Adolescent Patient Perspectives on Family-Based Treatment: A Pilot Study

Abstract

Objective

Family-based treatment (FBT) is the recommended first-line treatment for adolescent eating disorders (EDs), yet evidence suggests it is effective for only 50% of youth. Ambivalence about initiating treatment and/or recovery predicts treatment nonresponse for youth with other psychiatric disorders and may also contribute to poor FBT outcomes. Thus, understanding patient perspectives on FBT is essential to mitigating challenges to treatment acceptance, with great potential for improving treatment efficacy.

Methods

A qualitative, inductive approach was used to develop hypotheses about adolescents' perspectives on FBT and patient-perceived facilitators of ED recovery. Semi-structured interview data were analyzed using a grounded theory methodology.

Results

Interviewees (N = 10) expressed ambivalence toward FBT—particularly its use of parental empowerment and pragmatic focus on weight recovery. Many participants stated that FBT was effective, necessary for recovery, and improved relationships with caregivers; however, some reported that a perceived lack of agency and sidelining of psychosocial distress and family conflict negatively impacted their treatment engagement. Regarding ED recovery, participants reported a preference for cognitive/emotional aspects of recovery and framed recovery as an ongoing or lifelong process. Peer support was identified as an important facilitator of behavior change.

Discussion

Findings support addressing adolescent concerns (e.g., psychosocial well-being, agency, connection with peers, and family relationships) within the FBT framework. Results may inform future FBT implementation and adaptation and suggest the need for continued investigation of the treatment experience from multiple perspectives (i.e., patients, family members, and clinicians).