Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
Department of Psychiatry and UCSF Weill Institute for Neurosciences, University of California, San Francisco, California.
Int J Eat Disord. 2019 Apr;52(4):481-487. doi: 10.1002/eat.22980. Epub 2018 Dec 6.
Family therapy has long been advocated as an effective intervention for eating disorders. A specific form of family therapy, one that utilizes family resources, has proven especially effective for adolescents with anorexia or bulimia nervosa (AN and BN). First developed in London, a behaviorally focused adaptation, called family-based treatment (FBT), has been manualized and systematically studied in six randomized clinical trials for adolescent AN and two for adolescent BN.
This Commentary focuses on manualized FBT; what we know, what we do not know (yet), and what we hope for.
We do know that efficacy data for FBT, especially adolescent AN, are quite robust, even though remission rates remain elusive for more than half of all cases. While preliminary, moderators of FBT for adolescent AN have been identified and could aid us in determining the most (or least) responsive patient groups. And weight gain (∼2.5kg) by week four has been confirmed as an early predictor of remission at end-of-treatment. What we do not know, yet, is whether specific adaptations to manualized FBT will confer improved remission rates.
Finally, and in terms of what is hoped for, we highlight the promise of improved access, dissemination, and implementation of FBT.
家庭治疗长期以来被提倡作为治疗进食障碍的有效干预措施。一种特殊形式的家庭治疗，即利用家庭资源的治疗方法，已被证明对患有厌食症或贪食症的青少年（AN 和 BN）特别有效。首先在伦敦开发的一种行为焦点的适应性治疗，称为家庭为基础的治疗（FBT），已经被手册化并在六项针对青少年 AN 的随机临床试验和两项针对青少年 BN 的临床试验中进行了系统研究。
本评论重点介绍手册化的 FBT；我们知道什么，我们不知道（还不知道），我们希望什么。
我们确实知道，FBT 的疗效数据，特别是针对青少年 AN 的数据，相当可靠，尽管所有病例中仍有一半以上的缓解率难以实现。虽然初步的，但已经确定了 FBT 治疗青少年 AN 的调节因素，这可能有助于我们确定最（或最不）有反应的患者群体。并且，体重增加（约 2.5kg）在第四周已经被确认为治疗结束时缓解的早期预测指标。我们还不知道的是，对手册化的 FBT 进行特定的调整是否会提高缓解率。
最后，就我们所希望的而言，我们强调了改善 FBT 的可及性、传播和实施的前景。
