Goldschmidt Andrea B, Tortolani Christina C, Accurso Erin C, Dunbar Eva-Molly Petitto, Egbert Amy H, Donaldson Deidre, Donaldson Abigail A
Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Department of Counseling, Educational Leadership, and School Psychology, Rhode Island College, Providence, RI, USA.
J Eat Disord. 2023 Aug 5;11(1):130. doi: 10.1186/s40337-023-00850-8.
Anorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is unavailable to many families, particularly those from lower income and racial and ethnic minority backgrounds. Furthermore, some families do not respond optimally to FBT, possibly because of challenges translating skills acquired in office-based treatment settings to naturalistic settings. Home-based treatment could reduce barriers to access and enhance generalization of newly learned treatment skills. Home-based models demonstrate initial feasibility, acceptability, and efficacy for adolescent AN, however, FBT principles have yet to be applied as a stand-alone intervention in a home-based level of care. This paper describes the rationale for and process of adapting FBT principles/interventions to improve fit within a home-based model delivered in the context of community mental health, and discusses potential strengths and opportunities associated with this approach.
Adaptations were made through consultation with collaborating community agencies and were guided by the complex interventions framework. The primary modifications included: (1) altered dose; (2) multiple family meals; (3) additional support for meal preparation and supervision; (4) clinician attendance at medical appointments; (5) cultural adaptation; and (6) introduction of distress tolerance and emotion regulation skills.
Implementing FBT in the home may present one promising and novel approach to enhance engagement and treatment outcomes for adolescents with restrictive eating disorders, particularly those who are underserved, but evaluation of efficacy/effectiveness is needed.
神经性厌食症（AN）是一种严重的精神疾病，发病率和死亡率都很高。基于家庭的治疗（FBT）是一种针对青少年AN的成熟治疗方法，但在社区环境中未得到充分利用，许多家庭无法获得这种治疗，尤其是那些来自低收入以及种族和少数民族背景的家庭。此外，一些家庭对FBT的反应并不理想，这可能是因为将在门诊治疗环境中获得的技能转化到自然环境中存在挑战。居家治疗可以减少获得治疗的障碍，并增强新习得治疗技能的推广。居家治疗模式已证明对青少年AN具有初步的可行性、可接受性和疗效，然而，FBT原则尚未作为一种独立干预措施应用于居家护理层面。本文描述了调整FBT原则/干预措施以更好地适用于社区心理健康背景下的居家治疗模式的基本原理和过程，并讨论了这种方法的潜在优势和机遇。
通过与合作社区机构协商进行了调整，并以复杂干预框架为指导。主要修改包括：（1）调整剂量；（2）多次家庭聚餐；（3）为膳食准备和监督提供额外支持；（4）临床医生陪同就医；（5）文化适应；（6）引入痛苦耐受和情绪调节技能。
在家庭中实施FBT可能是一种有前景的新方法，可提高患有限制性饮食障碍青少年的参与度和治疗效果，尤其是那些未得到充分服务的青少年，但需要对疗效/有效性进行评估。
