Although FBT was described by Dare and Eisler, the approach was mostly confined to London or to those under the direct supervision and training at the Maudsley Hospital until the approach was manualized and published by Lock and colleagues¹⁷ and made available in other settings. A parent guidebook was published to provide parents with an additional resource as they struggle to combat the challenging behaviors associated with anorexia nervosa in family treatment.¹⁸ Research findings Research supporting FBT for anorexia nervosa has been develop- ing for the past 20 years. The initial study published in 1987 by Russell and colleagues¹⁹ was the first to demonstrate systematic benefits of a particular treatment, which was FBT, for adolescents with short-duration anorexia nervosa. In that study, adolescents who had anorexia nervosa for less than 3 years and who were treated with FBT had significantly better outcomes than did a similar group that was treated with individual supportive therapy. This superiority was maintained through a 5-year follow-up.²⁰

Subsequently, to assess the importance of family criticism on outcome, a study comparing whole-family counseling with counseling of parents on their own found no overall differences in outcomes between the 2 forms of FBT.²¹ However, in families with high levels of criticism of the patient, seeing the parents separately for counseling was superior. These results held up at follow-up.²²

A small study compared FBT to a form of individual therapy aimed at promoting individuation and autonomy.²³ This study found that FBT was more effective in restoring physical health, but no differences were found on psychological outcomes.

The first and largest study to use the manualized form of FBT found that FBT was highly efficient.²⁴ Families who received only 10 sessions of FBT in 6 months did as well as those who received 20 sessions in a year. However, patients with the most severe degree of obsessional thinking about their weight as well as families with divorce, remarriage, or a single parent did better with longer treatment. Follow-up of the cohort from this study found that treatment gains were maintained 4 years after the end of treatment.²⁵

Although definitions of remission and recovery are contested in anorexia nervosa, using conservative estimates of weight normalization and psychological normalization on standardized measures shows that between 70% and 80% of adolescents treated with FBT had recovered at the end of treatment and follow-up.²⁶ Furthermore, preliminary data suggest that leveraging parental resources may decrease the cost of treatment.²⁷

Future directions for FBT
Current research provides evidence of the benefits of FBT for adolescent anorexia nervosa of short duration; however, support for a differential benefit of the approach compared with other forms of therapy is more limited. Studies to address this gap in knowledge have begun. A collaborative study funded by the NIMH at Stanford University and the University of Chicago has completed treatment of 120 patients randomized to either FBT or individual therapy aimed at supporting individuation and adolescent autonomy. Results of that study should be available next year.

Another 7-site collaborative study (Stanford University, Cornell University, Washington University, Sheppard Pratt Hospital, University of Toronto, Laureate Hospital, University of California, San Diego) also funded by the NIMH is just getting under way. The plan is to randomize 240 patients to either FBT or systemic family therapy. The study will also examine the benefits of adding fluoxetine(Drug information on fluoxetine) to both forms of family therapy. The results of these 2 studies should provide important clinical information about which treatments are better, as well as guidance for better matching of treatments to specific subpopulations of adolescents with anorexia nervosa.

A trial designed to see whether FBT can reduce the rate of conversion to full-syndrome anorexia nervosa in adolescents with prodromal symptoms of the disorder has begun at Mount Sinai Hospital in New York. In a study at Duke University, researchers are comparing FBT to a group family therapy program. Other studies using FBT are taking place elsewhere. In London and in Dresden, Germany, a study directed by the Maudsley group is examining a multifamily group format of FBT. The potential for FBT to reduce the need for hospitalization is being examined in Sydney, Australia, in collaboration with the University of Sydney.

In addition to these studies for anorexia nervosa, le Grange and colleagues²⁸ at the University of Chicago recently studied a population of adolescents with bulimia nervosa, including a randomized clinical trial that compared FBT with supportive individual treatment. This study found that patients who received FBT had higher abstinence rates from binge eating and purging than those who recieved individual treatment. In contrast, a study from the Maudsley group in London found CBT was more cost-effective than FBT for bulimia nervosa in this age group.²⁹

Despite the encouraging data about FBT for adolescent anorexia nervosa and the evolving research related to it, much remains to be studied. One of the key issues will be to develop and test dissemination strategies for FBT should it prove to be the initial treatment of choice. Current providers are generally unprepared to use FBT. One small dissemination study found that the approach can be replicated, but larger and more focused attention to this issue is needed.³⁰ As noted, it remains unclear how helpful FBT is for bulimia nervosa in adolescents; larger randomized clinical trials with active comparison treatments are required to provide more definitive guidance about this. Clinicians can help support these efforts by joining organizations to advocate for the need for eating disorder research and, when feasible, referring patients to ongoing studies in their communities.