Family-based treatment with metacognitive therapy for adolescents with anorexia nervosa: findings from a phase II trial

BackgroundThe incidence of anorexia nervosa (AN) has increased over the past decade, particularly among school-aged children. Family-based therapy (FBT), which focuses on parental management and control, is the recommended and standard treatment for adolescents with AN. While FBT promotes weight gain and improved parent-child interactions, it does not directly address the adolescents' cognitive change, which could make them vulnerable to relapse. Metacognitive therapy is scarcely studied in AN, and this trial tested its feasibility and long-term effects for adolescents with AN.MethodsThis phase II trial included 14 adolescents with AN in an A-B design. Medical tests and diagnostic assessments were conducted before and after treatment. Assessments were conducted before treatment, by end of treatment and at 12 months after end of treatment. We integrated family-based treatment and metacognitive therapy for patient intervention and parental guidance.ResultsAt posttreatment, 13 of the 14 patients no longer met the diagnostic criteria for AN. There were significant increases in percentage expected body weight and reductions in emotional and cognitive symptoms. One patient continued to have eating disorder symptoms at posttreatment and withdrew before follow-up. No significant changes were observed in areas of family conflict or parent-child communication. The treatment was well tolerated and deemed meaningful by both parents and patients. No adverse events or rehospitalization occurred during the 12 month follow-up period. Data collection was challenging, especially with respect to patients' disclosure of family interactions and symptoms.ConclusionsThe trial revealed positive effects posttreatment at the 12 month follow-up for 13 of 14 participants with AN. The treatment was well tolerated with no adverse effects. Despite the small sample size and lack of control, the results suggest that larger-scale trials of this intervention are warranted.Trial registrationThe study has been approved as a clinical and quality audit of the delivered clinical service registered by the institutional research board at Levanger Hospital HF (IRB-13672).