There is exciting news in eating disorder treatment!
A 2008 paper published in the Journal of Clinical Child & Adolescent Psychology makes it very clear: "At this time, the evidence base is strongest for the Maudsley model of family therapy for anorexia nervosa."
The authors of another 2008 article (available by special permission on the FEAST site) describe published research on family-based interventions showing "at 4-5 year follow-up, the majority (60-90%) will have fully recovered while only 10-15% will still be seriously ill"... "Outpatient family therapy compares quite favorably to other treatment modalities such as inpatient care where full recovery rates vary between 33% - 55%."
Put simply, the Maudsley Approach sees the parents of the ill person as the best ally for recovery. The effects of dieting (or insufficient food for a person's activity level) are for many people a self-perpetuating cycle that requires intervention. In this evidence-based approach, parents are seen as the most committed and competent people in the patient's life and therefore best qualified to find ways to fight the illness, to regain healthy weight, and end unhealthy behaviors.
Without question, the Family-Based Maudsley approach represents a very different way of looking at eating disorders and treatment from traditional approaches. Some in the eating disorders community are shocked and even offended by the emphasis on nutrition and behaviors instead of insight and motivation. Still others remain skeptical of the role of parents in the treatment. Yet the results are clear: there is no other scientifically-validated treatment approach for adolescents with anorexia living at home who have been ill fewer than three years. The approach is also appropriate for bulimia and for older patients whose families are able to take on this role, according to leading researchers in the field.
In most cases, the treatment has three phases over a period of 6-12 months, led by a family-based therapist (some family therapists do family-based therapy, most do not), and involve the entire family in hour-long weekly sessions. The parents are coached in how to help the patient eat (and/or stop purging and over-exercising) and siblings are encouraged to ally with the ill sibling. Patients are neither expected to nor asked to cooperate - in fact in the first session of FBT/Maudsley therapy a meal is eaten in the therapist's office and the ill person is asked to resist eating to demonstrate the difficulties and dynamics of the family around the meal.
(The treatment for bulimia is slightly different: the patients - usually older and more ready to engage in therapy - are more involved with the problem-solving phase of recovery.)
No one is blamed in Maudsley therapy - the illness is not seen as anyone's fault. In fact, finding cause for the eating disorder is not part of the treatment at all.
The Maudsley Approach to eating disorder treatment was first developed by progressive clinicians in the 1980's at the Maudsley Hospital in London. Initially used for anorexia nervosa, a modified version appropriate for bulimia nervosa is also in use. Clinical treatment manuals are available, published by Guilford Press (Anorexia manual / Bulimia manual ). Since successful use in the UK, the treatment has spread to the United States, Australia, Canada, France, Germany, Israel and Poland. Research has validated the use of the Maudsley Approach for use with children and adolescents living at home. Modified versions of the approach have been used successfully with older patients, multi-family group trainings, Binge Eating Disorder patients, and for couples.
The three phases of treatment are: * Parents take control of decisions of what, when, and how much the ill patient eats. * After weight restoration is nearly achieved, control is carefully given back to the patient. * Finally, the therapist and family work to restore normal and age-appropriate lifestyle and relations between family members.
At this time it is still difficult to find clinicians trained in the Family-Based Maudsley approach. Unfortunately, many parents will find that their local clinicians are either unfamiliar with or openly dismissive of the approach. It will take time for information and training to find its way into widespread practice, but parents can travel to evidence-based clinics for treatment or arrange for consultations between modern clinics and local resources. Clinicians interested in learning about or training in the approach can contact TRAIN2TREAT4ED.com, a training institute for certification.
For a partial list of eating disorder specialists offering Family-Based Maudsley treatment, visit the F.E.A.S.T. Treatment Provider List. If you know of providers who are offering FBT/M and not yet on the list, please contact us so we can send them an invitation.
"Why a page for one type of treatment? Is F.E.A.S.T. promoting one treatment approach over others?"
F.E.A.S.T. is committed to educating parents about what role they can play in recovery, and in evidence-based treatment. Information about the Family-Based Maudsley approach is still not widely available, despite the strong and growing evidence of its efficacy compared to other treatment, especially when employed as early as possible. For all these reasons, F.E.A.S.T. feels a special responsibility to make sure parents know about the option of FBT/Maudsley treatment.
clinics and clinicians offering Maudsley, see list HERE
certification training in FBT/Maudsley and a list of certified therapists: TRAIN2TREAST4ED.com
F.E.A.S.T. (Families Empowered And Supporting Treatment of Eating Disorders) P.O. Box 331 ♦ Warrenton, VA 20188 ♦ USA ♦ (540) 227-8518 ♦ info@FEAST-ED.org F.E.A.S.T. is registered as a nonprofit organization under section 501(c)(3) of the United States Internal Revenue Code Information on this site is meant to support, not replace, professional consultation. Unless otherwise noted, content is edited by F.E.A.S.T. volunteers with assistance from our Professional Advisory Panel.
