For years now, members of the eating disorders community have been watching and waiting for clinical trials to verify what families and treatment experts have been observing in practice: that the Maudsley Method is an extremely effective treatment for many young anorexia patients. Last week The New York Times reported a new study by Maudsley pioneer Daniel Le Grange at the University of Chicago:
Researchers randomly assigned 121 patients ages 12 to 18, mostly girls, to a year of either family or individual therapy at the University of Chicago and at Stanford -- 24 hours in all. Twelve months after the treatment had ended, 49 percent of those who had been in family therapy were in full remission, more than double the 23 percent of those who had been in individual therapy. And among patients who were in remission at the end of the treatment itself, only 10 percent of the family-therapy group had relapsed a year later, compared with 40 percent of those who had individual therapy.
That's pretty impressive, especially given the short duration of treatment -- 24 hours isn't a whole lot of treatment for a life-threatening illness. But it is important to consider the caveats. These patients were mostly teenage girls, and all had been ill for no more than a year and were at least 75 percent of their healthy body weight. And as a general rule, pre-screening for the Maudsley method excludes families with overly domineering or controlling parents who are unwilling to change themselves.
How does it work? The family treats food as medicine, and it's the job of the parents to administer this medicine -- and to see that the patient absorbs it. But there's more to it:
The therapist sits in on a family meal to observe the dynamics, Dr. Le Grange said. Everyone in the family has a role: siblings are instructed to clear out once they are finished eating, "not jump up and yell at their sister for not eating or yell at the parent." Unlike traditional approaches, the Maudsley method "says we don't think the parents are to blame for the problem," Dr. Le Grange said. "We think they're part of the solution, and should be center stage." Their job is to be calm, supportive and consistent.
Teaching families to be "calm, supportive and consistent," I suspect, is key to the Maudsley method's success. Unfortunately, more serious eating disorders often occur in families that are already struggling with substance abuse, depression, anxiety disorders, and physical and emotional abuse. Sometimes, the eating disorder represents a dysfunctional but quite understandable attempt by a sensitive child to escape the uncontrolled conflict or rigidity of the family. Few of these families would qualify for the Maudsley method -- unless other family members are themselves willing to change.
There's one other critical aspect of the Maudsley method that often gets overlooked in general descriptions of the approach. Once the patient's weight and brain function is restored, and the family has learned a new way to feed, calm, and support her -- and, perhaps, each other -- she does move on to individual therapy. In other words, once her family has given her the nourishment she needs to think straight, she still needs to develop the tools to mature into a strong and self-reliant adult apart from them. The Maudsley approach does not replace individual therapy, but precedes it.
The ultimate goal of all effective treatment is to equip the patient to thrive on her (or his) own. Strong families not only need to learn how to provide the "calm, supportive and consistent" base for a healthy childhood, but they also need to know how and when to release their children to the wider world.
Maudsley Parents - family-based treatment for eating disorders ...
Types of Treatment - The Something Fishy Website on Eating Disorders
What are the phases of the Maudsley Method?
For Bulimics and Anorexics, Mom Uses Maudsley Method and Succeeds ...
What is the Maudsley Approach to Anorexia?: Different Approaches ...
With Maudsley Method, Bringing In Family to Fight Anorexia ...
I'm confused as you are perpetuating the myths here three years on.
Perhaps this will help those really searching for understanding of eating disorders: Dr Tim Walsh on CBS: http://www.cbsnews.com/video/watch/?id=5285479n&tag=mncol;lst;2
Bingo. Asking any of the abusive family to "help" the an patient is just irresponsible, if not criminal. Karen Carpenter, the 70s singer who died of AN, had a very involved parent that directly contributed to her eventual death. And that parent never knew the wiser, and only acknowledged their disappointment and disgust of Karen throughout her life.
This is my experience with friends/family with AN.
The idea that parents who succeed with Family-Based Maudsley therapy are somehow different is the really important issue these studies help us understand. We're not. The difference is often the stance of the treatment environment starting with the benefit of the doubt in the direction of normality, not pathology.
I believe that the next generation of recovered patients will be more numerous, less ravaged, and more healthily connected to their families throughout their lives. I believe the view of parents will change as well.
Have you considered that anorexia could be a severe form of OCD or that bulimia may be could a severe form of anxiety? Or that eating disorders may be a neurological condition?
This blaming the parents for a brain "illness" has to stop as it is particularly outdated and unhelpful and, quite frankly, uneducated.
There is no one "symptom" for the symptoms of a common cold. Every individual reacts differently to the same virus. Could you try considering that it might be the same for mental illness? Broadening your perspective might then stop you perpetuating such damaging myths as overbearing mothers or abusive families.
This new study is helping a lot of families help their children recover. Unless you have been through the hell of an eating disorder, it is very difficult to understand how important hope is in the whole recovery process. Perhaps speaking to a wider audience of Maudsley successes would help for your next article.
www.aroundthedinnertable.org
"I'm curious about what you say about "more serious eating disorders often occur in families that are already struggling." I haven't noted or seen research on this. The severity of the presentation of an eating disorder doesn't seem to be me to be correlated to the family circumstances. I can see, however, that families who are otherwise struggling will be even more challenged by the requirements of treatment: all the more reason to bring the whole family into treatment!"
Would you please address this?
Thank you.
I think there is a grand olde tradition in eating disorder circles to blame parents either for the illness or lack of recovery. In my opinion, one reason for that is because their treatment is not successful and they won't blame themselves. If a person did not get better with one type of chemotherapy, would the patient be responsible for that? No! It's the same with psychiatric problems and I think that's what this study shows us. The treatment made the difference, not the parents.
