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Family therapy best for bulimic teens

Family therapy is more effective than traditional solo psychotherapy in helping teens with bulimia to abstain from bingeing and purging, a new study shows.
/ Source: Reuters

Family therapy is more effective than traditional solo psychotherapy in helping teens with bulimia to abstain from bingeing and purging, a new study shows.

The study is the first in the U.S. to evaluate any treatment for bulimia nervosa in adolescents, Dr. Daniel le Grange of the University of Chicago, the study’s lead author, told Reuters Health. He and his colleagues tested a family-based treatment modeled on an effective therapeutic strategy for anorexia nervosa in adolescents known as the Maudsley approach.

In the U.S., le Grange noted, psychotherapy in which a person meets with a therapist to understand the emotional issues involved in their eating disorder is currently the standard treatment for bulimia nervosa. To investigate whether getting families involved might make treatment more effective, they randomly assigned 80 adolescent patients (12 to 18 years old) with bulimia to supportive psychotherapy or the family-based approach.

The family-based therapy consists of three phases: in the first, lasting two to three months, patients and their parents meet weekly with a therapist, with the goal of helping parents stop their children from engaging in unhealthy weight-control behaviors.

Family follows three stages
Once the patient is able to abstain from bulimic behavior, the family moves on to the second phase, in which therapy sessions are every other week and the goal is to “transition control over eating issues back to the adolescent,” le Grange and his colleagues explain in the Archives of General Psychiatry.

In the third phase, families meet with the therapist once a month and attempt to address how the eating disorder affects developmental processes in adolescence.

Patients in the supportive therapy arm of the study followed the same basic frequency schedule of therapy meetings, with the goal of exploring emotional problems that may have triggered the disorder.

At the end of treatment, 39 percent of the 41 patients who participated in family-based therapy were completely abstaining from bulimic behaviors, compared to 18 percent of the 39 patients who underwent psychotherapy.

Six months later, 29 percent of patients in the family therapy group were still abstinent, compared to 10 percent of those in the psychotherapy group.

“There’s room for improvement,” said le Grange, who pointed out that he and his colleagues used the rigorous standard of complete abstinence to gauge treatment effectiveness, not whether a patient had merely shown reductions in bingeing and purging behavior.

While family-based treatment for bulimia nervosa is not currently widely available in the U.S., interested parents can seek out practitioners trained in the Maudsley approach for anorexia nervosa, who will be able to adapt the strategy to bulimic patients with the help of a treatment manual, added le Grange.

“I’m excited about what we’ve done,” he concluded, “but I temper my excitement by the fact that this is the first study.”