Family-Based Treatment Can Help Depression and Self-Esteem Too!

FBT Depression and Self-Esteem [image description: silhouette of a child with arms out in a field]

Family-based treatment (FBT) is the leading evidence-based treatment for teen eating disorders. It represents a paradigm shift from older treatments that focused on helping teens become independent from their parents in order to recover from their eating disorders. In FBT, parents are central members of the treatment team and they are charged with guiding and changing their teen’s eating disorder behaviors. In FBT, the therapist meets weekly with the entire family, spending only about 5 minutes alone with the teen at the start of each session. It is designed as a standalone treatment. The teen is also followed by a medical doctor but does not have additional appointments with a therapist or a dietitian.

Symptoms of depression and low self-esteem are common in teens with bulimia nervosa. One of the many concerns that I hear from parents considering Family-Based Treatment (FBT) for their teen with anorexia or bulimia is that FBT won’t address other symptoms the teen may have like depression or anxiety. Furthermore, families who are receiving FBT often feel pressured to add additional treatments such as individual psychotherapy for their teens to address these other issues. Even other non-FBT clinicians continue to be incredulous that teens can improve without other counseling. Fortunately, Cara Bohon, Ph.D., and colleagues at Stanford University recently published a paper that addresses this concern for teens with bulimia nervosa.

In their study, 110 teens with bulimia nervosa from two sites were randomly assigned to receive either individual Cognitive Behavioral Therapy (CBT) for adolescents or FBT. Cognitive-Behavioral Therapy (CBT), which is the most successful treatment for adults with eating disorders, focuses on understanding the factors maintaining bulimia symptoms and developing strategies to challenge problematic thoughts and change behaviors. The therapist meets weekly with the teen. The two treatments are of comparable lengths.

Results showed that both FBT and CBT significantly reduced symptoms of depression and improved self-esteem. Previous papers suggest that abstinence from eating disorder symptoms occurs faster in FBT when compared with CBT for teens with bulimia nervosa. Thus, FBT may be a better option in many cases.

It is important to dispel parents’ fears that FBT will not adequately address depression and self-esteem. The authors state in the paper, “This concern can subsequently steer families away from an evidence‐supported approach in favor of therapies that may not be as successful in reducing binge eating and purging.”

In fact, the researchers point out that it may be that the cycles of binge eating and purging of bulimia serve to maintain depressive symptoms and poor self-esteem. Thus, one may not need counseling that specifically targets depression.

Dr. Bohon stated, “The reason we conducted this study is because comorbid [also having] depression is the norm with bulimia nervosa, and it was important to establish that you don’t automatically need any extra treatment to see improvement in the context of FBT. Obviously, if someone is still struggling after completing FBT, a referral for CBT for depression or another evidence-based treatment would be important, but it is likely not needed for most individuals.”

If you are interested in learning more about our FBT approach for eating disorder treatment for teens, please contact us.

Source

Valenzuela, Fabiola, James Lock, Daniel Le Grange, and Cara Bohon. 2018. “Comorbid Depressive Symptoms and Self-Esteem Improve after Either Cognitive-Behavioural Therapy or Family-Based Treatment for Adolescent Bulimia Nervosa.” European Eating Disorders Review: The Journal of the Eating Disorders Association26 (3): 253–58.

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