PDF(Pubmed)
Abstract：
Although family-based treatment (FBT) is considered a first-line treatment for adolescent anorexia nervosa (AN), it is underutilized in community settings and is unavailable to many families for a multitude of practical reasons (e.g., costs of treatment, transportation constraints). Adapting FBT interventions for delivery in home-based and community-based settings may reduce pragmatic barriers to treatment uptake and engagement.
This pilot effectiveness-implementation trial will assess outcomes, implementation, and mechanisms of FBT adapted for the home setting (FBT-HB), delivered in the context of community-based behavioral health agencies. Adolescents with AN-spectrum disorders (n = 50) and their caregivers will be randomly assigned to either FBT-HB or home-based treatment as usual (TAU; integrated family therapy approach). Caregivers and adolescents will provide data on weight, eating, and putative treatment mechanisms, including caregiver self-efficacy and adolescent eating-related and weight-related distress. Implementation constructs of feasibility, acceptability, and appropriateness will be measured among providers and participating families.
We expect that FBT-HB will be feasible, acceptable, and appropriate, and will outperform TAU in terms of improvements in adolescent weight and eating-related psychopathology. We further expect that caregiver self-efficacy and adolescent eating-related and weight-related distress, but not general distress, will show greater improvements in FBT-HB relative to TAU and will be associated with better adolescent weight and eating outcomes in FBT-HB.
The proposed study has clear potential to advance scientific and clinical understanding of the real-world effectiveness of FBT for AN, including whether adapting it for the home setting improves its accessibility and effects on treatment outcome.
This pilot effectiveness-implementation trial will assess outcomes, implementation, and mechanisms of FBT adapted for the home setting (FBT-HB), delivered in the context of community-based behavioral health agencies. Adolescents with AN-spectrum disorders (n = 50) and their caregivers will be randomly assigned to either FBT-HB or home-based treatment as usual (TAU; integrated family therapy approach). Caregivers and adolescents will provide data on weight, eating, and putative treatment mechanisms, including caregiver self-efficacy and adolescent eating-related and weight-related distress. Implementation constructs of feasibility, acceptability, and appropriateness will be measured among providers and participating families.
We expect that FBT-HB will be feasible, acceptable, and appropriate, and will outperform TAU in terms of improvements in adolescent weight and eating-related psychopathology. We further expect that caregiver self-efficacy and adolescent eating-related and weight-related distress, but not general distress, will show greater improvements in FBT-HB relative to TAU and will be associated with better adolescent weight and eating outcomes in FBT-HB.
The proposed study has clear potential to advance scientific and clinical understanding of the real-world effectiveness of FBT for AN, including whether adapting it for the home setting improves its accessibility and effects on treatment outcome.
摘要：
尽管以家庭为基础的治疗（FBT）被认为是青少年神经性厌食症（AN）的一线治疗，它在社区环境中没有得到充分利用，由于多种实际原因，许多家庭无法使用(例如，治疗费用,运输限制)。在家庭和社区环境中调整FBT干预措施可以减少接受和参与治疗的实际障碍。
这项试点有效性实施试验将评估结果，实施，以及适用于家庭环境的FBT机制(FBT-HB)，在基于社区的行为卫生机构的背景下交付。患有AN谱系障碍的青少年（n=50）及其照顾者将被随机分配到FBT-HB或家庭照常治疗（TAU；综合家庭治疗方法）。照顾者和青少年将提供体重数据，吃,和假定的治疗机制，包括照顾者的自我效能感和青少年饮食相关和体重相关的困扰。可行性的实施构造，可接受性,适当性将在提供者和参与家庭之间进行衡量。
我们预计FBT-HB将是可行的，可接受,和适当的,在改善青少年体重和饮食相关精神病理学方面将优于TAU。我们进一步预计，护理人员的自我效能感和青少年饮食相关和体重相关的困扰，但不是一般的痛苦，与TAU相比，FBT-HB将显示出更大的改善，并且与FBT-HB的青少年体重和饮食结局有关。
拟议的研究具有明显的潜力，可以促进对FBT对AN的现实世界有效性的科学和临床理解。包括是否适应家庭环境可以改善其可及性和对治疗结果的影响。
这项试点有效性实施试验将评估结果，
我们预计FBT-HB将是可行的，
拟议的研究具有明显的潜力，可以促进对FBT对AN的现实世界有效性的科学和临床理解。
