI: 10.1002/erv.2571] - DOI - PMC - PubMed
Nevonen 2015 {published data only}
    1. Nevonen L. The Gothenburg anorexia nervosa treatment study. www.isrctn.com/ISRCTN25181390 (first received 21 July 2015).
Rugiu 1999 {published data only}
    1. Santoni Rugiu A, Giacomo P, Calo P, Giacomo A, Catucci A, Viola G. A comparison of family therapy and day hospital integrated treatment in anorexia and bulimia nervosa. Current Opinion in Psychiatry 1999;12(Suppl 1):335.
Zucker 2008 {published data only}
    1. Zucker NL. Group parent training for adolescent eating disorders (GPT‐AN). clinicaltrials.gov/ct2/show/NCT00672906 (first received 6 May 2008).

References to ongoing studies

Bilyk 2017 {published data only}
    1. Bilyk BF. Effectiveness of a cognitive behavioral management pilot program in a sample of Brazilian adolescents with anorexia vervosa [Efetividade de um programa piloto de tratamento cognitivo comportamental em uma amostra de adolescentes brasileiros com anorexia nervosa]. www.ensaiosclinicos.gov.br/rg/RBR‐4dpths/ (first received 14 September 2017). [Trial ID: U1111‐1202‐0493]
Bulik 2012 {published data only}
    1. Bulik C, Baucom D. UNCAN2: Enhancing treatment for adult anorexia with a couple‐based approach. clinicaltrials.gov/show/NCT01740752 (first received 4 December 2012).
Carrot 2017 {unpublished data only}
    1. Carrot B. Family therapy and anorexia nervosa : Which is the best approach? (THERAFAMBEST). clinicaltrials.gov/ct2/show/NCT03350594 (first received 22 November 2017).
Hildebrandt 2016 {unpublished data only}
    1. Hildebrandt T. Reward systems and food avoidance in eating disorders. clinicaltrials.gov/ct2/show/NCT02795455 (first received 10 June 2016).
Lock 2017 {unpublished data only}
    1. Lock JD. Adaptive treatment for adolescent anorexia nervosa. clinicaltrials.gov/ct2/show/NCT03097874 (first received 31 March 2017).
McCormack 2014 {published data only}
    1. McCormack J. Know and grow: An investigation into parent and family involvement in eating disorder treatment. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614001296628 (first received 12 November 2014). [U1111‐1163‐9479]

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