Family Based Treatment (FBT)
- Anorexia Nervosa
- Bulimia Nervosa
- Avoidant-Restrictive Food Intake Disorder (ARFID)
- Binge Eating Disorder (BED)
- Other Specified Feeding or Eating Disorders (OSFED)
- Family-Based Treatment for Transition-Aged Youth (FBT – TAY)
- Parent-Focused Treatment (PFT)
- Family-Based Treatment + Cognitive-Behavioral Therapy (FBT + CBT)
Three Phases of Family Based Treatment
Family-Based Treatment (FBT), also known as The Maudsley Method, is a highly practical, solution-focused, evidence-based treatment for eating disorders that enlists the patient’s family as a vital resource in supporting recovery at home.
Clinical trials have demonstrated that FBT is more effective than individual therapy in helping patients achieve and sustain remission from eating disorders.
Initially developed to treat adolescent anorexia nervosa, FBT has been adapted to treat Bulimia Nervosa, Binge Eating Disorder, and Avoidant-Restrictive Food Intake Disorder (ARFID).
FBT involves three distinct phases:
Phase 1
Parents are empowered to take charge of their child’s eating behaviors and interrupt eating disorder symptoms. It is understood that the eating disordered patient is suffering from a brain illness which is largely beyond his or her control, and thus needs significant parental support to overcome his or her symptoms and restore health.
Phase I typically involves parents choosing, preparing, and supervising the child’s meals and snacks. For anorexia nervosa and other restrictive eating disorders, the primary goal of Phase I is to re-nourish the patient, helping her to restore weight steadily until she reaches her individualized optimal body weight range.
For Bulimia Nervosa and Binge Eating Disorder, Phase I involves eliminating dieting and re-establishing a pattern of structured, normalized meals and snacks at regular intervals to interrupt binge eating behaviors. When patients have purging symptoms, parents step in to support their child after meals by providing emotional support, distraction, and supervision.
Phase 2
Begins when the patient is well-nourished, weight-restored, medically healthy, and abstinent from binge/purge behaviors. The goals of Phase II are to re-establish normal eating patterns and to help the patient re-learn to eat on her own with an age-appropriate level of independence.
Parental supervision and support are gradually withdrawn as the patient demonstrates increasing ability to make health-promoting food choices without resorting to eating-disordered behaviors.
Phase 3
Begins when the patient able to eat with an age-appropriate level of independence while maintaining a healthy weight and remaining abstinent from binge/purge behaviors. Eating disorders cause significant disruption to adolescent development and place major strain on an entire family.
The goals of Phase III are for the patient to re-establish a healthy identity independent of the eating disorder and for the family to resume a normal life, which is finally possible, now that the eating disorder is in remission. Any individual or family struggles that have been put aside while dealing with the eating disorder are now brought into sessions for discussion and resolution.
If the patient is struggling with a co-morbid condition, such as an anxiety disorder or depression, or is still experiencing lingering psychological effects of the eating disorder, such as body image distress or difficulty with emotion regulation, she may begin individual therapy with me during Phase III to address these issues. Relapse prevention planning is also part of Phase III.
A full course of FBT typically requires approximately 20 – 25 sessions over the course of 12 months. However, the length of treatment and time to recovery varies considerably based on the type of eating disorder diagnosis, the severity of the eating disorder, and the presence of comorbid conditions.