I have been the bad mother-and if I had listened to our first psychologist, I would be one of the bad mothers you think is in camp of bad mothers. It was quite difficult for us to change teams and start FBT but it changed me into a "good" mother, the minute I walked in the door. So please, throw out all your preconceived notions about parents. I do believe that care of someone with eating disorders is stressful and takes a toll on parents and families and perhaps that's where some of these old thoughts come from--professionals who first meet families after the illness starts.
I don't understand your logic. This new randomized controlled clinical trial shows that family based refeeding is superior, on average, to the individual psychotherapy that it was tested against. Consequently, in selecting a first line of treatment, this should be the first option. The fact that some parents suffer from depression, anxiety, or substance abuse is irrelevant at the initial stage, since the families involved in the experiment would have had the same characteristics, on average, as the general population of families whose kids have anorexia, yet they still, even if you assume depression, anxiety, and substance abuse, on average outperformed the individual psychotherapy group.
The only real problem I have seen in my research is not that parents are in dential, but that despite these impressive results, and the 25 years of prior experience with this method, only a small percentage of eating disorder treatment providers offer the Maudsley option in their clinical practice. I think that because of the recent publicity, however, more families will be asking for this type of therapy and the opportunity for professionals who offer this approach will expand greatly. In addition, the Maudsley approach is much less expensive than other models of treatment. Parents now have a proven alternative to other options, such as residential care, that have driven many families into bankruptcy.
Again, thank you for this informative article.
But I've interviewed hundreds of eating disorder veterans and professionals and done extensive research for 3 different books on these disorders, and there is abundant research indicating the frequent co-occurrence of eating disorders with depression, anxiety, and substance abuse -- all of which have a genetic component and can run in families. Not always, but often. And some families are in denial about these problems, as they may even be about their child's eating disorder. Parental denial can be a serious impediment to recovery, even with as promising a treatment method as the Maudsley.
Those of you who have commented on this blog are clearly in a different camp. You've signed on to be part of the solution. And that's why you're perfect candidates for the Maudsley method. If all parents were like you, we'd likely have a much higher recovery rate!
But we didn't think so, so we went to Dr. LeGranges team for the new therapy. We were considered to be mentally healthy adults who wanted to help our ill child! We were assisted in helping our daughter eat and stay at a healthy weight. She was never hospitalized after that-over a year now. It helped us all so much to be treated like a normal family and she understands that she didn't cause or choose her own illness! As if anyone would choose this!!!
Please read the study! There were 2 groups-half the patients had individual care, the other half had Family Based Treatment (FBT isn't family therapy, it's focused on the teenager and the eating, not the family dynamics). Families in the study weren't chosen to be in the FBT group because of any special characteristics-they were randomly assigned to the FBT or traditional therapy group. This means that the treatment was what was different, NOT the families. The study showed that FBT was superior and offers a real chance for teens to get better!!!! Eating disorders are biologically based mental illnesses so of course they need therapy after. The news here is that more people can recover with this treatment! Yay!!!!
Theories of the family being causative of Eating Disorders have been well and truly discredited as what they are, mythical theories. In just the same way they have been for many other illnesses that seemed to defy explanation in past times. We can all think of many examples of that form bygone times. Move on.
All families have their imperfections, simply because they are made up of human beings. However families who would consider this for their loved one are equipped with immeasurable love, care, concern and for the sufferer. That is the strength they bring that no clinician can. With a wise clinician empowering them with good techniques and guidance through the stumbling blocks, everybody can grow and help heal the sufferer and restore the balance the disorder has taken from to the family.
Thank you Dr's Lock and le Grange!
A wonderful resource for families that has not already been mentioned is:
The F.E.A.S.T. forum at http://www.aroundthedinnertable.org/
When a randomized trial is done, families are not pre-screened for being overly domineering or controlling. This would defeat the very purpose of a randomized trial. Maudsley has shown that many, many families are capable to 'doing it' and it is not for the special few. From my point of view, most family members would do anything to get their ill young person better, including going bankrupt, giving up a job to stay home and re-feed for a year, etc. That is pretty drastically changing yourself and your life. When you say "parents are unwilling to change themselves" (vs. a sick child being the one to do the needed changing), this philosophy smacks of the old 'something is wrong with the family (or patient) blame game'. The 'it's a choice' and 'if only Mom wouldn't be so controlling' or Dad wouldn't be so authoritarian, withdrawn, moody, fill-in-the-blank, Susie or John wouldn't starve themselves to death.
This is a mental illness. In my experience, families do a tremendous amount of work and changing to get their ill one better. No one is to blame. Maudsley is empowering and healing to the whole family system. What better medicine is there than that?
anne
http://www.ncbi.nlm.nih.gov/pubmed/18444053
I would like, however, to correct a couple of misperceptions that might have been created by your article. First, you write that families with "overly domineering or controlling parents" are screened out in advance. That's actually not correct. In the study you cite, the two experimental groups were selected at random. There was no pre-screening or other selection process, which helps to show that families don't need to be special in any way to succeed with this method. Also, your article may have left the impression that certain kinds of families (those with uncontrolled conflict or rigidity) can actually be the cause of anorexia nervosa. In 2006, the American Psychiatric Association reviewed all available data on this question. It concluded "No evidence exists to prove that families cause eating disorders."
http://www.psychiatryonline.com/pracGuide/pracGuideTopic_12.aspx (Page 26) The idea that family styles can cause anorexia nervosa has never been established by empirical evidence. While, of course, uncontrolled family conflict or rigidity are problems, saying that they cause anorexia nervosa has been debunked by modern research.
For those interested, more information on the Maudsley model of family based treatment is available at www.feast-ed.org and www.maudsleyparents.org