Summary of An Open Trial of Acceptance-Based Separated Family Treatment (ASFT) for Adolescents with Anorexia Nervosa
The aim of this open trial was to conduct a preliminary test of an innovative family-based approach to the treatment of anorexia: Acceptance-based Separated Family Treatment (ASFT). Treatment was grounded in Acceptance and Commitment Therapy (ACT), delivered in a separated format, and included an ACT-informed parent skills program (Off the CUFF; Zucker 2006, adapted). Adolescents (ages 12-18) with anorexia nervosa or sub-threshold anorexia nervosa and their caregivers received 20 sessions over 24 weeks. Primary outcomes included eating disorder symptomatology reported by the parent and adolescent, and percentage of expected body weight achieved. Secondary outcomes included quality of life and adaptive functioning (not yet reported) Psychological flexibility/acceptance were also assessed as a process of change (results coming).
The study included 2 cohorts recruited at separate sites-- Duke (Merwin) and the University of the Sciences in Philadelphia (Timko).
Adolescents were mostly female (n = 41, 89%) and white (n = 43, 93%). Approximately one third (n = 17, 34%) entered outpatient treatment immediately after hospitalization for medical stabilization. The mean adolescent age was 14.02 (SD= 1.58). The mean BMI at baseline was 17.30 ±1.43 (BMI z score M = -0.91, SD = 0.74).
Full remission was defined as achieving 95% of ideal body weight as determined by CDC growth curves and developmental trajectory and Eating Disorder Examination (EDE) scores within 1 standard deviation of population norms. Partial remission was defined as achieving 90% of ideal body weight irrespective of EDE scores. Nearly half of the adolescents (48.0%) met criteria for full remission at the end of treatment. An additional 29.8% met criteria for partial remission. Just over 20% of the adolescents were less improved. Outcomes are consistent with rates achieved with Family Based Therapy (FBT) as manualized by Lock et al. Overall, there was a significant change in eating disorder symptoms from baseline to end of treatment. The largest effect was for restriction as measured by the restraint sub-scale [t(31) = 6.61, p < 0.01, d = 1.22], followed by global scores [t(31) = 4.34, p < 0.01, d = 0.78], shape concerns [t(31) = 3.04, p < 0.01, d = 0.54], weight concerns [t(31) = 2.89, p < 0.01, d = 0.52], and eating concerns [t(31) = 2.35, p < 0.03, d = 0.42].
Results indicated that weight increased steadily followed by a slowing in the acceleration of weight at week 12 when adolescents typically reached 95% of expected weight. Parents reported decreases in observed anorectic behavior across treatment that followed a similar pattern of acceleration and slowing.