Family-Based Treatment, also called “FBT” or “The Maudsley Method”, is widely accepted as the leading evidence-based treatment for Anorexia Nervosa in childhood and adolescence. Studies show that FBT is similarly effective in treating Bulimia Nervosa in young people. In this blog, we’ll primarily be referencing work with adolescents but please note that FBT is also the treatment of choice for child and pre-teen patients, and even some young adults, with eating disorders.
Parent Empowerment and Long-Term Recovery
FBT empowers caregivers to play a central role in the adolescent’s full recovery while avoiding the extreme disruption of hospitalization. Remarkably, patients are able to participate fully in the treatment while continuing with school, important extracurricular activities, and social life; of course, eating comes first but activities are allowed around mealtime. This efficient, time-limited treatment was designed originally by a team of child and adolescent clinicians and researchers at the Maudsley Hospital in London, England; hence the alternative name “Maudsley Treatment” or “Maudsley Method.”
At Columbus Park, we’ve been working with families using Family-Based Treatment as our first line for child and adolescent eating disorders for well over a decade. The approach gives caregivers the necessary tools to support a complete and sustained recovery for their child.
About Family-Based Treatment
Parental* empowerment is at the core of FBT. The treatment charges parents with the critical role of restoring the teen back to optimal mental and physical health through re-feeding. For a malnourished person with anorexia, food is THE medicine. More traditional “talk-based” therapies typically result in a slow and arduous process for a young person “under the influence” of anorexia as the brain is starved and not functioning optimally. We see many manifestations of this starvation such as increasingly rigid and obsessive thinking, preoccupation with food and eating, compulsive need to control food procurement and meal planning, increased anxiety, withdrawal. Remarkably these features resolve with re-feeding and weight restoration, even in the absence of traditional psychotherapy. This improvement is a function of the brain recovering as it gets fueled with steady nutrition. Parents are often amazed as within weeks of initiating FBT, they may see their child is steadily returning “back to themselves” with an easing up of resistance, more smiling, laughing, “normal” interactions. FBT requires the commitment of at least one primary caregiver, but other close family members or friends may be central supports as well.
The Re-Feeding Process: Food is Medicine
In FBT, families participate in once-weekly sessions with a certified FBT therapist. Many parents are initially surprised to hear that treatment can be this efficient; they expect the process to involve many more points of contact and hours of appointments with multiple providers. The key is to streamline the process and guide parents in becoming true experts in supporting their teens rather than being overly reliant on a team of therapists, dieticians, etc.
Phases of Treatment
In Phase One of treatment, parent[s] seize control of the food from the anorexia. Of course, there is typically initial resistance from the teen; if it was so easy to get your child to eat, you wouldn’t be reading this article! We expect a challenge, so the provider is prepared to support the parent[s] through this initial phase with concrete strategies and guidance directed to achieve the necessary compliance from the teen. We talk about the food as “medicine” and explain that “nothing happens without eating” first – not school, not homework, not phone time … nothing. With their newfound resolve and confident authority, parents learn how to ensure that the teen completes three energy-dense meals and two to three snacks daily and often find that within a few weeks, they’re building momentum and the feeding gets easier. Again, the patient begins to show signs of returning health – physically, emotionally, and behaviorally.
Upon achieving full weight restoration, the treatment moves to Phase Two when parents systematically transfer feeding responsibilities back to the teen. Phase Two is about maintaining weight with normalized eating and a gradual return to more age-appropriate independence. The teen may start by preparing their own breakfast, self-portioning dinner, or grabbing snacks independently. Progressively they become more and more self-reliant while maintaining weight, showing that they are truly recovering and capable of moving on from their anorexia.
In Phase Three families work together to restore a more normal lifestyle and relationships, with a particular focus on addressing gaps in development, which eating disorders often leave behind. Beginning in stage 2 and throughout stage 3, if the patient has an underlying mood condition (like social anxiety, generalized anxiety, OCD, depression), we will be sure to address it via an evidence-based treatment designed for the specific condition. It’s worth noting that many young patients move on from FBT without needing additional therapy as many symptoms they evidenced at the height of their illness were a direct result of being malnourished; once the starvation is resolved, so are many of the associated psychological symptoms.
In our next blog, we’ll highlight common misconceptions about Family-Based Treatment and will set the record straight.
Please reach out to our Clinical Director and Certified Family-Based Treatment Therapist, Melissa Gerson, LCSW, directly to discuss whether FBT is right for your family.